General Principles in Older Adults
Persistent pain is widely prevalent in older adults and is often underdiagnosed and ineffectively managed. Pain affects more than 50% of older persons living in a community setting and more than 80% of nursing home residents. Pain management disparities are common in older adults for a variety of reasons. Older adults are less likely to report pain owing to (a) a mistaken perception that pain is a normal part of the aging process, (b) not wanting to burden their caregivers, (c) cognitive impairment, and (d) limited health literacy. Even when older adults do report pain, they are less likely to receive opioid analgesics for moderate-to-severe pain and also report lower overall reduction of posttreatment pain scores compared to younger patients. It is also to be noted that any older adults may be reluctant to take opioids as they believe these class of drugs to be too potent, they are concerned about how these drugs may interact with the many other medications they are taking, fear of addiction and dependence, and worries about side effects of feeling “drugged.” Data also show that pain is commonly undertreated in cognitively impaired older adults, who receive less analgesic medication than younger cognitively intact persons. Pain limits functional status in older adults and can result in diminished quality of life, sleep disturbances, social isolation, depression, delirium, and increased health care costs and resource utilization (Table 54–1).
Table 54–1.Consequences of poorly treated persistent pain in older adults. |Favorite Table|Download (.pdf) Table 54–1. Consequences of poorly treated persistent pain in older adults.
Decreased quality of life
Impaired gait (low-back and lower-limb pain)
Impaired appetite, increased weight loss
Associated depression and anxiety
Agitation in cognitively impaired older adults
Relief of suffering and promotion of patient dignity are primary tenets of geriatric medicine. Timely and effective assessment and management of persistent pain in older adults will help in alleviating their suffering, while maintaining and augmenting quality of life.
A transition from acute to chronic pain in older adults is likely influenced by various factors, including lower socioeconomic status, vivid memory of childhood trauma, obesity, low level of physical fitness, overuse of joints and muscles, chronic illnesses, lack of social support, and elder abuse. The term “persistent pain” is often used interchangeably with the term “chronic pain,” and once again denotes pain that persists beyond the expected healing time. Table 54–2 lists other terms commonly used when describing pain.
Table 54–2.Terms commonly used when describing pain. |Favorite Table|Download (.pdf) Table 54–2. Terms commonly used when describing pain.
|Nociceptive pain |
Nociceptive pain is the perception of nociceptive input, usually as a result of tissue damage (eg, postoperative pain).
Nociceptive pain is further subdivided into somatic and visceral pain.