IASP promotes the Global Day and Global Year Against Pain to raise awareness of timely aspects of pain worldwide. The focus in 2006-07 was on Pain in Older Persons. During the year, IASP members, chapters and other health care professions organized various presentations and events with the aim to improve and understand mechanisms of pain in older persons, to improve pain relief in older persons, and to distribute information about pain in the elderly.
Why focus on pain in older persons?
The number of elderly people is increasing dramatically, both in the developing and the developed world. Thus, by 2050, the proportion of people over the age of 65 will increase from 17.5% to 36.3% in the developed countries, and those older than 80 years will increase threefold.
Health-related issues are often neglected in this group of people. Within recent years we have obtained new information about the prevalence of pain in the adult population, including the elderly. With about 20% of adults suffering from chronic pain, it is a substantial proportion of elderly patients who have this problem. We know that sensitivity to pain may be reduced in older adults, yet that does not mean that these people experience less pain. In the elderly, it is important to know that age-associated psychosocial phenomena, such as loss of family and friends and loss of independence, may contribute to pain and suffering. It is important to inform the public that other symptoms such as depression and anxiety, sleep disturbances, weight loss and cognitive impairment may be related to pain, and even be a manifestation of pain in older persons. Pain is not only a verbal report, but pain behaviors such as guarding, agitation, facial expression and altered mobility could represent pain, for example, in Alzheimer’s disease.
The management of pain in older persons represents a particular challenge. Pain in many elderly patients is under treated. We know little about the pain manifestations in dementia, but it is often under treated and a proactive approach in treating these patients is often necessary. Pharmacological treatment of pain is particularly important. Many elderly patients tolerate analgesics such as opioids, anti-inflammatory drugs and adjunctive agents like tricyclic antidepressants less well than younger people. The result is often sedation and confusion. It is therefore important to recognize that there are other treatments than pharmacology available for this group of patients. For example, multidisciplinary pain programs combining pharmacological and non-pharmacological treatment are efficacious in the management of longstanding pain in older persons.
Our current knowledge of pain in older persons is incomplete and there is a need for increased research, better educational programs and dissemination of new knowledge about pain in the elderly. Since the elderly represent a fragile and large group of the population both in the developed and developing world, we need to pay close attention to pain. While a world without pain may be an unobtainable goal, we could - and should - all work together for pain relief throughout the world.
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