Global Year Against Pain in Older Persons

Global Year Against Pain in Older Persons 12 September 2006 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 Proportion of population > 65 years old 30 25 20 % 15 10 5 0 1996 World 2006 More developed countries 2025 Less developed countries 2050 Source: U.S. Census Bureau, International Programs Center, International Data Base Shift in the age distribution of the world’s population • Over-80 age group will more than triple Proportion of population > 80 years old 30 25 20 % 15 10 5 0 1996 World 2006 More developed countries 2025 Less developed countries 2050 Source: U.S. Census Bureau, International Programs Center, International Data Base Pain is a very common problem for 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 Pain is a very common problem for 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 – Neuropathic • Peripheral neuropathy (diabetes, alcohol, vitamin deficiency, …) • Postherpetic neuralgia • Post-stroke – Cancer Pain has several detrimental effects in older persons • Physical / functional – – – – – sleep disruption appetite disturbance weight loss cognitive impairment limitations in performance of daily activities • Psychosocial – – – – depression suicide risk anxiety social isolation • Global –  quality of life – poorer health status –  use health care services 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 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 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 - pain impacts - utilization of coping strategies - beliefs and attitudes toward pain - other medical illnesses - cognitive functions - functional status - social situation and support 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 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