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