Pain Management in Elderly Patients
At the recent annual meeting of the Oncology Nursing Society, an important presentation provided an in-depth understanding of how elderly cancer patients cope with pain-and what can be done to alleviate this highly treatable side effect.
More than 90 percent of cancer patients report some level of pain at various times during the course of their treatment. At least half of all cancers are diagnosed in patients over 65 years of age, but studies have shown that more than 40 percent of these older cancer patients experience "unrelieved" pain that is not adequately treated.
In their presentation to attendees, Jeannine Brant, RN of St. Vincent Hospital in Billings, Montana, and Rita Wickham, RN, Ph.D., of Rush-Presbyterian St. Luke's Medical Center in Chicago, addressed many of the barriers that prevent adequate pain management in elderly cancer patients.
They noted that the attitudes of older patients are often the biggest barriers to effective pain relief. They may regard pain as a normal part of the aging process, or they simply want to be "good" patients and not complain about their pain. Fear of addiction to narcotics is also a major concern for many patients (of all ages).
Beyond the patients themselves, however, Brant and Wickham placed some blame on the families of elderly patients, who often share the same misconceptions about having to accept a certain amount of pain, or fearing addiction if too many painkillers are taken.
They also take some clinicians to task for subtle "age bias" in the way they treat their older patients, and for lacking sufficient knowledge to accurately assess pain levels in this distinctly unique patient population.
Brant and Wickham went on to note some important physiologic differences in the way older patients absorb pain medications. For example, kidneys become smaller with age, with decreased blood flow and less effective filtration. The liver also becomes smaller, as functional tissue is replaced by fat.
Furthermore, the way drugs are administered to elderly patients can become a challenge. Decreased saliva may hamper swallowing, and injections may be more difficult due to decreased muscle mass. Oral drugs may be poorly absorbed due to changes in stomach acidity.
They warned their nursing colleagues that consistent monitoring for adequate relief of pain, as well as for adverse reactions to pain medications, is absolutely essential for providing quality care to the rapidly growing population of elderly cancer patients.
SOURCES:
26th Congress of the Oncology Nursing Society, May 17-20, 2001, San Diego, California
Oncology Nursing Society (http://www.ons.org)
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