Opiates are indicated for management of both acute and chronic pain, as well as for the different classes of pain such as nociceptive and neuropathic pain. According to the World Health Organization palliative pain management ladder, patients with moderate to severe pain should receive opioid analgesics as the mainstay of treatment ( WHO 2006). Many geriatricians provide care to elderly patients as part of a palliative care treatment plan. It is important for those clinicians who provide care for elderly to have training in the recognition of pain and the subtle behaviors associated with those patients who may be in pain but are unable to communicate. ![]() ![]() Other common problems that should be taken into consideration when caring for older adults include polypharmacy, multiple comorbities, and the potential of more side effects or treatment failures ( Linnebur et al 2005). This can be very challenging due to the alterations in opiate pharmacokinetics which occur with normal physiologic aging. It is important to assess for pain, evaluate, treat, and recognize side effects that may be associated with the pharmacologic management of pain in older adults. The American Geriatrics Society (AGS) panel on persistent pain in older persons states that up-to 80% of long-term care residents have substantial pain ( AGS 2002), and 25% of those received neither analgesic medication nor nonpharmacological treatment for their pain ( Won et al 2004). Studies report the prevalence of pain in community-dwelling elderly at 25%–50% and for nursing home residents as high as 70% ( Ferrell 2003). The care of older adults can occur in varied settings ranging from independent living to long term care and palliative care. ![]() The prevalence of pain in older adults is high.
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