Managing Pain in the Elderly Population: Pearls and Pitfalls

Chai, Emily; Horton, Jay R.

doi:10.1007/s11916-010-0148-0

Cited by 34 publications

(50 citation statements)

References 18 publications

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“…Numerical rating scales and verbal descriptor scales have been used successfully in cognitively intact elderly patients, whereas visual analog scales may lead to frequent unscorable responses with the elderly. 46 In patients with mild to moderate dementia, the 0 to 10 pain assessment scale and the verbal descriptor scale have been found to have adequate, but not perfect, reliability and validity. 47 In patients with severe dementia, pain assessment may be performed with one of several pain assessment tools available for seniors with limited verbal communication secondary to the presence of dementia.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

A Guide to Improving the Care of Patients With Fragility Fractures

Bukata

DiGiovanni

Friedman

et al. 2011

Geriatr Orthop Surg Rehabil

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ForewordFragility fractures, low-energy injuries that occur from a fall from a standing or lower height, represent a serious public health problem. After age 50, the lifetime risk of having a fragility fracture is 33% for an American woman and 20% for a man. 1 In the United States, 2.1 million people will suffer a fragility fracture each year.1 The incidence of fragility fractures increases steeply after age 65.2 Osteoporosis is present in most patients with a fragility fracture.Hip fractures are the most serious in terms of cost and morbidity. The average cost of inpatient care for a hip fracture in 2005 was $33 962.3 The lifetime risk of having a hip fracture is 6% for men and 17.5% for women. Although the mortality risk after a hip fracture is much higher for a man, a woman's risk of dying from a hip fracture is high and exceeds the lifetime risk of death from breast cancer, uterine cancer, and ovarian cancer combined. For those who survive after a hip fracture, most do not regain their preinjury level of function, and 30% lose their independence. This loss of independence is greatly feared by patients and is very costly to patients and society.Although a hip fracture may have the most serious consequences, other bones, such as the wrist, shoulder, ankle, pelvis, and spine, frequently fracture in the osteoporotic patient. For example, the lifetime risk of a forearm or vertebral compression fracture is 16% and 15.6%, respectively, for a woman and 2.5% and 5%, respectively, for a man. 4 These statistics clearly show that fragility fractures are a major problem facing American society today, 5 and the care of such fractures presents an even greater challenge, in part because the quality of care delivered in the United States varies widely, even within one region. Many such fractures are treated in an outpatient setting, although some may be treated in the inpatient hospital setting. However, the quality of care for seniors with fragility fractures receives relatively little attention. In 2004, the United States Surgeon General issued a comprehensive report calling for health professionals to make significant improvements in our nation's bone health, and an improvement in the system and methods of care was suggested. 5There has been little written on the subject of improving the system of care delivery in the United States.The goals of this blue book are to review the methods used in inpatient and outpatient care, as well as rehabilitation of the patient with a fragility fracture. We discuss evidence-based best care models and, where evidence is lacking, present expert opinions in an effort to improve the standard and the quality of care for the patient with a fragility fracture. We hope that this monograph will provide guidance to physicians, nurses, rehabilitation therapists, other health care providers, and administrators.Stephen L. Kates, MD Editor-in-Chief Simon C. Mears, MD, PhD

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Section: Postoperative Considerationsmentioning

confidence: 99%

A Guide to Improving the Care of Patients With Fragility Fractures

Bukata

DiGiovanni

Friedman

et al. 2011

Geriatr Orthop Surg Rehabil

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“…Según las guías actuales, el tratamiento con opioides debe iniciarse en la dosis más baja posible, aumentarse con lentitud y adaptarse meticulosamente en función de la respuesta y la tolerabilidad del paciente (3,4).…”

Section: Discussionunclassified

“…Las dudas relativas a la posible relación causal de los opioides en el deterioro cognitivo también contribuyen a la reticencia a prescribir estos fármacos. Los AA inducidos por los opioides que se notifican con más frecuencia son el estreñimiento, la sedación, la depresión respiratoria, las náuseas y vómitos y el delirium (3). A diferencia de la mayoría de los AA, que se resuelven con el uso prolongado de opioides debido al desarrollo de tolerancia, el estreñimiento es persistente y es una causa frecuente de reducción de la dosis o abandono del tratamiento (5).…”

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Eficacia y tolerabilidad de dosis bajas de oxicodona/naloxona de liberación prolongada para el dolor crónico no oncológico en pacientes ancianos con y sin deterioro cognitivo

Montero¹,

Curado²

2016

Rev. Soc. Esp. Dolor.

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“…The guidelines in Table 1 are for treating chronic pain, the focus of this article, but there are guidelines not listed here for acute/postsurgery pain, cancer pain, and endof-life pain, each of which has separate treatment approaches. There also are additional considerations when treating specific populations, including elderly or frail patients [11], patients with mental illness and substance use histories [12], and those with specific common pain conditions [13, 14••].…”

Section: Existing Treatment Guidelinesmentioning

confidence: 99%

Opioid Use in Primary Care: Asking the Right Questions

Lewis

Trafton²

2011

Curr Pain Headache Rep

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Pain is one of the most common reasons that patients seek treatment from health care professionals, often their primary care providers. One tool for treating pain is opioid therapy, and opioid prescriptions have increased dramatically in recent years in the United States. This article will review recent research about opioids that is most relevant to treating chronic pain in the context of a typical primary care practice. It will focus on four key practices that providers can engage in before and during the course of opioid therapy that we believe will enhance the likelihood that opioids, when used, are an effective tool for pain management: avoiding sole reliance on opioids; using adequate opioid doses to address pain; mitigating the risk of opioid misuse by patients; and fostering collaborative relationships for treating complex patients.

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Managing Pain in the Elderly Population: Pearls and Pitfalls

Cited by 34 publications

References 18 publications

A Guide to Improving the Care of Patients With Fragility Fractures

A Guide to Improving the Care of Patients With Fragility Fractures

Eficacia y tolerabilidad de dosis bajas de oxicodona/naloxona de liberación prolongada para el dolor crónico no oncológico en pacientes ancianos con y sin deterioro cognitivo

Opioid Use in Primary Care: Asking the Right Questions

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