Overview of Pain Management in Older Persons

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The purpose of this article is to situate the social and demographic context of pain management in older adults. It summarizes representative literature on the age and sex composition of pain among older adults and considers sources of assessment bias that likely lead to the conflicting descriptions of prevalence. It also describes treatment options that are both available and acceptable to older adults.

Section snippets

Who is at risk now and in the future?: aging in the United States

Based on short-form data from Census 2000, the 65-and-older population comprised 35 million people, representing 12.4% of the 281.4 million people enumerated on April 1, 2000. Within this group, 18.5 million people, representing 53% of the elderly were in the age group 65 to 74; 12.3 million (35%) were aged 75 to 84, and 4.2 million (12%) were aged 85 and over.1

Disability in older ages

In 2000, 42% of the population 65 and over reported some type of long-lasting condition or disability. The Census 2000 asked about various sensory, physical, and mental disabilities, and disabilities causing difficulty giving self-care and difficulty going outside the home.2 Disability in each category is much higher among the elderly than in the total population, and

Prevalence of pain in older adults

Research on the prevalence of pain in adult populations is in agreement that pain is a common and important deterrent to quality of life in older people. It is important to recognize, however, that that is apparently where agreement ends. The context of this article is one in which prior research shows little consensus concerning the level, population composition, and age trajectory of pain.

In establishing the background and significance for guidelines for managing persistent pain in older

Overview of impact of pain in older adults

Research has shown that the effect of pain may be multimodal, affecting quality of life far beyond the local region of injury. Some have proposed that the number of sites of pain may be more important than the precise location [32]. Although this insight is undoubtedly of great significance, there is another reason to think beyond regional pain conditions. The comorbidity of pain and psychologic distress is well-documented. The feeling of loneliness is the single most important predictor of

The problem of pain assessment

It is clear that the basic facts about pain prevalence still need to be settled. Prior research is tainted by the lack of statistical power because of small sample size, inconsistencies in fundamental definitions and measurement, and sample selection biases. The effects of survey design and content on the understanding of the health and functioning of older person now are understood [51], [52]. Corder and Manton provide an excellent review of the analytic issues in studying morbidity of the

Overview of pain management in older adults

If one sets aside the possibility that prevalence could be too low to constitute a management issue, uncovering the direction and magnitude of change is a necessary prerequisite to management. For example, if prevalence truly decreases at older ages, then it is productive to determine whether that change is a function of change in nociceptive pathways or whether the elderly deemphasize or misattribute pain because of the aging process and accruement of significant life events such as death of a

Summary

The most recent United States censuses and population projections show that America's elderly are growing in number and diversity. This takes on added importance, because most models of prevalence of pain embrace the notion of age-related change. Citing Andersson and colleagues [26], Jones and Macfarlane [32] discuss four such models. The first holds that pain increases with age and then decreases at older ages (ie, ages 70 and beyond). They suppose that this pain typically has a mechanical

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