Aging well with chronic pain in rural areas: an ecologically informed study

ABSTRACT

Over half of people in the UK aged 75 years and above experience chronic pain – defined as pain lasting three or more months. Chronic pain can impact activities of daily living, quality of life, and independence. Rural perspectives on aging with chronic pain are rare despite demographic trends indicating that rural populations are aging faster than urban populations and with an increasing prevalence of long-term painful conditions. Through interviews and observations, we explored the experiences of rural older people with chronic pain. Our inquiry was framed by an ecological model of wellness, which argues that socio-spatial and resource environments are crucial in nurturing and developing individual opportunities and competencies, promoting positive perceptions of the environment, and in contributing to overall health. Through an adapted constructivist grounded theory approach, our analysis revealed three key concepts, each an ongoing (re)negotiation between health and the rural environment: “Life coming inwards,” “Managing chronic pain,” and “Maintaining meaning.” Findings highlight the relational nature of rural environments and key factors inherent in supporting people to adapt in order to age well with chronic pain. We consider implications for our understanding of processes of aging well, future research, and policy and service provision.

KEYWORDS:

• Rurality
• aging well
• chronic pain
• exploratory methods

Acknowledgments

To Moorlands Homelink, Age UK Staffordshire, and local Women’s Institute and Mothers Union groups for supporting participant recruitment. To the Research Advisory Group for their ongoing support and guidance throughout the original study. To the Patient and Public Involvement and Engagement (PPIE) team at Keele University and Research User Group members for contributions to the development of the original study.

Declaration of Contribution of Authors

Lead author – project conception, data generation, analysis, and production of original manuscript draft.

Second author – refined design and methods, reviewed data collection, analysis and contributed to manuscript drafting process.

Last author – project conception, refined design and methods, reviewed data collection, analysis, and contributed to manuscript drafting process.

Disclosure Statement

No conflict of interest.

Additional information

Funding

The original research was funded by Keele University through an ACORN studentship. First author’s current role is funded by Midlands Partnership NHS Foundation Trust, St George’s Hospital, Stafford, ST16 3SR. Last author’s role is funded by the National Institute for Health Research, Applied Research Collaboration (ARC) West Midlands, Keele University, UK.

Notes on contributors

Tom Kingstone

Tom Kingstone is a post-doctoral Research Associate in Mental Health in the School of Primary, Community and Social Care at Keele University. Prior to this, Tom was awarded an Acorn PhD Studentship at Keele; his thesis explored lived experiences of chronic pain among rural dwelling older adults to identify factors to support aging well. Tom is a key member of the Mental Health Research Programme and works to deliver a joint research strategy between Keele University and Midlands Partnership NHS Foundation Trust. Tom has expertise in qualitative methods and his research interests include mental and physical long-term conditions, including multimorbidity, aging, and examining the role of the environment in health and well-being. Tom has conducted research funded by the National Institute for Health Research on themes of medically unexplained symptoms, multimorbidity, and anxiety and depression in older people. Tom led a rural health initiative called FRRESH (Forum for Rural Research on Health and Well-being), funded by a Keele Innovation grant.

Carolyn Chew-Graham

Carolyn Chew-Graham is Professor of General Practice Research at Keele University, Honorary Professor of Primary Care Mental Health at Midlands Partnership NHS Foundation Trust, Honorary Professor of Primary Care, University of Manchester, Visiting Professor, University of York; and GP Principal, Manchester, UK. Carolyn is currently Chair of the Society for Academic Primary Care (SAPC), a member of the Royal College of General Practitioners (RCGP) Scientific Foundation Board, Chair of RCGP Research Paper of the Year panel, and RCGP “Curriculum Advisor, Mental Health” . Carolyn’s main areas of interest and expertise include the primary care management of people with anxiety and depression, multiple health conditions, unexplained symptoms. She has qualitative research methods expertise, drawing on theories from social sciences and psychology, but always with a focus on clinical practice – trying to answer questions that are important to patients, their families, health care professionals and the NHS.

Bernadette Bartlam

Dr Bernadette Bartlam is a nurse by profession and joined the Family Medicine team at Nanyang Technological University in Singapore in April 2018. Prior to this, Bernadette undertook a PhD in Social Policy as a NHS New Blood Research Fellow and then in 2000, Bernadette joined the School of Social Relations at Keele University as a Research Fellow. She moved to Keele’s School of Medicine as a Lecturer in Gerontology in 2005, before joining the Research Institute for Primary Care and Health Sciences in 2012. Bernadette’s main areas of interest are around health inequalities, multi-morbidity - particularly in relation to chronic pain and mental health - environments and aging across the life-course. She has experience of inter-disciplinary large scale projects and expertise in qualitative and mixed-methods research informed by sociological and psychological theories. With colleagues, she has worked to strengthen the involvement and engagement of patients and the public in research.