Epidemiology of Pain in Older Persons

The literature suggests a dichotomy between acute and chronic pain states in the elderly. There is a high prevalence of atypical, less frequent, and even absent pain symptoms in acute and life-threatening conditions, where as the prevalence of chronic pain is usually higher in older segments of the population for most health conditions.

About 20% to 30% of community-dwelling elderly and 40% up to 80% of institutionalized individuals suffer from chronic pain. Chronic pain in older persons seems to increase up to, but not beyond, the seventh decade of life. In most studies chronic pain in older persons is more often experienced in major joints, the back, legs and feet, whereas visceral pain and headache are reported less often. Knee pain and back pain are the most prevalent musculoskeletal pain conditions in persons aged 75 years or older. The prevalence of cancer rises with advancing age, and pain is present in 80% of elders with advanced cancer but cancer pain symptoms decrease in intensity with age. Only 30% to 40% of those suffering joint or back pain that impair daily functioning are prescribed an analgesic drug for regular use. Chronic pain in the elderly is associated with depression and sleep disturbances and reduces activities of daily living.

The literature on pain epidemiology in older persons, particularly those of advanced age to oldest old, is scarce and results vary between studies and are often inconsistent, possibly due to different target populations, different case definitions, and invalid pain assessment tools for demented people, and/or low response rates. While the prevalence of pain may be high in elders, the prevalence of treated pain in elders is shockingly low. Reasons for this undertreatment may be lack of training in the assessment and management of geriatric pain, nihilistic attitudes of some health professionals, numerous myths concerning pain in older people, and/or financial restraints. In acute conditions age may blunt the protective and warning mechanism of pain, suggesting a need of patience of the medical team in order to reach at a correct diagnosis.

References:

Helme, RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001; 17: 417–31.

Urwin, M., Symmons, D., Allison, T., Brammah, T., Busby, H., Roxby, M., Simmons, A., Williams, G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 57:649–55.

Pitkala KH, Strandberg TE, Tilvis RS. Management of nonmalignant pain in home-dwelling older people: a population-based survey. J Am Geriatr Soc. 2002; 50:1861–5.