This Page Intentionally Left Blank - Int Medical

patients, safe and effective geriatric pain care requires that the acute care
provider maintains vigilance with regard to a variety of patient factors.
Equally important is provider awareness of and avoidance of biases and
legends, which produce poor pain care in the elderly.
n Oligoanalgesia
Despite the fact that they experience acute and chronic pain as frequently as
younger patients, older adults often receive significantly less analgesia for
comparable conditions. 2 The disparity may be secondary to patients’ medical
complexities and the related fear of drug complications. Another potential
cause of oligoanalgesia is underreporting of pain levels to providers. Older
adults may have cognitive impairment, or they may be reticent (owing to selfdoubt)
to describe sensations as painful. Even when pain sensation is conveyed
to providers, discomfort of medical staff and misguided beliefs about
older adults’ pain treatment can lead to inadequate treatment. 3,4
Geriatric oligoanalgesia is well known to occur in the acute care setting,
and the problem has serious ramifications. 2,5 Just as effective pain management
improves patient outcomes and reduces length of stay and resource
use, untreated pain prolongs functional impairment and increases risk of
delirium. 6–9
n Decreased physiologic reserve:
pharmacological implications
Geriatric analgesia 43
Aging changes the physiology of drug absorption, distribution, metabolism,
and elimination. 1 Age-associated physiologic changes vary from patient to
patient, in both degree and directionality (e.g. increased or decreased sensitivity).
Even the directionality of some effects (e.g. increased or decreased
drug sensitivity) may differ, both between patients and within an individual
(i.e. varying effects at different receptor sites).
As adults pass their third decade, progressive loss of organ system functional
reserve alters both pharmacokinetics (drug distribution and elimination)
and pharmacodynamics (i.e. drug action at receptor sites). 10 These