Pain assessment in the elderly

Admissions to hospital for patients aged over 65 years are three times higher than for younger patients for all medical and surgical wards. Older people are often excluded from trials on pain assessment and treatment because of cognitive or sensory impairments. Professionals tend to underestimate pain needs, under-prescribe and under-medicate in general and in older people in particular. Where studies have included older people, the benefit of treatment is similar regardless of age. The first step in managing acute pain is through its assessment. Although pain is a subjective experience, pain rating scales are valid and reliable when used appropriately. Older people demonstrate some differences in reporting pain that may be attributable to a range of factors including biology, culture, religion, ethnicity, cognitive impairment, organisation or social context. Attitudinal barriers are also relevant because these include a persistent belief that older people experience less pain than other age groups. Not surprisingly, older people themselves might believe that pain is something to be endured, strong analgesics lead to addiction, complaining about pain is a sign of personal weakness and pain is an inevitable part of aging. Undertreatment of pain can lead to the development of chronic pain syndromes that can prove difficult to treat and adversely affect long-term quality of life. Effective treatment is paramount because of the increased morbidity and mortality associated with undertreated pain.