Transcript Document
Global Year Against Pain in Older Persons 12 September 2006 Shift in the age distribution of the world’s population • Proportion of world’s population over 65 years old will rise from 7.4% to 16.4% by 2050 Proportion of population > 65 years old 30 25 20 % 15 10 5 0 1996 2006 World More developed countries 2025 2050 Less developed countries Source: U.S. Census Bureau, International Programs Center, International Data Base Shift in the age distribution of the world’s population • Over-80 age group will more than triple Proportion of population > 80 years old 30 25 20 % 15 10 5 0 1996 2006 World More developed countries 2025 2050 Less developed countries Source: U.S. Census Bureau, International Programs Center, International Data Base Pain is a very common problem for older persons • Most frequently reported symptom – > 50% of community-dwelling – > 80% of nursing home residents • 19% of older persons admitted to the hospital have moderately or extremely severe pain • Cancer is the second leading cause of death over 65 years old Pain is a very common problem for older persons • Pain in older persons tends to be – – – – – Constant Moderate to severe intensity Lasting for several years Multifocal Multifactorial • Examples of chronic pain conditions – Musculoskeletal • Osteoarthritis • Spinal canal stenosis • Fibromyalgia – Cancer – Neuropathic • Peripheral neuropathy (diabetes, alcohol, vitamin deficiency, …) • Postherpetic neuralgia • Post-stroke Pain has several detrimental effects in older persons • Physical / functional – – – – – sleep disruption appetite disturbance weight loss cognitive impairment limitations in performance of daily activities • Global – quality of life – poorer health status – use health care services • Psychosocial – – – – depression suicide risk anxiety social isolation Pain is undertreated in older persons • likelihood of atypical pain presentations • Under-report of pain – Misinterpretation of physical sensations – Difficulty using standard pain assessment scales – False beliefs about pain and its management • Lack of scientific evidence to support treatment approaches Pain is undertreated in older persons • Underrepresented in multidisciplinary pain management clinics • Often suffer from multiple medical and nutritional problems, and take several different medications treatment with analgesics limited due to risk of adverse effects and problems with complex drug interactions • Older persons with dementia or communication problems are even more at risk Pain can be treated in older persons • On initial presentation or admission of any older person to any healthcare service, a healthcare professional should assess the patient for evidence of persistent pain • Any persistent pain that has an impact on physical function, psychosocial function, or other aspects of quality of life should be recognized as a significant problem (American Geriatrics Society, 2002) • Evaluation requires multifaceted and comprehensive assessment - pain characteristics - pain impacts - utilization of coping strategies - beliefs and attitudes toward pain - other medical illnesses - cognitive functions - functional status - social situation and support Pain can be treated in older persons • Pain is better managed with combination of - medications - educational programs - physical therapy - social interventions - psychological methods - complementary therapies • Multidisciplinary pain programs have demonstrated efficacy for management of pain in older persons, if they are adapted to their specific needs • Older person and his/her family must be involved in every step of the pain management plan • Effective treatment of pain in older persons requires expertise in pain medicine combined with advanced knowledge of older persons medical and psychosocial characteristics URGENT NEED • Better professional education programs • Further dedicated research to help guide clinical practice • Better pain management strategies that specifically target the special needs of older persons