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Global Year Against Pain in Older Persons

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					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


				
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