Analgesic use in the older person

Abstract

To summarize developments in analgesic use in the older person. Observational studies, reviews and a few randomized trials dealing with analgesic use in the older person have been published during the past year. Recent trials examine also pharmacological/nonpharmacological interventions, and education of older patients as well as clinicians in pain management. Under-treatment of pain remains a major concern in community-dwelling or institutionalized older persons, especially with dementia. An increased awareness of pain and palliative pain management in the older person is present throughout the literature. Age-related factors affect the safety and efficacy of the analgesic treatment and pharmacological aspects are often underlined, especially when impaired cognition and frailty are present. The use of topical analgesics, well tolerated in older persons, allows reduction of concomitant treatments and of adverse events. Optimizing analgesic use in older patients is carried out by exploring motivations and attitudes of the patients, by analysing barriers and practices of clinicians and by setting up structured educational nursing interventions. Although a larger number of older persons are included in studies, prospective and large-scale trials are needed in this vulnerable population characterized by a high variability and heterogeneity.