Given the aging population and the number of pain episodes that increase with age, it is important to better understand what are some of the biases among caregivers that may affect pain assessment and care given to older patients. The patient’s and the healthcare provider’s characteristics in a patient-provider relationship influence pain assessment and perception, thus the help that could be offered to the patient. These characteristics include being associated with a certain age group (being young or old) or gender (being a man or a woman). While these characteristics have been considered separately in previous studies, no research has attempted to address them simultaneously in people with pain and observers.
Goal
It is important to better understand how different biases affect the caregiver-patient relationship in order to improve healthcare provided to vulnerable populations. Therefore, the objective of this study was to examine the effects of age and gender of people with potential pain as well as these same characteristics in observers and how these effects impacted on the pain assessment and help offered.
Methodology
40 young adults (18 to 30 years old) including 20 women and 40 older adults (50 to 82 years old) including 20 women performed an experimental computer task. They had a caregiver role meeting various people who were potentially in pain. These participants watched short video clips of people with shoulder pain. In these videos, seven intensities of pain expressed equally on people’s faces (from zero to pain to severe pain) were shown. In addition, four groups of people were identified according to their age (young aged 19 to 39 years old or old aged 58 to 67 years old) and to their gender (women or men). For each video, participants were asked to rate in two distinct steps their person’s perceived pain and the help they would like to give this person by indicating the time required to treat the pain. Depending on the amount of help provided, participants were asked to wait longer before the next video (represented on the screen by a time gauge) and were informed that the treatment cost would be higher to provide care. After the experimental task, participants completed two questionnaires regarding their level of empathy (i.e., ability to understand and feel others’ emotions) and social desirability (i.e., tendency to present themselves favorably).
Main findings
Results show that at equivalents levels of expressed pain, older and male individuals are perceived as having more pain and are given more help than younger and female individuals, regardless of the age and gender of the observers. Indeed, older people may be perceived as more vulnerable and in need of more medical care than younger people. In addition, it is often reported than women show a greater pain sensibility and a greater risk of chronic pain, while men are less likely to express their pain. Thus, considering these biases, the same level of expressed pain could be perceived as being higher in men than in women. In sum, pain assessment and help provided to a person expressing pain seem to be influenced by the person’s age and gender, rather than by the observers’ characteristics. However, younger observers with high levels of social desirability rated older adults as having more pain than younger adults. Part of the age bias could be explained by the fact that some people tend to respond according to what they feel it is expected by the research team or society in general, rather than their own interpretation.
Take home message
For the same level of expressed pain, caregivers might perceive more pain and might provide more care to older adults and men, compared to younger adults and women. In addition, a caregiver who is more likely to conform to social norms would be more likely to reinforce this favorable bias with older. Thus, caregivers should be trained to be aware of these trends and avoid the risks of over- or under-treat pain in more vulnerable and marginalized health groups.
