Exploring factors that support rural older adults with chronic pain and maintain quality of life: a mixed methods study

Problem

The UK population is ageing. Rural areas are reported to be ageing at a faster rate than urban areas in the UK. Over half of the UK population aged 75+ years experience chronic pain. The impact of chronic pain can be profound and may negatively affect activities of daily living, quality of life and a person’s ability to maintain an independent lifestyle. However, there is a dearth of existing research on the experiences of older adults living with chronic pain in rural environments. Self-management is a central component of chronic pain management. Suffering in silence has been described as a means by which people in rural areas cope with chronic pain. Further research is necessary to explore this further and how it impacts on coping and self-management. The aim of the study reported here is to generate knowledge and understanding of older adults living with chronic pain in rural environments in order to inform health and social care policy and service provision.

Approach

Mixed method exploratory approach comprising: an initial sit-down narrative interview using a ‘lifegrid’ and quality of life measure (CASP-19); optional follow up with a further interview, and/or a photo-elicitation interview, and/or a ‘go-along’. Recruitment achieved through voluntary sector groups using snowballing and spectrum sampling. Inclusion criteria: over 65 years of age, living in a rural environment, and self-reporting chronic pain. Interviews were digitally recorded with consent and transcribed. Data analysis was conducted using techniques of constant comparison in which mixed data were integrated.

Findings

Fifteen interviews were conducted. All participants disclosed accessing Primary Care in order to manage pain and all used generic painkillers; however, these were ineffective as a standalone strategy. Chronic pain negatively impacted on control and autonomy through disability and restricted activities. A process described as “carrying on” was identified and seemed important for maintaining control and autonomy. Carrying on was underpinned by mixed self-management strategies aimed at maintaining health, psycho-social responses to chronic pain supported by attitudes and beliefs, and flexibility to adapt within the environmental context. A process of “living inwards” described the restrictive nature of chronic pain. Participants maintained capacity to take pleasure from life; but meaning in life was restricted by loss of activities, absence of suitable adaptations, and/or apparent lack of opportunities.

Consequences

Ageing with chronic pain in rural areas presents key challenges to maintaining different quality of life across different domains. The implications for services and policy highlight the importance of exploring self-care strategies and the essential role of rural outreach services.