An aging population is a global phenomenon. As people get older, they become more vulnerable to age-related diseases and the resulting pain. The prevalence of chronic pain among community-dwelling older adults is high. For instance, in Hong Kong, 37 to 50% of community-dwelling older people suffer from pain [1, 2]. The prevalence of pain among nursing home residents in Hong Kong may even be as high as 70% .
Chronic pain can have severe adverse impacts on older adults. The consequences of unrelieved chronic pain include hindered activities of daily living, depression and anxiety, decreased social interaction, impaired mobility, falls, sleep disturbance, malnutrition, and increased health care utilization and expenses . These adverse effects of chronic pain may worsen pre-existing health problems, thereby increasing the burden on health care and social services.
Analgesics remain the primary method of managing chronic pain . However, some older people prefer not to use pain medication and often request them only when the pain reaches an intolerable level. In a local study, 173 community-dwelling older persons were interviewed and only 47% of the participants used oral analgesic drugs to relieve their pain .
Due to the limited acceptance of pharmacological approaches to managing pain, an increasing number of studies are being conducted to examine the effectiveness of non-pharmacological strategies to relieve pain. In a literature review, Reid et al. investigated the evidence on self-managed interventions for pain among older adults. A total of 27 articles were identified, including those that evaluated programs sponsored by the Arthritis Foundation and other programs such as yoga, massage therapy, Tai Chi, and music therapy. Among the reviewed studies, 96% showed positive outcomes, with a median reduction in pain scores of 23%.
Another 8-week integrated pain management program (IPMP) was carried out among Hong Kong nursing home residents . A total of 535 older adults were randomized into an experimental group (n = 296) and a control group (n = 239). The participants in the control group only received regular care but not the IPMP. The participants in the experimental group received the IPMP, which included a 30-minute physical exercise program (PEP) and 30 minutes of either multisensory stimulation therapy or an arts and crafts activity each week. The PEP included exercises in muscle strengthening, stretching, and balancing, and was conducted in small groups of 10 to 15 older residents. In the multisensory session, relaxation techniques to control pain and the use of the five primary senses were taught. In the arts and crafts session, older adults made artwork such as photo albums, paper flowers, and paper fans to exercise their fine motor activities and for multisensory stimulation. Upon completing the program, the participants in the experimental group showed a significantly higher reduction in pain scores, higher happiness and life satisfaction scores, and lower scores in loneliness and depression than were observed among the control group; no significant differences were seen in the control group. A significant increase in the use of non-pharmacological methods of pain relief was also seen among the participants in the experimental group as compared to the control group.
Although the pain management program, which includes physical activity, has been shown to have health benefits and improve pain management among older adults , studies have found educational interventions to be effective among older adults only over the short term . People who participated in these interventional programs often fell back into their old habits of inactivity after completing the program . Therefore, it is important to develop interventions that can be sustained over time.
It is suggested that interventions with some type of social support, such as a ‘buddy’ system, have great potential to increase the participation of older adults in exercise and overall fitness activities , and will lead to greater adherence to such activities, as well as result in a higher level of enjoyment of them . Social support interventions in community settings focus on changing physical activity behavior through building, strengthening, and maintaining social networks that provide supportive relationships for behavioral change. In general, these interventions involve making a ‘contract’ with companions to achieve specified levels of physical activity, or setting up walking or other groups to provide companionship and support while being physically active . In a study conducted in the United States, 81 sedentary adults were randomly assigned to two 16-week group-based programs: 1) peer-delivered or 2) a ‘standard’ community-based exercise promotion intervention. No significant difference in moderate-to-vigorous physical activity (MVPA) minutes/week at week 16 was found between the two groups, but both reported significantly more MVPA minutes/week relative to baseline at week 16. Moreover, peer volunteers (PVs) enhanced the long-term maintenance of physical activity, as the active intervention group was able to maintain and slightly increase their PA behavior by the 18-month follow-up session, while the standard community intervention group began to return to their baseline levels. There was significantly more physical activity among the group with peer support relative to the standard community intervention group after 18 months .
The effectiveness of PVs was also studied in a fall prevention program. After a 10-week intervention program, participants (n = 52, aged 65 to 94) in the peer-led group reported a 27% decrease in falls and more weekly walking for 34 minutes compared with the control group (n = 25), who had been taught by a trained instructor and had been without peer support .
Our research team conducted a search of databases (PubMed and ScienceDirect) to study the application of PVs in intervention programs for older adults in Hong Kong from 1998 to the present. Four studies were identified, and they have been shown to achieve positive outcomes. However, the programs studied were those for healthy living, coping with stress, post-discharge support, and physical activity [15–18]. No pain management programs involving PVs were found. PVs were chosen over other forms of social support as the Hong Kong population is aging and people are living longer. After retirement, some older adults are still enthusiastic about serving the community. Therefore, we will select the PVs from the Institute of Active Ageing (IAA), which is dedicated to promoting active aging and the view of older adults as important contributors to society. As the IPMP has already been validated and published, and its effectiveness has been established, the effectiveness of the IPMP among older adults is well understood; however, whether this effect will be extended with the use of PVs is unknown. Therefore, in the present study we will attempt to test only the effectiveness of an IPMP that will be sustained by PVs.
The aim of this study is to determine the feasibility of PVs in an IPMP for Hong Kong older adults with chronic pain. According to the literature, pain management programs range from 4 weeks to 8 weeks. As the previous 8-week IPMP has already been validated, in this study we would also like to examine the dose-response relationship of an IPMP with PVs (that is, the possibly nonlinear association between intervention duration and pain intensity score). Our objective is to run a pilot study for a future main study with a randomized controlled design. It is hypothesized that the implementation of an IPMP supplemented with PVs for older adults with chronic pain will lead to improvements in levels of pain intensity, functional mobility, physical activity, loneliness, and happiness, and in the use of non-pharmacological pain-relieving methods.