Older patients often describe pain as an inability to move through the world. Treating pain in older adults is crucial to supporting everyday activities, mobility, and independence. While many older adults live with pain—some estimates range as high as 50 percent of people living independently—there are many treatments available.
“Patients often grin and bear it,” says Lauren A. Kelly, MD, a geriatrician at The Mount Sinai Hospital. “But pain has many consequences—social, medical, and psychological.”
Lauren A. Kelly, MD
In this Q&A, Dr. Kelly, Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, says it is important for older adults to get treatment for their pain—since just living with it puts you at risk in many ways.
How does pain affect older adults?
Pain can affect physical and mental well-being, accelerate physical disability, impair focus and sleep, and make it harder to do everyday activities or cope with simple daily stressors. Pain can also add to a cycle of frailty, whereby pain contributes to deconditioning, mobility problems, and poor nutrition—resulting in more frailty. It’s important to identify and treat pain to minimize its far reaching effects.
How common is pain among older adults?
Unfortunately, chronic pain is very common with estimates suggesting that between a quarter to half of adults aged 65 and older experience it. In nursing home settings, the prevalence rises to over 80 percent.
How does pain put me or my loved one at risk?
Pain is often an accelerator of functional decline. Pain puts patients at greater risk for falls, weakened physical abilities, and more disability, which can worsen the pain experience.
When patients have a sudden increase in their pain, such as after orthopedic surgery, this acute pain needs to be treated quickly and effectively. Allowing acute pain to go unchecked can lead to changes in how the brain processes pain, making it harder for older adults to recover and potentially leading to persistent chronic pain and decline in function.
Is pain a natural part of aging? What are some of the causes?
Aging, as a factor by itself, is not a cause of pain. We see many older adults who don’t experience chronic pain. As people get older, health issues such as osteoarthritis, chronic back pain, surgery, falls, and pain related to your muscles and nerves—like myofascial pain, peripheral neuropathy, fibromyalgia syndrome—all become more common. Also, as we age, there are changes in the way the nervous system processes pain that make us less able to tolerate it and therefore more susceptible. For many older adults, these factors can add up and lead to significant problems with function and quality of life as a result of pain.
You mentioned pain affects mobility and vice versa. How does that work?
The relationship between pain and things like mobility and mood is complex. We call these relationships “bidirectional” because often, each factor can influence each other. For example, we know that pain is more likely in patients with impaired mobility, gait issues, or a history of falls. If a person’s gait or mobility gets worse, or if they suffer a fall, that can then influence the severity of pain. Another example is that we see much higher rates of pain in patients with depression, anxiety, or even social isolation.
How does mental health affect pain?
Mood is a modulator of pain pathways in the brain, particularly the pathways that inhibit pain signaling. Worsening depression can deepen the pain experience, make it feel more intense, or like it’s lasting longer. Conversely, mental health treatment can significantly improve someone’s pain. Research shows that cognitive behavioral therapy for pain can have excellent results, so it’s important that when we’re treating pain that we recognize all the different factors at play and develop pain interventions that target each of those areas.
Are there special considerations in treating older adults for pain?
Older adults often face unique challenges—socially, financially, psychologically, and medically. Geriatricians have insight into the needs of older adults and consider several key areas that we call the “5Ms of Geriatrics.” These include “mobility,” “mind,” “mood,” “medications,” “multi-complexity,” or the presence of multiple medical conditions, and “matters most,” which takes the patient’s goals into consideration. The 5Ms framework allows geriatricians to take a comprehensive approach to pain with respect to each of these domains.
How do memory and/or cognitive problems affect pain management for older adults?
If a person has cognitive difficulties or dementia, it may be difficult for them to describe the pain they are experiencing. Things like behavioral agitation and delirium, or a sudden change in someone’s orientation to person, place, or situation as well as attention difficulties, are commonly seen. Additionally, since older adults may have multiple medical issues and often take many medications, care needs to be taken in prescribing new medications which can create more side effects and interactions. Many pain medications, particularly central nervous system depressants, can worsen cognition.
As providers, we need to identify and work toward the patient’s goals. For patients with cognitive impairment, that often means working with patients’ designated caregivers or health care proxies to create tailored care plans.
What other challenges do older adults with pain often face?
Older adults may be socially isolated and face financial concerns. Getting social work colleagues involved to ensure access to insurance and benefits, including things like home care and medical supplies to promote function and independence, is key.
It’s also important for older adults to keep moving. While physical therapy can support mobility and help with pain, the simple fact of getting out of the house to physical therapy can also help patients feel like they’re doing something positive for themselves and thus help their mood. Seeing other people, making jokes with your physical therapist, talking to the lady sitting next to you who is also getting physical therapy—these things are all a part of the healing process.