Despite the expansion of research into chronic nonmalignant pain, a majority of reported studies are based on patient populations of specialised pain management clinics, which may not adequately represent older people with chronic nonmalignant pain in the general community. Therefore, the overall aim of the present thesis was to fill some gaps in this knowledge base. / The findings of the present thesis support the notion that older people who attend multidisciplinary pain management centres are probably not representative of those with pain who live in the general community but do not attend specialised treatment centres. Indeed a conceptual framework developed from the findings suggest that less than 3 percent of a random community sample of older people with chronic pain share the profile of those who attend a multidisciplinary pain management centre. The majority (86 percent) of the community sample were found to have mild chronic pain that can be adequately managed in the community. However, about 11 percent of the community sample have moderate chronic pain, and it is probable that additional community-based pain management services can improve the management of pain. / Development of instruments to measure the perceived helpfulness and use of pain management strategies by community-dwelling older people with chronic pain is another area that has not received adequate attention. A preliminary survey questionnaire was developed to measure the use and perceived helpfulness of pain management strategies in community dwelling older people. The findings have provided new insight from the user’s perspective regarding the relative effectiveness of different pain management strategies, and highlighted the potential clinical application of strategies that are less commonly used, such as TENS (transcutaneous electrical nerve stimulation), and relaxation techniques that are beneficial for specific subgroups of older people with chronic pain. / The evaluation of the efficacy of a community-based intervention program that provides free choice of intervention for improving outcomes for older people with chronic pain showed that the program was successful in reducing pain and improving level of physical activity for those who completed the program when they were compared with matched subjects who did not participate. The findings also suggest that an educational seminar can have a positive impact that empower participants to make a more informed choice regarding interventions for managing pain. However, the long-term effect of the program has not been established. Therefore, further research will be needed to evaluate whether this approach is a viable alternative clinical option for effective, accessible, and low cost pain management for the general community of older people with chronic pain. / The pain management service model was developed based on a synthesis of the findings. The model was based on a targeted approach that focuses on community-based interventions designed to improve access and outcomes for the majority of community-dwelling older people with chronic non-malignant pain who do not use specialised pain management services. / Overall, the findings of the present thesis have enhanced our understanding of the management of chronic non-malignant pain in community-dwelling older people, which has important implications for the development of services, and has generated hypothesis for future research that may contribute to improve outcomes for older people with chronic non-malignant pain.

Ageing is a process that starts from the moment of conception. It is accompanied by gradual impairment of body functions rendering the elderly less active socially as well as physically as a result of organ failure and compromised immunity system, leading to physical illness that may cause pain as well as mental illness such as dementia. In the United Kingdom majority of elderly people suffers from dementia and are cared for by nurses in the nursing homes. Patients with dementia experience pain as a result of other co- morbidities such as arthritis, but may be undiagnosed and therefore under-treated due to change in their behaviour. Inability to express pain causes concern to the nurse who provides care to the patient. Although some consequences of ineffective pain management have been evaluated, the question of nurses' opinions of pain experience in patients who suffer from dementia has, according to the extensive literature search done by the researcher, not been investigated. The purpose of this study is to describe and explore nurses' opinion of pain in patients suffering from dementia. The researcher adopted a qualitative approach to capture the participants' experiences and opinions of the nurses. A non-experimental qualitative research approach which is exploratory-descriptive and contextual in nature guided the researcher to explore and describe the nurses' opinion of pain in patients who suffer from dementia. Structured interviews and focus group discussions were conducted with seven participants involved in elderly care delivery. Biographical data were analysed and presented using descriptive statistics. The program for qualitative data analysis guided the process of categorizing and coding the data. / Health Studies / M.A. (Health Studies)

Ageing is a process that starts from the moment of conception. It is accompanied by gradual impairment of body functions rendering the elderly less active socially as well as physically as a result of organ failure and compromised immunity system, leading to physical illness that may cause pain as well as mental illness such as dementia. In the United Kingdom majority of elderly people suffers from dementia and are cared for by nurses in the nursing homes. Patients with dementia experience pain as a result of other co- morbidities such as arthritis, but may be undiagnosed and therefore under-treated due to change in their behaviour. Inability to express pain causes concern to the nurse who provides care to the patient. Although some consequences of ineffective pain management have been evaluated, the question of nurses' opinions of pain experience in patients who suffer from dementia has, according to the extensive literature search done by the researcher, not been investigated. The purpose of this study is to describe and explore nurses' opinion of pain in patients suffering from dementia. The researcher adopted a qualitative approach to capture the participants' experiences and opinions of the nurses. A non-experimental qualitative research approach which is exploratory-descriptive and contextual in nature guided the researcher to explore and describe the nurses' opinion of pain in patients who suffer from dementia. Structured interviews and focus group discussions were conducted with seven participants involved in elderly care delivery. Biographical data were analysed and presented using descriptive statistics. The program for qualitative data analysis guided the process of categorizing and coding the data. / Health Studies / M.A. (Health Studies)