Challenges to effective pain management in the elderly

What are the challenges to effective pain management in the elderly?

The effective treatment of pain in the elder population is multifactorial, and barriers/challenges exist at many levels from the patients themselves, health care professionals, to the health care system.

Patient Barriers: Many elder patients have the misconception that pain is untreatable and a normal part of aging, and therefore do not seek treatment. In addition, some older individuals whose pain may cause significant limitations avoid treatment, secondary to fear that their independence may be taken from them or that the medications prescribed will cause side effects or addiction. For others, comorbidities such as depression or dementia, sensory impairments such as vision and hearing loss, and memory impairment can make compliance and effective management challenging.

Provider Barriers: Lack of adequate knowledge, training, and education on assessment, diagnoses, and pain medications used in elder individuals may limit many health care professionals from providing optimal care to elderly individuals in chronic pain. Many health care professionals have difficulty assessing patients, given the factors listed previously, while others, untrained in medication management in the elderly, may be in fear of polypharmacy, overdose, adverse reactions, and managing need for dose escalation. Failure to understand the physiologic changes that occur in the elderly that predispose them to increased risk for medication adverse reactions and at lower dosages is the main reason for apprehension among health care providers dealing with elderly individuals suffering from chronic pain.

System Barriers: Lastly, systemic factors also affect access to care and treatment in the elderly. Many older patients have limited access to treatment secondary to health insurance, cost of medications and interventions, and transportation to office visits.


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