The Influence of Age on Pain Care in Tanzanian Hospitals

Kelsey Cook 

 

Research Question: How does age impact the distribution and perception of paincare in Tanzanian hospitals? 

 

Problem Statement, Research Question, and Theoretical Background: The lack of essential pain medications in lower-income countries is a persisting issue. While Western European and North American countries face an alarming number of opioid-related deaths, countries such as Tanzania are suffering from a severe shortage of needed medication. Six high income countries are responsible for 79% of global morphine consumption whereas low-middle income countries, which account for 80% of the world’s population, are responsible for a mere 6% of global morphine consumption (Yao et al., 2023). The limited availability of opioids and related medications can affect many populations, regardless of sex, gender, or age. However, globally, older people are oftentimes not adequately prescribed pain medication, regardless of supply. While this data varies by country, pain is often undertreated in the geriatric population for many reasons. These include providers’ misconception of pain as a consequence of aging, communication barriers, concerns of side effects, and patients underreporting pain (Borsheski et al., 2014). Moreover, the aging population is rapidly increasing across the globe, and the percentage of people older than sixty in Tanzania is expected to increase from 4 to 10 percent by 2050 (United Republic of Tanzania, 2003). As the aging population rises, research concerning pain management becomes even more crucial. The older population in Tanzania forms a significant percentage of people seeking care for chronic illnesses, and the majority of older Tanzanians reside in rural areas, increasing the barriers to proper health management (Isangula, 2022). Many nations have not properly considered how the demographic transition towards an older population will affect healthcare (Mwanyangala et al., 2010). Unfortunately, few studies have been conducted on adult health and aging in Tanzania, highlighting the necessity of considering age in future medical anthropology studies (Mwanyangala et al., 2010).

Considering the barriers within Tanzania’s pain management practices due to a limited supply and the barriers for seniors across the globe, for this research, I will ask: How does age impact the distribution and perception of paincare in Tanzanian hospitals? Are seniors less likely to be prescribed pain medication when there is a limited supply? How does age impact the way pain and pain care is understood?
 

Sample, Research Design, and Methods: This research project will be focused within Iringa, Tanzania, under Dr. Adrienne Strong’s larger NSF-funded project on pain care practices. Considering this, this research already has IRB and Tanzanian research clearance.  I will be in Tanzania from approximately May 9th to July 11th. Through the course of these nine weeks, my research will further our understanding of whether and how age is a determining factor in the distribution of pain medications within a low resource healthcare setting. This project will largely be based in Tosamaganga District Hospital (TDH), but the data collected can be representative of many Tanzanians’ care as TDH provides general services. Another objective of this project is to explore if age impacts perceptions of pain medications and how people of different ages manage their pain when substances like opioids are not widely available. 

To investigate these issues, I will employ a variety of ethnographic research methods. Firstly, semi-structured interviews with younger generations and senior populations will provide a baseline to understanding differing perceptions and interpretations of pain across age groups. While I have some Swahili training at an intermediate level, I will also be working with an interpreter for these interviews. Additionally, interviewing healthcare providers, including physicians and nurses, will offer valuable insight into the factors and considerations influencing their allocation of pain medication. These interviews will establish a foundational understanding of the extent to which age impacts beliefs and treatment. From the data collected, I will then utilize the free listing method and rank ordering to understand who is perceived as needing stronger pain medications, such as strong morphine, when there is a limited supply. I intend to ask Tanzanian nurses, patients, and those part of the everyday population to participate in the free listing and ordering activity. The free listing method will consist of asking participants to list preferred ways of managing pain after being presented with various examples of ailments, including physical and psychological. For the ordering task, I will present non-identifiable, hand-drawn images of individuals at different ages facing similar ailments. Participants will then be asked to rank the images based on who they believe is most deserving or in need of medication. After the participants have completed their ranking, participants will then be asked to explain their choices in order for the factors influencing their decisions to become clear. Throughout all stages of this research project, participant observation within the hospital will provide valuable insight into the diverse responses to pain. This may include shadowing doctors and nurses to observe how they assess, understand, and treat pain and also how patients respond to their treatment. Considering pain is very subjective, verbal and non-verbal language is especially important to observe in order to better grasp what pain means to each individual. In addition to recording field notes and observing how people describe and respond to their pain, taking note of who receives the limited supply of strong medications may reveal additional insight into other factors care providers consider, outside of pain severity. I will also participate in community focus group discussions with Dr. Megan Cogburn, the project’s postdoctoral researcher, in order to gain insight into community perceptions of pain and aging, pain and pain relief, or deservingness of pain relief for different populations, including the elderly versus young people. 

