Pain management in frail, community-living elderly patients

Background. Pain is a common problem among older people living in different community settings. As indicated by the World Health Organization (WHO), p ain can be relieved using pharmacologic agents. However, pain continues to be addressed inadequately. Objectives: To describe the prevalence of pain in frail elderly people livi ng in the community and to evaluate the adequacy of pain management. Methods: We analyzed data from a large collaborative observational study gr oup, the Italian Silver Network Home Care project, that collected data on p atients admitted to home health care programs. Twelve home health care agen cies participated in the project evaluating the implementation of the Minim um Data Set for Home Care instrument. We enrolled 3046 patients, 65 years a nd older, in the present study. The main outcome measures were the prevalen ce of daily pain and analgesic treatment. Results: A total of 1341 individuals (39%, 49%, and 41% of those aged 65-74 , 75-84, and greater than or equal to 85 years, respectively) reported dail y pain. Of patients with daily pain, 25% received a WHO level I drug; 6%, a WHO level 2 drug; and 3%, a WHO level 3 drug (eg, morphine sulfate). Patie nts 85 years or older were less likely to receive analgesics compared with the younger patients (univariate odds ratio, 0.73; 95% confidence interval [CI], 0.60-0.89). Another independent predictor of failing to receive any a nalgesic was low cognitive performance (adjusted odds ratio, 0.80; 95% CI, 0.69-0.93). Conclusions: Daily pain is prevalent among frail elderly patients living in the community and is often untreated, particularly among older and demente d patients.