PAIN IN ELDERLY HAS BEEN OFTEN UNDERESTIMATED

Abstract

The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments. Aging is an inevitable component of life. However, there is no overall accepted definition about an elderly individual. One could be determined as old by physical characteristics, e.g. white or gray hair, changes in social activities, having grandchildren, by changes in occupational status (e.g. being retired) by biological characteristics - e.g. age, etc. An adequate definition should probably contain maximum characteristics of such kind. In this context, it could be assumed that the physiological age can have a more significant impact than the biological one. In the last decades, the age range of all societies has changed to a sustained increase towards older population. According to reliable demographic and sociological calculations, the segment of individuals over the age of 65 in industrial societies will increase from 17.5% in 2000 to 36.3% in 2050 [1]. Retrospective studies performed in the period between years 1983-2003, established that the US population over the age of 65 has increased from 11.7% to 12.4%, and the proportion of individuals over 80 increased from 2.4% to 3.5%. The prognosis is that in 2045 the proportion of these age groups will be 20%, and 7.2% respectively [2]. Within the global population, the proportion of the individuals over 65 increased from 6.9% in 2000 to 7.7% in 2009, and in 2050 will reach 16.7%. The proportion of population aged over 80 is dramatically increasing from 1.2% in 2000 to 1.5% in 2009, and in 2050 will increase more, up to 4.9%. These changes are mainly due to the increased life expectancy, which in 2020 for women will be 80.4 years and for men - 79.5 years [3]. There is a dissonance though between these facts and the data that the raised life expectancy does not actually correlate with wholesome living throughout these years [4]. There is an increased complex co-morbidity in the aging population, among which pain of different variety is a frequent symptom. Epidemiological studies indicate that 40-75% of adult individuals complain of chronic pain of various etiology and pathogenesis, with the largest group composed of elderly women [5]. The prolonged pain is most often a consequence of chronic musculoskeletal disorders, osteoporosis with fractures or fissures, metabolic and neuro-degenerative diseases with neuropathic symptoms, etc. The pharmacotherapy of pain syndromes in adults should be consistent with number of factors complicating the application of conventional analgesic approaches. Adult individuals have reduced nociceptive capabilities, i.e. feel less pain, but tolerate strong and continuous pain syndromes more difficult. They suffer with more than one disease, take many medications of different groups, and rarely report alarming symptoms. Their treatment is complicated by the diminished cognitive capacity in many of them or by the neuropathic pain caused by bone or vertebra fractures, diabetes or other chronic diseases. For the evaluation of pain intensity in elderly patients, different approaches should be used - preferably verbal scales with clear definitions, such as: no-pain, weak-, moderate-, middle-, or severe pain on visual, numerical, picture, mimic and other types of scales [1].