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Pain Management in Elderly

San Diego Pain Management mirrors the pain management problems in the rest of the country. It has been estimated that pain occurs in from 45 percent to 85 percent of the geriatric population. Much of it is undertreated.

Pain in elderly patients is not always assessed properly, and may be underreported.

According to two reports in “Rx Consultant” and “Journal of Pain and Palliative Care Pharmacotherapy,” 30% of people with moderate pain and more than 50% of those with severe chronic pain are not receiving adequate therapy.

Kathryn Hahn, pharmacist and affiliate faculty member at Oregon State University and the Chair of the Oregon Pain Management Commission says, “Many people suffer needlessly with pain that could be treated.” She goes on to say “it’s worse with the elderly and Medicare patients.”

Senior citizens are undertreated for pain far more often than younger patients.

According to various studies, 40% to 80% of elderly nursing home residents suffer needlessly due to inadequate pain treatment.  (Roberto Bernabei, MD et al., JAMA 1998; 279(23); Cancer Pain Release, World Health Organization; Facts on Dying, Brown University).

Undertreated pain leads to other problems, including reduced quality of life, decreased socialization, depression, sleep disturbances, cognitive impairment, and malnutrition. For a population already vulnerable because of aging, the costs incurred by more frequent physician visits and hospitalizations can be financially devastating.

 

Health professionals have a moral imperative to help elderly people in pain.

The management of pain in geriatric patients can be complicated by the changing physiology that occurs with aging. Older people are also more likely to be living with multiple chronic diseases, necessitating many daily medications, thereby increasing the risk of negative drug-disease and drug-drug interactions. Older patients often show atypical presentations of pain. Depression can also play a role in the assessment and treatment of pain. For a number of reasons, many older people choose not to report their pain. Often they are afraid that they will be involuntarily hospitalised or subjected to invasive procedures if they report pain.

Older people are often misinformed about the aging process, analgesics, pain management, and opioid addiction. Too frequently, elderly patients do not report their pain because they fear retaliation, the possibility of addiction, or loss of respect. They may be stoical or believe that pain is a natural part of aging.

They are not the only ones misinformed about pain management. Some health care professionals erroneously believe that the elderly are less sensitive to pain, or give weak doses of pain medications for fear that older patients will not tolerate opiods. They may equate pain management with addiction and fear problems with the state Medical Board (Sopie Colleau, Cancer Pain Release Vol 13. No. 2 (2001)

Geriatric Care Managers and elder care advocates of all kinds need to be especially committed to San Diego Pain Management through the education of health professionals as well as the general public. It is helpful to refer to the WHO Ladder which was developed in 1985 as a set of guidelines for managing cancer pain and it has since been adopted for use in the elderly population.

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