Pain management in the elderly

Ula Hwang, Timothy Platts-Mills

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

3 Scopus citations


Pitfalls. Undertreatment. It has been repeatedly demonstrated that older adults face disparities in pain care when compared with younger adults. Although older adults have acute and chronic pain as often as if not more than the general population, they frequently receive less treatment and experience less pain relief than younger adults [1–4]. This is particularly true in the emergency department (ED) setting, where oligoanalgesia among older adults has been described based both on high rates of pain at the end of the ED visit and lower rates of treatment for older versus younger adults [5–10]. While increased attention to this issue has resulted in some improvement in pain care documentation and use of analgesics in older adults [11], older adults with acute pain are still less likely to receive treatment than younger patients and still often leave the ED with pain. Unrelieved pain has negative consequences for physiological, functional, and psychological outcomes resulting in an unnecessary burden on patients and the health care system [12]. Pain in older adults interferes with day-to-day functioning as indicated by difficulty or dependence in the ability to perform basic activities of daily living [13,14]. Unrelieved pain can result in impaired gastrointestinal and pulmonary function, nausea and dyspnea, increased metabolic rate (and in the case of cancer, increased tumor growth and metastases), impaired immune response, insomnia, delayed healing, and inability to walk or move about [12,15,16]. Pain has been identified as a risk factor for functional decline and increased dependency in older adults [17]. Psychological changes associated with persistent pain include anxiety and depression [18]. Unrelieved acute pain is associated with poor outcomes during hospitalization and with the development of chronic pain [19,20]. For older adults, it has been shown that unrelieved hip fracture pain is associated with longer hospital length of stay, missed or shortened physical therapy sessions, and delays to ambulation [21)]. Inadequate analgesia for older adults after surgery has been shown to be a risk factor for developing delirium [22,23]. For patients with hip fractures who do not receive adequate analgesia, severe pain increases the risk of delirium greater than ninefold [24].

Original languageEnglish
Title of host publicationGeriatric Emergency Medicine
Subtitle of host publicationPrinciples and Practice
PublisherCambridge University Press
Number of pages8
ISBN (Electronic)9781139250986
ISBN (Print)9781107677647
StatePublished - 1 Jan 2014


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