The Mediating Effect of Pain and Fatigue on Level of Functioning in Older, Article Review Example

Abstract

Throughout the practice of medicine, one of the primary concerns of doctors has always been, in the absence of completely eradicating disease, to at least alleviate pain. However, as many age, they carry with them conditions which are chronic in nature, and difficult to treat. Consequently, the onset of age, along with the already present pain and more often than not– fatigue, which accompanies many chronic ailments, has begun to cause great concern among some in the medical community who observe otherwise afflicted individuals, presently and at times permanently, disabled by a combination of the two contributors. Therefore, the directive of this study, was to attempt to find links and commonality between pain management and an increase in functionality, even with the chronic ailment or disease still present. Statisticians used a complex model, in order to effectively track the movement and pain levels of patients, during and after pain management procedures, in order to find a pathway which would allow for continued mobility, throughout chronic illness and the aging process. What was discovered was enlightening and encouraging. The conclusive results are promising signs of the future of medicine, and how all can expect to maintain functionality, even in the midst of debilitating illness.

The Mediating Effect of Pain and Fatigue on Level of Functioning in Older Adults

The scope of the science and work contained within the study entitled “The Mediating Effect of Pain and Fatigue on Level of Functioning in Older Adults” was conducted in hope of finding additional means and methods of alleviating pain in chronic sufferers, especially those at age 65 and over. The purpose for the study was to simply determine levels of functionality in patients, when considering already present medical conditions, and then whether that condition is mediated (made better or worse) by the presence of continuing pain and fatigue. In particular the patients in question were aged from 65 to 90, who were chronic sufferers of chronic pain and fatigue, and conditions associated with chronic pain and fatigue (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 254). Along these lines, the hypothesis is formed, and can be asked as follows.

Hypothesis

If symptoms were made less severe, by an improvement in pain and/or fatigue, would the level of functioning improve in patients, even if underlying medical conditions were not and could not be cured?

Significance

In large part, the significance of this particular study relies on the notion that although the role of symptoms in the treatment of some older adults has been established for quite some time, “any studies that have explored the relationships between medical conditions, symptoms, and functioning in a single comprehensive model” are unknown to the author(s) (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 254).  Accordantly, the information that may be gleaned from this report, could go a considerable distance in establishing certain thresholds by which other, all inclusive treatment patterns may be formulated. For this reason, as well as for the timeliness of the study, there is great significance to be recognized.

As an example, it is commonly accepted that a chronic condition cannot, in most cases, be cured. Hence, the term chronic is used as a descriptive for that ailment. The medical profession is also keenly aware of limitations; in quality of life, mobility, and level of pain, which a chronic condition can have on the overall prognosis of any particular case. However, in the course of the study, and as a specific point of the study, it was found that a possibility exists which, if the model were successful, would hold that a moderation of pain (which is possible in most cases), would make a marked improvement on a condition which is in any other way, unable to be modified (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 261). When viewed in broad terms of pain management, and a holistic picture of the patient’s well-being, this is indeed exciting news.

Furthermore, as alluded to prior, earlier studies have not attempted to combine two or more aspects of chronic pain and functionality issues. As such, the presence of the model in this study may provide the first clues as to how to effectively treat a condition which has, until now, been not only unidentified, but fully neglected in research and study. This would then necessarily lead to a neglect, though an unintentional one, in the care provided or treatment prescribed, for patients who are within the parameters of this survey.

Research Design and Methodology

The design of the research was aimed at providing optimal care, and focused on two key points: 1. to understand reasons why some adults may or may not limit daily activities due to pain issues, and 2. to identify any factors which could otherwise be changed and/or modified which would lead to that limiting of activity. As such, a model was constructed whereby a sequence of models were analyzed, with each model based on the key point of the literature. The initial model utilized “theoretical framework” … “where all independent variables predict the first aspect of functioning (lower body performance). Lower body performance predicts self-reported physical functioning, which, in turn, predicts self-reported role and social functioning” (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 256). Although a good deal of the model relied upon self-reporting, this is easily quantifiable, as a patient has little doubt when he or she is in pain, and responds to that stimuli with little fail.

Additionally, five indicators were added to the final stages of the model, in order to evaluate and narrow covariance of data. As an example, two such indices were the “chi-square”, and the “goodness of fit (GFI)”, and these were selected, with others, as a reliable means to indicate a good result.

The method of data collection, briefly discussed previously, relied somewhat on self-reporting. However, it must be noted that the self-reporting portion of the data collected was in the field, as is the case of many other self-reporting pain monitors, and is very widespread in around the clock observances during times that a patient is not under immediate care. In other areas, data was collected from 225 participants, ranging in age from 65-90. The samples, rated in terms of “points” in “medical condition” (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 256) were tallied and kept in respective table and charts, until comparison were made. It was at this point and others, that the self-reported data was compared against clinical data, giving a sharper image, of those findings. During many of the initial models, some variation was noted. However, with the application of the final model, and controlling indices, the associations between performance in clinical study and self-reporting were conceptualized, and the differences became small to moderate. This indicated a normal progression, and a workable model, based on its design (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 260).

Results and Conclusions

Even during pre-test and testing phases, models predicted a poor outcome in regard to function. However, upon conclusion, it was found that only casual differences existed, thereby indicating that pain and fatigue are indeed “likely to cause declines in function rather than the reverse” (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 263). Overall factors resulting from the study are encouraging, in that even though “chronic medical conditions predict poor functioning, most of the relationship is explained by the presence of pain and fatigue” (Jill A. Bennett, Stewart, & Kayser-Jones, 2002, p. 263). Importantly, early in the study and included in the models, pain and often times fatigue were determined to be negligible and possibly well managed. This conclusion then, upholds the hypothesis, and renders it true.

It does appear that functionality may be improved through pain management techniques, or other mechanisms which are modifiable to a certain condition and/or situation. This is an important step in moving forward in this field and will prove to be helpful in improving the functioning capabilities of aging adults. Although the pre-existing and underlying, often chronic and/or terminal conditions, may not be alleviated, some functionality and quality in life is easily seen to be available, merely through a responsible and adequate utilization of already proven and available pain management techniques, mechanisms, drugs, and practices. As such, in the mean time between further empirical studies, and final analysis’, the medical field may begin to have a somewhat better understanding of treatments which are already available and accepted, without having to wait for any approval of experimental treatments or worse, to be forced by institutional stalemate, to be limited in the tools which a physician may offer to his or her patient, knowing that positive results are possible, and imminent, if employed reasonably.

References

Jill A. Bennett, J. A., Stewart, A. L., & Kayser-Jones, J. &. (2002). The Mediating Effect of Pain and Fatigue on Level of Functioning in Older Adults. Nursing Research, 254-265.