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Background: Chronic pain is common among the older population. A literature review on pain management program showed that exercise, yoga, massage therapy, Tai Chi, and music therapy could significantly reduce pain. In spite of the proven benefits of pain management programs, these intervention programs were effective only in the short term, and older adults would resume their old habits. It has been suggested that interventions comprising some type of social support have great potential to increase the participation of older adults. Therefore, we propose the inclusion of peer volunteers in an integrated pain management program to relieve pain among frail older adults. This study aims to explore the effectiveness of an integrated pain management program supplemented with peer volunteers in improving pain intensity, functional mobility, physical activity, loneliness levels, happiness levels, and the use of non-pharmacological pain-relieving methods among frail older adults with chronic pain., Methods/design: We intend to recruit 30 nursing home residents and 30 peer volunteers from the Institute of Active Ageing in Hong Kong in a group trial for an 8-week group-based integrated pain management program. There will be 16 sessions, with two 1-hour sessions each week.The primary outcome will be pain levels, while secondary outcomes will be assessed according to functional mobility, physical activity, loneliness levels, happiness levels, the use of non-pharmacological pain-relieving methods, and through a questionnaire for volunteers., Discussion: In view of the high prevalence of chronic pain among older adults and its adverse impacts, it is important to provide older adults with tools to control their pain. We propose the use of peer volunteers to enhance the effects of an integrated pain management program. It is expected that pain can be reduced and improvements can be achieved among older adults in the areas of physical activity, functional mobility, loneliness levels, happiness levels, and the use of non-pharmacological pain relieving methods. Using these results, we will assess the need to conduct a larger study with a randomized controlled design., Trial Registration: This trial was registered on 24 February 2014 at the Australian New Zealand Clinical Trials Registry (ANZCTR) with the trial number: ACTRN12614000195651.

Aims and Objectives: To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain., Background: Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain., Design: Single-blinded randomised control study., Methods: Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group., Results: Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p < 0.05) for experimental group, while no significant improvement in control group except on the happiness scale. Regarding group differences in the outcome measures, the change scores on pain intensity, state anxiety and depression were significantly better in the experimental group., Conclusion: Motivational interviewing and physical exercise programme is effective in improving pain, physical mobility, psychological well-being and self-efficacy for community-dwelling older persons with chronic pain., Relevance to Clinical Practice: Motivational interviewing is a feasible counselling technique whose content can be modified based on target group to change maladaptive behaviours, elicit ambivalences and enhance self-efficacy for making changes. Thus, promoting motivational interviewing and physical exercise programme to older persons with pain is effective and important., (© 2013 Blackwell Publishing Ltd.)

Background: Pain is 1 of the most common symptoms that a cancer patient would experience. A significant barrier to positive pain management is patients' misconceptions regarding analgesics and inadequate use of nonpharmacological strategies as pain relief., Objective: The purpose of this study was to investigate the effectiveness of a pain management program (PMP) on pain intensity, use of PRN drugs and nonpharmacological strategies as pain relief, and barriers to managing pain in cancer patients., Methods: The study was conducted in the palliative care and hospice ward of a public hospital in Hong Kong. Patients were randomized to either an experimental group (receiving the PMP) or a control group (routine care). There were 38 hospitalized patients, with 20 (13 males and 7 females) in the experimental group and 18 (11 males and 7 females) in the control group; mean age was 61.95 years (experimental group) to 63.94 years (control group)., Results: Upon the completion of PMP, pain scores were significantly reduced in both groups, yet patients in the experimental group showed a significant increase in the use of PRN analgesics and nonpharmacological strategies to relieve pain (P < .05) and significantly reduce barriers to managing their cancer pain (P < .05) compared with the control group., Conclusion: Cancer patients should be empowered with pain management education to gain knowledge and correct misconceptions in managing their cancer pain., Implications for Practice: Integration of the PMP into routine clinical work may help to improve the standard of care for cancer patients. It is recommended to provide pain management education to all cancer patients.

