Snapshot: Older Adults, Pain and Pain Medications

by Deborah K. Nelson, M.A.

Chronic pain in older adults is considered an individual, social, medical and economic crisis.  It has often been described as epidemic as the percentage of older individuals in our population continues to grow.  Research has shown that half of the elder adults who live independently and three-fourths who live in a care facility suffer from persistent pain (National Pain Foundation, Seniors and Pain, 2010).

Compounding the problem is the fact that physicians are often hesitant to prescribe pain medications for the elderly.  Concurrent illnesses and multiple health problems make pain evaluation in older adults difficult (American Geriatrics Society, 2009) as pain is experienced across physiological, psychological and social domains.  Thus, discriminating which factors are most important for the purpose of treatment can be very challenging.  Furthermore, there are many age-associated differences in drug effectiveness, sensitivity and toxicity as older patients are generally at a higher risk of adverse drug reactions (American Geriatrics Society, 2009).

Physicians, nurses, caregivers and family members have long known that older adults’ pain-related attitudes, experiences and management needs are unique from younger members of society.  Many elderly patients are less willing or less able to vocalize their pain symptoms, often because they have learned to accept pain as part of aging (Martinez, 2010).  Even when they’ve been prescribed pain medications, many older adults are often reluctant to utilize pain medications.

Despite recognition of these complex issues, this topic has been (until just recently), presented as anecdotal information in the chronic pain literature. From my experience working with older adults, and witnessing first hand the significant impact untreated pain had on the lives of seniors, I sought to better understand this phenomenon.  Using my dissertation as the research tool, my goal was to better understand how older adults view their pain medications – in particular, the emotional heuristics older adults use when deciding whether to take their pain medications.

Participants in my study were an ethnically and socioeconomically diverse sample of eleven community-dwelling older adults (ages 63 – 86), all under a physician’s care for moderate to severe persistent pain.  They participated in semi-structured video interviews that focused on their daily pain management strategy, including perceptions and use of their pain medications and use of non-medication approaches.  I used qualitative data analysis to identify key heuristics and created a 30-minute DVD of participants that highlighted major emergent themes.

Results showed that regardless of physician recommendations for how and when to use pain medication, participants crafted highly individual processes for their pain management and use of pain medication.  Emotional heuristics were very much in use, with a chief concern being fear of addiction.  Other key concerns included: side effects and the total pill load consumed each day.  Regardless of their trust in their physician, most participants actively sought out their own information and were consumers of written, broadcast or internet information.  A key determinant of pain management strategy was socioeconomic status, which determined the kinds of complementary interventions that were possible and utilized.

Another significant and confounding issue is that pain and depression are: often comorbid, are prevalent in the older adult population, and they mutually influence each other.  The results of this are profound.  A study of pain among older adults reported that the odds of poor physical functioning were 11.2 times greater among those with comorbid chronic pain and depression than among those experiencing chronic pain alone (Mossey & Gallagher, 2004).

Psychologists have long worked collaboratively with physicians and pain management specialists to help those experiencing pain improve their quality of life. For those interested in working with older adults who are experiencing pain, the key is to evaluate their full day-to-day experience, understand their life goals and create a custom pain management plan.

For further information, please contact Deb Nelson at debnelsonpsyd@gmail.com.

References:

American Geriatrics Society, AGS Panel on the Pharmacological Management of Persistent Pain in Older Persons. (2009).  Pharmacological management of persistent pain in older persons.  Journal of the American Geriatrics Society, 57, 1331-1346.

Martinez, E. (2010). Pain and age: The older adult.  National Pain Foundation. Retrieved from http://www.nationalpainfoundation.org/articles/161/pain-and-age-the-older-adult.

Mossey, J.M., & Gallagher, R.M. (2004). The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents. Pain Medicine, 5(4), 335-348.

National Pain Foundation. (2010).  Seniors and pain.  Retrieved from http://www.nationalpainfoundation.org/articles/244/seniors-and-pain.

# # #

Please visit http://www.marincountypsych.org for more information about our association and membership benefits or to locate a licensed clinical psychologist in Marin County.

# # #

Blog Disclaimer:

The opinions expressed by the authors are their own and do not reflect the opinions of the Marin County Psychological Association. The information posted on this blog is not intended as, and is not, a substitute for professional mental health services.