Page 281 Guide to Pain Management in Low-Resource Settings

Chapter 35

Pain in Old Age and Dementia

Andreas Kopf

What is a geriatric patient? the geriatric patient will be a special challenge, since the
percentage of patients with chronic pain (pain lasting
A geriatric patient is a person of advanced biological age more than 6 months) increases continuously from 11%
(the age in years being less important), with multiple to 47% between the ages of 40 to 75 years. Health care
morbidity, possibly multiple medications, psychosocial workers have to be aware that geriatric patients not only
deprivation, and an indication for (general) rehabilita- expect the general respect of society but—with increas-
tion. Th e treatment of geriatric patients is complicated ing life-expectancy—deserve adequate medical treat-
when dementia is present, because of the patient’s im- ment, including pain management. Societies have to
paired communication abilities. discuss how they want to cope with this demand.

Pain management What do elderly patients expect
from their doctor?
in geriatric patients
In surveys, the older generation has defi ned a “wish list”:
Why is pain management for the geriatric being active until death, individual treatment, no pain,
patient a medical challenge for tomorrow? autonomous decision making, being able to die “early
An important demographic phenomenon of the last few enough” before needless suff ering starts, and addressing
decades in highly industrialized countries is the con- reduced social context and contacts.
tinuous increase of the higher age groups in relation to
the younger generation. Within a few decades, the same Why do elderly patients not receive the care
they need and deserve?
demographic change will take place in countries outside
the Organization for Economic Co-operation and De- From the patient’s perspective:
velopment (OECD) as well. For example, in Germany • Th e incidence of dementia increases with age,
the number of inhabitants in the age group of above 80 resulting in impaired communication.
years increased from 1.2 million in 1960 to 2.9 million • Elderly patients tend to behave like “good pa-
today, and will further increase to 5.3 million by 2020. tients”.
Th erefore, the health care system and health care work- • Th ey have a traditional “trusting” view of the
ers will need to be prepared to be able to cope with this doctor “who will take care of everything that is
special patient group. With regard to pain problems, necessary.”

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 269
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