title: Older peoples' strategies for coping with chronic non-malignant pain: A qualitative meta-synthesis.
abstract: BACKGROUND
  There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies.
  
  
  OBJECTIVE
  To examine how older people cope with non-malignant chronic pain.
  
  
  METHODS
  This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence.
  
  
  METHODS
  PubMed and Ovid Medline from 1995 to 2015.
  
  
  METHODS
  Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings.
  
  
  RESULTS
  Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: 'adjusting to the inevitable', 'doing it my way without medication' and 'the importance of support in managing the struggle'. There was high confidence in the evidence for 'doing it my way without medication' and moderate confidence in the evidence for the other two meta-themes.
  
  
  CONCLUSIONS
  Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required.
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand(1). Electronic address: marie.crowe@otago.ac.nz.
authors.forename: Marie
authors.initials: M
authors.lastname: Crowe
authors.affiliation: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gillon
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand(1).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
authors.forename: Cate
authors.initials: C
authors.lastname: McCall
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D006801:Humans; D009723:Nurse-Patient Relations; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D036301:Qualitative Research
keywords: Aged; Coping; Meta-synthesis; Older people; Pain; Pain management; Qualitative research; Self-management; Systematic review