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Geriatric analgesia
ULA HWANG AND ANDY JAGODA
n Topics
n Oligoanalgesia
n Loss of physiologic reserve
n Polypharmacy and adverse drug events
n Beers criteria
n Acetaminophen, NSAIDS, and opioids
n Introduction
Analgesia care in geriatric patients requires consideration of several agespecific
aspects of pain assessment and treatment. Perhaps most importantly,
the elderly tend to have a more complex medical history and much
comorbidity compared with younger adults. There is, therefore, higher
potential for analgesia complications, as well as polypharmacy-related untoward
drug effects. Older patients may suffer from physical and cognitive
impairments that add to the challenge of pain evaluation and management.
Some of the challenges of geriatric pain assessment, as well as recommended
tools for pain evaluation in the elderly, are outlined in this chapter on pain
assessment.
In geriatrics, some analgesic therapies have disease-specific utility (e.g.
calcitonin for vertebral compression fractures) or particular concerns (e.g.
triptans). Use of these agents is addressed in relevant chapters of this text.
This chapter focuses more upon general principles of pain relief in older
patients.
The well-recognized increased risk of adverse drug reactions in older
adults has not been shown to be associated with age itself but is related
rather to characteristics prevalent in older adults: polypharmacy, comorbidities,
higher illness acuity, smaller body size, and changes in hepatorenal
drug handling. 1 Regardless of the root cause of analgesia’s risk in older