Pain and Age - The Older Adult

Chronic pain in the elderly is a known problem that is widely accepted. Compared to the rest of the population, the elderly experience more chronic joint problems such as osteoarthritis, rheumatoid arthritis, and osteoporosis that cause painful symptoms. Other chronic health conditions that are more common as we age, such as cancer, Parkinson's disease, poor circulation, and inflammatory disease, also lead to and worsen pain symptoms.

Pain is a common problem in older adults:

• 73% to 80% of the entire elderly population have reported pain symptoms
• 78% of independent, healthy people aged 60 to 69 report chronic pain
• 64% of independent, healthy people aged 80 to 89 report chronic pain
• 25-50% of people who live at home or in a community (i.e., those who do not live in an assisted-living or nursing home) have pain
• 71-83% of patients in assisted living or nursing home facilities report chronic pain that affects their quality of life and interferes with activities of daily living

A leading researcher from Australia, Robert D. Helme, has studied pain in older adults and concluded the following:

• Pain is more prevalent in older adults when compared to younger age groups
• Pain results from degenerative joint disease (e.g., arthritis) and spine disease as well as leg and foot disorders
• Pain reports peak at age 65
• The older age groups – people ages 75 to 84 and 85 and older – report less pain, suggesting that older age is almost protective against chronic pain.

Other researchers have found similar results in older adults. Reasons why pain seems to decline in the very old were given by Lucy Gagliese, a researcher from Canada:

• Decreases may be due to higher death rates in the very old
• Elderly people may be more hesitant or less able to vocalize pain
• Elderly pain studies use varying definitions of chronic pain. For example, some researchers regard arthritis as temporary and do not classify it as a chronic pain condition. This would obviously make pain seem lower in elderly pain studies where arthritis diagnosis is so high.

Disparities

Despite the widespread presence of pain in the elderly, many older adults do not receive treatment for their pain. This surprising disparity is evident in the following statistics:

• 47-80% of older adults in community settings (i.e., living at home) do not receive treatment for pain
• 16-27% of older adults living in institutionalized settings do not receive treatment for pain
• One dementia research study found that 84% of older patients with dementia and suffering from pain do not receive any treatment.

How can these disparities still exist in a population that is very visible and is known to suffer from chronic pain?

• Some researchers think pain assessment in the elderly is inadequate. If pain is not measured correctly, some people in pain will be missed and not given treatment.

• Other researchers have said that elderly patients are less willing or less able to vocalize pain symptoms. This may be because older adults have learned to accept pain as part of aging and believe they have to live with it until they die. If pain is not reported, treatment cannot be given.

• Still other researchers have said that, due to the risks, doctors and other health professionals are less willing to treat pain in older adults with medication, leaving some to suffer without relief.

• Some researchers believe that some health care providers accept that pain is a part of aging. Like older adults in pain, health care providers may believe that their elderly patients are used to the pain and do not need any treatment.

• Finally, it is thought that other pain treatment options that could help the elderly are not known, not used, and not looked upon favorably by older adults, leaving elderly persons in pain without options for treatment.

Treatment Options

A multi-disciplinary approach to treating pain in older adults may be particularly helpful in relieving their pain symptoms. Psychological treatment helps many patients deal with and improve their pain symptoms and coping ability. Since health care professionals may worry about the risk of pain medications, perhaps psychological outlets should be introduced and more widely used to help older adults. Also, some researchers suggest that older adults may be able to take smaller doses of some pain medications rather than one large dose to help their pain.

Misunderstandings still exist regarding pain in older adults. This may be the reason why some elderly patients do not receive proper treatment or even any treatment at all. Pain that is so intense that it interferes with daily living is not normal and should not be accepted as a normal part of aging. Older adults should not be excluded from comprehensive pain management programs as they can benefit from these programs as much as any other age group. For more information about the myths related to pain as you age, read Dr. Debra Weiner's Pain in Older Adults.


Elisa Martinez graduated with a master's degree from Drexel University School of Public Health in Philadelphia, Pa., in May 2006. She is now the project manager for tobacco cessation research at Fox Chase Cancer Center.