Download Global Day Launch Powerpoint

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