Aims: To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and promoting activities of daily living for older people living in nursing homes., Background: Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for many older people., Design: This was a quasi-experimental pre and posttest control group design., Methods: Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental group), while older people in other nursing homes were treated as the control group; they received regular care without the eight week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age, gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness, physical activity and social network situation, before and after the eight week indoor gardening programme for both the experimental and control groups. Also, details of experimental group subjects' experience of the indoor gardening programme were elicited using open-ended questions., Results: There were significant improvements in life satisfaction and social network and a significant decrease in perception of loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of daily living were unchanged for both groups after the programme., Relevance to Clinical Practice: Given the positive effects of gardening activities, it is suggested that they be promoted more widely among nursing home residents.

Objectives: To explore nursing home-related beliefs among older Hong Kong Chinese and identify strategies that make nursing homes a better place to live., Background: Increased life expectancy has markedly increased the prevalence of age-related disease and disability, which limits the self-caring ability of older persons. Nursing home placement offers one possible alternative. However, the perspectives of older persons on nursing home admission have been seriously neglected and under-reported., Methods: The research was a qualitative descriptive study. Clients of a community centre for older people were approached and invited for an interview., Results: Participants included 118 older persons (61 female and 57 male) age from 60-89 years. Ninety per cent had chronic diseases and needed regular follow-up. Half of participants had never visited a nursing home. Of them, 85% would not want to live in a nursing home upon getting old and their nursing home-related beliefs were found to be negative. Participants expressed the feeling of being abandoned by their family members, insecure and lonely regarding the nursing home placement. Living in a nursing home was considered as 'living in jail' and that their privacy would be lost. Nevertheless, positive aspects of nursing home placement were mentioned, and strategies were explored that would make nursing homes a better place for older people to live., Relevance to Clinical Practice: Positive aspects of nursing home placement need to be promoted. Nurses should be advocates for the health of the elderly, and help make nursing homes a better place to live.

Aim: To explore pain relief interventions used by older people with chronic pain in Hong Kong. The frequency and perceived effectiveness of non-prescription measures were also explored., Background: With increasing life expectancy, the incidence of chronic illness and chronic pain also increases. Chronic pain robs older people of their quality of life., Design: This was a descriptive qualitative study., Results: Forty-four older people (37 female and seven male) who were residents of a nursing home in Hong Kong took part in this study. Their ages ranged from 65 to 82 years, median age was 75 years. Almost 80% had experienced moderate to severe pain during the previous three months. The most common sites of pain were muscles and joints; 35% of subjects reported continuous pain, 27% reported pain associated with activities of daily living, and 38% reported pain during exercise but not at rest. Only a few of the study group had taken prescribed medication to relieve pain, and only two of the 44 subjects studied had used a combination of drug and non-prescription intervention for pain relief. The majority of participants used non-prescription intervention only and the most commonly used were topical analgesics with massage. The majority (58%) of the subjects perceived the used of non-prescription intervention to be very effective in pain relief., Conclusions: The prevalence of pain was found to be high among older people in this study. Yet, they were taking a pro-active and responsible role in treating their chronic pain by using non-pharmacological patient-initiated intervention; also older people perceive themselves to have control over their pain status., Relevance to Clinical Practice: This active role of older people in their pain relief is likely to enhance the effect of education seminars and workshops aimed at novel, non-pharmacological pain relief strategies for older people with chronic pain.

Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). The response rate was 43%. The Nurses' Knowledge and Attitudes Survey Instrument questionnaire developed by McCaffery and Ferrell was translated into Chinese and used with permission. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.87 and the test-retest reliability (Spearman's p coefficient) was 0.812. The percentage of correctly answered questions was 44%. There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study support the concern of inadequate knowledge and attitudes in relation to pain management. Further intensive continuing education and staff development is highly indicated for nurses in Hong Kong.