Management of Pain in Elderly Patients With Cancer

Abstract

; for the SAGE Study Group Context.-Cancer pain can be relieved with pharmacological agents as indicated by the World Health Organization (WHO). All too frequently pain management is reported to be poor. Objective.-To evaluate the adequacy of pain management in elderly and minority cancer patients admitted to nursing homes. Design.-Retrospective, cross-sectional study. Setting.-A total of 1492 Medicare-certified and/or Medicaid-certified nursing homes in 5 states participating in the Health Care Financing Administration's demonstration project, which evaluated the implementation of the Resident Assessment Instrument and its Minimum Data Set. Study Population.-A group of 13 625 cancer patients aged 65 years and older discharged from the hospital to any of the facilities from 1992 to 1995. Data were from the multilinked Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database. Main Outcome Measures.-Prevalence and predictors of daily pain and of analgesic treatment. Pain assessment was based on patients' report and was completed by a multidisciplinary team of nursing home personnel that observed, over a 7-day period, whether each resident complained or showed evidence of pain daily. Results.-A total of 4003 patients (24%, 29%, and 38% of those aged Ն85 years, 75 to 84 years, and 65 to 74 years, respectively) reported daily pain. Age, gender, race, marital status, physical function, depression, and cognitive status were all independently associated with the presence of pain. Of patients with daily pain, 16% received a WHO level 1 drug, 32% a WHO level 2 drug, and only 26% received morphine. Patients aged 85 years and older were less likely to receive morphine or other strong opiates than those aged 65 to 74 years (13% vs 38%, respectively). More than a quarter of patients (26%) in daily pain did not receive any analgesic agent. Patients older than 85 years in daily pain were also more likely to receive no analgesia (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.13-1.73). Other independent predictors of failing to receive any analgesic agent were minority race (OR, 1.63; 95% CI, 1.18-2.26 for African Americans), low cognitive performance (OR, 1.23; 95% CI, 1.05-1.44), and the number of other medications received (OR, 0.65; 95% CI, 0.5-0.84 for 11 or more medications). Conclusions.-Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients.

Pain in older people with frailty

“…This can result in under-recognition of pain and subsequent inadequate pain treatment management for older patients with cognitive impairments 49 . It has been proposed that older, frailer, and more cognitively impaired people receive the least treatment for pain, even though that population has the greatest need for assistance 50 . Within this review, analgesic consumption appeared to be higher in people with frailty compared to fit older people, although limited data precludes strong conclusions.…”

Pain Management of Elderly in Nursing Homes

“…[35,36] Farklı bir çalışmada analjezik kullanan yaşlı bireylerin %16'sı narkotik olmayan analjezik, %32'si zayıf opioidler, %26'sı morfin veya türevi ilaçlar kullanırken ve %27'sinin adjuvan ilaç kullandığı bulunmuştur. [37] Hwang ve ark. [33] tarafından yapılan çalışmada ise ciddi ağrı olan yaşlı bireylerin %80 oranında opioid kullandığı belirtilmektedir.…”

Pain is prevalent and persisting in cancer survivors: Differential factors across age groups

“…4,11,15,16 It is critical to understand pain in older cancer survivors, as greater than 60% of new cancers occur in people aged 65 and older. 1 However, reports of pain vary widely, between 20 and 85% of older adults following cancer.…”

“…1 However, reports of pain vary widely, between 20 and 85% of older adults following cancer. 4,15,17,18 Our knowledge of the expected prevalence and predictors of pain in cancer survivors is limited by differences in methodology in cancer survivor research (e.g., design, sampling, measurement). 19 A common clinical measure of pain intensity is the Numeric Ratings Scale (NRS) that utilizes a 0-10 scale.…”