With the consent of participants and upon returning to the United States in July, I will translate and transcribe all interviews for more concise data analysis. I will analyze the data collected from interviews, observation, free lists, and rank ordering to highlight patterns and themes. I will also employ software such as MAXQDA to code the data using thematic analysis. 

Intellectual Merit:  Research concerning pain medication allocation is essential in developing our understanding of the potential barriers to relieving pain, specifically the extent to which age is a factor. Furthermore, understanding generational differences in regard to perspectives and practices for pain relief can reveal crucial insight into the beliefs and usage of pain medications and meanings of pain. A deeper understanding of these potential disparities allows for a more holistic approach in deciphering the decision-making process behind pain medication distribution and how meanings of pain develop. Subsequently, looking into the diverse approaches to pain management can reveal the importance of considering generational differences and the extent to which age impacts belief systems. Considering the gap in current research and knowledge about pain relief for seniors and how age impacts the distribution of this care, this research can uplift more equitable practices in many healthcare settings. All of this information combined can also significantly contribute to medical anthropology, specifically our understanding of how opioid shortages might impact meanings of pain and how age influences experiences within a healthcare environment. You could add a sentence somewhere in this paragraph that says something about there being a gap in the research/knowledge

Broader Impacts: This data will be summarized in my undergraduate honors thesis, to be completed by December 2025. Moreover, this research will provide me with the necessary experience and training for future projects in graduate school. In the future, I am interested in understanding health disparities for people living with dementia, and this project is the first step to understanding generational differences in a healthcare setting. Results from this research will also be incorporated into the training workshop to be conducted in year three of the overall NSF project led by Dr. Strong. Understanding how age impacts the perceptions of and distribution of pain medications will provide healthcare professionals, patients, and researchers with new perspectives to consider. This research will be especially applicable in Tanzania, but can also extend more broadly across the globe. As mentioned, there has not been extensive research conducted on this subject in Tanzania or other countries. Therefore, understanding the potential differences due to age is very applicable in Tanzania, other African nations, and even countries such as the United States. Insights from this research could help inform better understandings of how age impacts pain care treatments in the United States and lead to more equitable pain care management for seniors. Somewhere: Results from this research will be incorporated into the training workshop to be conducted in year 3 of the overall NSF project led by Dr. Strong. 

 

References

Borsheski, R., & Johnson, Q. L. (2014). Pain management in the geriatric population. Missouri 

medicine, 111(6), 508–511.

 

Isangula K. G. (2022). The Dangers of Being Old in Rural Tanzania: A Call for Interventions for 

Strengthening Palliative Care in Low-Income Communities. Frontiers in aging, 3, 888396. https://doi.org/10.3389/fragi.2022.888396

 

Mwanyangala, M. A., Mayombana, C., Urassa, H., Charles, J., Mahutanga, C., Abdullah, S., & 

Nathan, R. (2010). Health status and quality of life among older adults in rural Tanzania. Global health action, 3, 10.3402/gha.v3i0.2142. https://doi.org/10.3402/gha.v3i0.2142

 

United Republic of Tanzania (2003). United Republic of Tanzania. The National Aging Policy. 

Ministry of Labour, Youth Development and Sports. Interactions.eldis.org. http://interactions.eldis.org/sites/interactions.eldis.org/files/database_sp/Tanzania/National%20Ageing%20Policy/NAP.pdf

 

Yao, J. S., Kibu, D. O., Asahngwa, C., Ngo, N. V., Ngwa, W., Jasmin, H. M., Gobina, R. M., Foretia, 

D. A. (2023). A scoping review on the availability and utilization of essential opioid analgesics in Sub-Saharan Africa. The American Journal of Surgery, 226 (4), 409-421.https://doi.org/10.1016/j.amjsurg.2023.03.013