Gaps in Clinical Data, Physician Education Thwart Progress in Geriatric Pain Management

MAY 06, 2013
Katie Eder
According to the Administration on Aging, patients older than 65 are expected to account for approximately 19 percent of the U.S. population by 2030, compared to 12.9 percent today. But guidelines and research on treating those patients for non-cancer pain won’t keep up with that population growth until the barriers to pharmacological pain management in older adults are removed — a topic discussed at length by the American Pain Society’s geriatric special interest group at its annual scientific meeting in New Orleans.
 
Data presented by Keela Herr, PhD, RN, FAAN, AGSF, co-chair of that special interest group and co-director of the John A. Hartford Center for Geriatric Nursing Excellence at the University of Iowa College of Nursing, shows a significant portion of older patients receive either no treatment or inadequate treatment for their pain across care settings. In nursing homes, 51 percent of geriatric patients with intact cognition suffer from pain, but 20 percent don’t receive treatment. The situation is worse in hospitals, where 67 percent of older patients report pain, but 51 percent aren’t treated or get inadequate care for the intensity of their symptoms. The mean pain intensity for the elderly in emergency departments is 7 out of 10, but no analgesics are ordered for 40 percent of those patients.
 
Herr said a number of patient, provider, and government issues prevent better pharmacologic pain management in older adults experiencing non-cancer persistent pain, and barriers such as multi-drug regimens, comorbidities, and side effects are deterring physicians from prescribing analgesics. However, Herr noted the gap in provider knowledge of geriatric pain management — including the lack of education on the benefits and risks of treatment plans — remains the greatest challenge, and with the majority of opioid studies excluding older adults as subjects, physicians are stuck with a slim amount of evidence-based analgesic treatment choices for the growing geriatric patient population.


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