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INTRODUCTION

Elderly men and women represent the fastest-growing segment of the population. In the United States, the number of people aged 65 and older is projected to grow to almost 80 million by 2040. Chronic pain is a growing problem in this increasingly aging population, as the incidence and prevalence of pain increase with age. It is estimated that up to 50% of older adults living in the community and 80% of elderly living in long-term care facilities experience chronic pain.1

Pain in the elderly is undertreated as a result of inadequate recognition, assessment, and management. Presentation of pain is often atypical, complex, and multifactorial. Pain often remains undetected, as the elderly often underreport symptoms or caretakers fail to adequately assess or recognize signs of pain.1,2 Cognitive decline and communication difficulties further complicate proper assessment.3 Management of pain is complicated by the lack of geriatric pain education for providers and reluctance to use potentially addictive medications. Multiple studies confirm undertreatment of pain in nursing homes and the community.4

Uncontrolled pain can result in significant physical and social consequences. Persistent pain may lead to functional loss, including impaired mobility and activities of daily living (ADLs), and generally reduced quality of life. Elderly with untreated pain may have exacerbation of cognitive impairment, mental health issues such as depression and anxiety, sleep disturbance, and social withdrawal.5,6 Inadequately controlled pain has significant socioeconomic consequences, including increased utilization of health care resources and financial costs, that will surely increase as this population segment continues to grow. Despite these difficulties, pain in the elderly is better managed through physician education, comprehensive multidisciplinary assessment, and the use of proper pharmacologic and nonpharmacologic management strategies.

DIFFERENCE IN EXPERIENCING PAIN WITH AGE

Many elderly individuals experience pain with their ADLs.7 Older individuals may experience more pain with age because they are undertreated; patients who appear frail or have several comorbidities have been shown to receive inadequate medication. Reasons for this include unfamiliarity with treating this population and with medication side effect profiles. Another contributing factor is the poor recognition of pain by pain screening tools or scales. The visual analog scale (VAS) has been reported to be less accurate in geriatric patient screening.8 Other tests have been shown to be inconsistent as well. Measuring intensity of chronic arthritic pain can give conflicting results regarding age differences on several one-dimensional scales, depending on the screening test.8

Pain complaints in the older population are more likely to be due to an underlying problem (i.e., malignancy, progressive spinal stenosis) as opposed to an acute issue. A caregiver may easily overlook a complaint as a “chronic issue” and not investigate any further. The patient may also attribute their daily pain to old age and accept it as a regular part of aging and not seek any pain-alleviating interventions. ...

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