Pain in Older Persons: Global Trends, Impacts, and Treatment

1. Global Year Against Pain in Older Persons 12 September 2006

2. Shift in the age distribution of the world’s population • Proportion of world’s population over 65 years old will rise from 7.4% to 16.4% by 2050 Source: U.S. Census Bureau, International Programs Center, International Data Base

3. Shift in the age distribution of the world’s population • Over-80 age group will more than triple Source: U.S. Census Bureau, International Programs Center, International Data Base

4. Pain is a very common problemfor older persons • Most frequently reported symptom • > 50% of community-dwelling • > 80% of nursing home residents • 19% of older persons admitted to the hospital have moderately or extremely severe pain • Cancer is the second leading cause of death over 65 years old

5. Pain is a very common problemfor older persons • Pain in older persons tends to be • Constant • Moderate to severe intensity • Lasting for several years • Multifocal • Multifactorial • Examples of chronic pain conditions • Musculoskeletal • Osteoarthritis • Spinal canal stenosis • Fibromyalgia • Cancer • Neuropathic • Peripheral neuropathy (diabetes, alcohol, vitamin deficiency, …) • Postherpetic neuralgia • Post-stroke

6. Pain has several detrimental effects in older persons • Physical / functional • sleep disruption • appetite disturbance • weight loss • cognitive impairment • limitations in performance of daily activities • Global •  quality of life • poorer health status •  use health care services • Psychosocial • depression • suicide risk • anxiety • social isolation

7. Pain is undertreated in older persons •  likelihood of atypical pain presentations • Under-report of pain • Misinterpretation of physical sensations • Difficulty using standard pain assessment scales • False beliefs about pain and its management • Lack of scientific evidence to support treatment approaches

8. Pain is undertreated in older persons • Underrepresented in multidisciplinary pain management clinics • Often suffer from multiple medical and nutritional problems, and take several different medications  treatment with analgesics limited due to  risk of adverse effects and problems with complex drug interactions • Older persons with dementia or communication problems are even more at risk

9. Pain can be treated in older persons • On initial presentation or admission of any older person to any healthcare service, a healthcare professional should assess the patient for evidence of persistent pain • Any persistent pain that has an impact on physical function, psychosocial function, or other aspects of quality of life should be recognized as a significant problem (American Geriatrics Society, 2002) • Evaluation requires multifaceted and comprehensive assessment - pain characteristics - other medical illnesses - pain impacts - cognitive functions - utilization of coping strategies - functional status - beliefs and attitudes toward pain - social situation and support

10. Pain can be treated in older persons • Pain is better managed with combination of - medications - educational programs - physical therapy - social interventions - psychological methods - complementary therapies • Multidisciplinary pain programs have demonstrated efficacy for management of pain in older persons, if they are adapted to their specific needs • Older person and his/her family must be involved in every step of the pain management plan • Effective treatment of pain in older persons requires expertise in pain medicine combined with advanced knowledge of older persons medical and psychosocial characteristics

11. URGENT NEED • Better professional education programs • Further dedicated research to help guide clinical practice • Better pain management strategies that specifically target the special needs of older persons