Written by Nick Papastamatis - Practice Leader
As people progress in age, they seem to be less concerned about their future selves, and more motivated to feel good about themselves and do things they enjoy. Whether that’s spending time with their kids and grandkids, playing golf, dancing with their spouse, going for walks or whatever it might be… They don’t spend too much time and energy dwelling on things that don’t enhance their present time mood.
The amount of times I've seen an older person limping, or clearly physically restricted and asked them,
“How is your hip going?”
and their answer is… “It’s fine… why do you ask?”
Almost as if the problem didn’t exist…
More often than not, they have pain or at the very least, some sort of health condition… but if their condition doesn’t stop them from doing the things they love, then they don’t seem to be phased by it.
Photo by Johnny Cohen on Unsplash
There is a flip side though…
There are older folk that really do become defined by their problem. They come into the clinic, very regularly, and use it as an opportunity to complain about it, to have it as their reason for not being able to participate in life. Once they’ve made up their mind that their problem isn’t going away - and it really wont, no matter how hard you try with them inside and outside the clinic.
So we have one set of older people who are bullet proof despite their limitations and the other set of older people go into their shell because of their limitations.
That’s a seemingly large gap between the two groups.
Here’s why this gap exists:
According to a 2021 research paper by Condon et al. (https://doi.org/10.1080/13607863.2019.1673308)
The older population, whilst highly motivated to sort it out while their pain is fresh, generally become more despondent to solving their issue the longer it is sustained and in fact, chronic pain in adults makes them 2-4 times more likely to enter depression.
Every mechanical problem can be managed in some way, even though as we get older, problems might be a bit more progressed than they were 20 years ago, but nevertheless, improvement can always be made. The difference is actually their MIND and how they FEEL!
There’s a strong link between pain intensity and one’s emotional intelligence. Emotional intelligence is your ability to recognise and manage one’s feelings and be able to mould behaviour and thoughts to get the outcome one wants. So the higher your emotional intelligence is, the lower your pain intensity will be.
And, you can measure it!
Condon et al. 2021, classifies four different factors associated with their thoughts and feelings for the older population: (and believes it’s different for younger people)
CONFUSION about feelings
ACCEPTANCE of feelings
REJECTION of feelings
INSIGHTS about feelings
As stated in the paper, there are various statements that the older population say that are categorised under these factors which are as follows along with my thoughts on how we can apply this clinically but also, important for patients to become aware too:
Confusion:
I can never tell how I feel
When upset, I realise all the good things in life are just illusions
I can’t make sense of my feelings
Sometimes I can’t tell what my feelings are
I am usually confused about how I feel
My beliefs and opinions change based on how I feel
Although sometimes happy, I mostly have a pessimistic outlook on life
It’s critical for patients to be able to make sense of what they are feeling and why they are feeling it. That can be with respect to their pain, but something that occurs that’s worse than the pain, is that it gets them feeling down about life. We need to be able to help them navigate through building an understanding of why they are in pain, and further (commonly missed), WHY their pain is getting them down.
Photo by Sven Mieke on Unsplash
Acceptance:
I pay a lot of attention to how I feel
Feelings give direction to life
I often think about my feelings
I believe in acting from the heart
The best way to handle feelings is to experience to the fullest
Listening to a patient whilst they are telling you how they feel about their problem is what allows them to feel listened to and is crucial in building an alliance between the patient and the practitioner. Things might be explained well to them, but if they don’t feel a connection or an understanding from you, they may feel despondent.
Rejection:
One should never be guided by emotions
Feelings are a weakness that humans have
People would be better if they felt less and thought more
I don’t think it’s worth paying attention to your emotions
I never give in to my emotions
Feeling strongly about not feeling things is a feeling in itself. The greatest pushback would be when encouraging someone who is not willing to explore feelings, to in fact, explore them. Although the research suggests that they’ll have a better outcome if they can moderate their feelings, it may well have a worse outcome, to force the patient to explore their feelings, when you don’t have their permission.
Insights:
I usually know my feelings about a matter
I almost always know exactly how I’m feeling
I am often aware of my feelings on a matter
I am rarely confused about what my feelings are
I am usually very clear about my feelings
When a patient is clear on the impact a problem is having on their life, it makes it very easy to set measurable goals working towards breaking down the limitation. It gives purpose to the sessions and sets the intention behind prescribed exercises.
Condon et al 2021 strongly informs this piece, and various experiential inferences have been applied to it based upon my experiences as a clinician over the past ten years.
It’s important as clinicians that we make every effort, not to intentionally build a patient’s emotional intelligence, but to at least, help them make sense of what they are feeling, and why they are experiencing those feelings.
Ultimately, their mindset stands between you and whether or not you’re able to help them achieve their outcomes and feel themselves again.
Written by Nick Papastamatis
Practice Leader
Ref: Shelley E. Condon , Patricia A. Parmelee & Dylan M. Smith 2021 Examining emotional intelligence in older adults with chronic pain: a factor analysis approach Aging & Mental Health 25:2, 213-218