Older People in Scottish Highlands: Chronic Pain Management

Abstract

• Introduction: The research understudy aspires to examine and explore the behaviours, views, and experiences of older people in the Scottish Highlands in the management of chronic pain. Precisely, the researcher intends to explore the severity and type of chronic pain as well as its management regimens, evident safety and efficacy, identify issues relating to regimens of chronic pain management and concomitant information in order to identify ways in which management of chronic pain can be improved.
• Methods: The research understudy has collected data via interviews. For this study, qualitative data was collected through interviewing target size predetermined to be around 40 participants.
• Result: The results depict that out of 12, total of 10 (83.3%) participants, who were experiencing a chronic pain took part in the study. The chronic pain management involves pharmacological and non-pharmacological approaches. Similarly, the influences of chronic pain management can include easiness, ability to manage pain and health management. The suggestions being received for services enhancement are making it more local and improving accessibility.
• Discussion: The overall findings of this study depicted that the behaviours, views, and experiences of older people in the Scottish Highlands in the management of chronic pain can vary based on multiple factors. It can be argued that chronic pain is common because majority elderly report pain of moderate or greater intensity. Arguably, the findings are relatable because literature shows that 1 in 5 adults suffers from pain.
• Conclusion: It can be summarised that the chronic pain among elderlies is common and results in substantial morbidity. (253)

Introduction

In the past few decades or so, rural regions have witnessed a higher rise in terms of average age as compared to their urban counterparts. Going forward, the population that is aged at least 65 years is expected to grow by nearly 50% in rural and urban regions from 2016 to 2039. The population of this age group (65 years and above is 11.8 million {{85 Coates, Sarah 2019;}}. Nevertheless, some non-uniformity has been observed in the pattern associated with demographic ageing. To illustrate, the number of people whose age is more than 75 years old in many rural regions of Scotland is significantly higher as compared to the urban regions {{86 Roberts, Anne 2015;}}. When it comes to rural Scotland, it is important for the provision of older adults to address a number of important challenges, such as comparatively few service recipients spread across a wider geographical area as well as the challenges associated with enticing and sustaining specialist workforce {{88 Wilson, N 2009;}}.

Owing to the expected increase in the population of the older age group, there is expected to be a corresponding rise in chronic pain, which impacts between 10.4% and 14.3% of Scotland’s population, and is defined as pain that persists for a minimum of three months {{79 Fayaz, 2016}}. It is particularly problematic for the older people by limiting their independently and making it necessary for them to seek external support. Enhanced pain relief brings about a reactivation of the mental and physical activity of an individual. This reactivation would reduce their increased demand for healthcare and allied services while enhancing the quality of their life (5)

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NHS Highland is the UK’s the largest geographical health board, encompassing almost 32 500 km 2 and accounting for 41% of Scotland’s entire land mass. However, the population is below 10% to that of Scotland’s population at 320 000. Just 25.8% of the population of Highland Council resides in urban regions (6) as compared with 69.5% of Scotland’s entire population. Many studies have examined a wide array of problems that are commonly faced concerning healthcare in rural and remote communities, such as trouble in gaining access to care; long distances; centralised healthcare services; long waiting times; high travel costs and service hours; GP relatability; resuming the care process; and utilising emergency and deterioration in health {{84 Alfaqeeh, Ghadah 2017;}}. According to Mezei & Murinson (2011), rural communities also lack access to primary care providers specialising in chronic pain management. Therefore, residents of these areas may need to solely depend on primary care providers that are quite often less equipped to tackle chronic pain management. Furthermore, these studies investigated the access of healthcare in Highland, albeit not in a focused manner. For this reason, the study aimed at examining the severity and type of chronic pain as well as its management regimens, evident safety and efficacy, identify issues relating to regimens of chronic pain management and concomitant information in order to identify ways in which management of chronic pain can be improved. (503)

Methods

This qualitative research project was conducted using individual telephone interviews as method of data generation because this approach allowed for free and open evaluation of thoughts on the part of participants, which cannot be done by using surveys {{82 Szolnoki, Gergely 2013;}}. In this study, participants aged 75 and over who lived in the Scottish Highlands as well as remote areas were targeted. The target sample size was predetermined to be 40 participants based on their availability and willingness to participate. However, only 37 participants responded to the request. All 37 participants divided into groups of students, were then asked to complete the consent form, provide their contact details and set the appropriate time for the telephone interview. Of these participants, only 10 in our group, agreed for telephonic interview. The participants who did agree were provided with the information leaflet after being reviewed by the research supervisor. This project was carried out as per the norms of the Research Governance and Research Ethics at Robert Gordon University. One of the fundamental principles of ethics is confidentiality. In fact, “Confidentiality is the assurance that any information or communication provided by the participant to the researcher would not be shared with anyone else who is not related to the study. Therefore, special codes were generated for each participant prior to contacting the participants.

In order to ensure the rigour of this study, all students were made to prepare their questions beforehand. Subsequently, these were combined and revised using the supervisor’s amendment. Finally, a list of questions was divided into five main areas of open-ended questions which were logically organised from simplest to more complicated questions. A semi-structured interview schedule, which focused on the nature as well as duration of pain, the type of the medical service provided, ways of managing pain and observing personal opinions on making improvements in the quality of services providers was focused on. One telephonic interview was conducted for each participant and a total of 10 interviews were held over a seven-day period. These interviews, which lasted between 20 and 25 minutes, were audio recorded and transcribed. Information was gathered by transcribing interviews in a Microsoft Word document to make sure that all statements made by each of these 10 participants were recorded.

Data analysis process commenced b getting familiar with the entire data set, by rereading transcripts, observing patterns in terms of language use and repetition of certain words {{83 Gibbs, Graham R 2018}}. Team meetings were subsequently held to discuss and develop data codes in order to develop themes and sub-themes. In other words, quotes from interviews were coded via a participant number. Thereafter, the researchers began searching meaningful units within all responses of the participants and then via the information gathered from all respondents. Subsequently, I began to identify new emerging themes as well as subthemes manually from the transcribed records. In addition, new codes were generated for emerging themes that were then added into a list of pre-existing codes that facilitated the development of the ultimate analytical framework, which, in turn, comprised of () codes grouped into 5 categories as per in table 2. (521)

Result

Participants’ Demographics

Out of 12, total of 10 (83.3%) participants, who were experiencing a chronic pain took part in the study. Among these participants, five were accounted for by males whereas the remaining five were comprised by women. As evidenced in Table 1, each participant was assigned a separate code along with deprivation category, urban and rural class cation, gender, age and ethnicity. The ethnicity of all participants was white and the average age of male participants was higher than their female counterparts. It is revealing that participant codes N29, N35, N30, N31 and N44 had the least favourable deprivation category, which has a clear relationship with their age and area of their location. This is not surprising because as mentioned above, chronic pain management in rural areas is less than satisfactory.