Pain Management and Opioid Epidemic in Elderly Population: Assessment, Scales, and Resources

Specifics Regarding Pain within the Elderly Population

Discuss specifics regarding pain within the elder population: perception of pain, pain assessment scales, etc. In addition, provide evidence-based cited information relating to the opioid epidemic within your state and what percentage of addicted individuals are elderly. What type of resources are available in your community to help those with substance abuse problems? Are there any services specific to the elderly?

The world’s older population is growing dramatically at an unprecedented rate. “Today, 8.5 percent of people worldwide (617 million) are aged 65 and over” (National Institutes of Health, 2017). Pain and pain management are huge growing concerns among older adults. The elderly population makes it hard for practitioners because of their comorbid medical conditions, declining physical function, declining mental function, and polypharmacy. Treating pain in the elderly is also difficult because many elderly patients have more than one chronic condition. For example, patients may have a combination of heart disease, chronic lung disease, arthritis, and diabetes. Undertreatment of pain is a big issue in the elderly population and even more of an issue for those that are struggling with dementia. “It should be noted that the undertreatment of pain in older adults is an especially significant problem for those who have severe dementia (Alzheimer’s disease). This is because they often have difficulty communicating their experience of pain due to major cognitive and linguistic impairments” (Hulla, 2021). Every patient has their own health issues and should be evaluated on an individual basis to determine the most effective strategies to use in hopes of achieving the best possible outcome with the least amount of side effects. Alternative strategies should also be used instead of medications for some patients to minimize the side effect risk. For example, instead of a narcotic, refer the patient to physical therapy to receive other alternative treatments. This will also decrease the risk of adverse reactions and possible drug-to-drug interactions. The elderly population is at a higher risk of adverse drug events as well. “Elderly patients also are at a higher risk of adverse drug events (ADEs) due to natural physiological changes in the body that come with age, such as the slowing of the gastrointestinal tract that may inhibit the absorption rate of some drugs, or the dwindling liver oxidation rate that can lengthen drug half-life” (Hulla, 2021). All of these issues combined, can make pain control for an elderly person very complicated for the practitioner. 

Some practitioners may believe that older people do not feel pain as much as younger people. Some older people assume as they get older, they lose some ability to perceive pain. This is far from the truth and could be the reason that elderly patient’s pain is not being managed appropriately. “A significantly large proportion of people over the age of 65 years will experience chronic pain. If nurses assume that an older person feels less pain, then the management of that individual’s pain may be less than adequate” (Taverner, 2019). Personally, I have seen that older people are less likely to complain of being in pain, but this doesn’t mean that they are experiencing less pain than younger individuals. Sometimes, different things can alter how the patient presents with pain. For example, dementia can affect how the patient presents themselves, or maybe a life experience has made the patient view their pain differently. 

There are numerous different types of pain assessment scales. For example, numerical rating pain scale, Wong-Baker Faces pain scale, FLACC pain scale, Comfort pain scale, and McGill pain scale. There are many others I did not list that include pain assessment in children and babies as well. These scales are designed to help assess the extent of a patient’s pain. The most commonly used pain scale used in health care is the numerical rating scale. You simply as the patient their pain on a scale of zero to ten with zero being no pain at all and ten being the worst pain they have ever experienced. Mild pain is rated 1-3. Moderate pain is rated 4-6. Severe pain is rated 7-10. “If you use the numerical scale, you have the option to verbally rate your pain from 0 to 10 or to place a mark on a line indicating your level of pain. Zero indicates the absence of pain, while 10 represents the most intense pain possible” (Jacques, 2020). I would like to discuss the Wong-Baker pain scale as it can be used for children or adults. This scale would be good to use with patients who suffer from dementia who cannot verbalize or comprehend the numerical pain scale. “The Wong-Baker FACES Pain Scale combines pictures and numbers for pain ratings. It can be used in children over the age of 3 and in adults. Six faces depict different expressions, ranging from happy to extremely upset. Each is assigned a numerical rating between 0 (smiling) and 10 (crying). If you have pain, you can point to the picture that best represents the degree and intensity of your pain” (Jacques, 2020). It is important for the practitioner to assess the patient first so they may best choose which pain scale will most appropriately fit the patient so their pain will be treated appropriately. 

While the opioid epidemic has taken its greatest toll on younger people, it has increasingly affected the elderly population as well. Older people are at a higher risk due to the way their body handles opioids. “Older people may develop some insufficiencies in liver and kidney functioning, and this can make it harder for the drugs to be eliminated from the body. Other issues like changing body composition (e.g., increased fat and decreased water) can result in changes in the ways the drugs are distributed throughout the body. This is why opioid painkillers should be started at a low dose and increased only with careful supervision” (Patterson, 2021). I was born and raised in North Carolina. There is obviously an opioid epidemic, but North Carolina has an Opioid Action Plan. “North Carolina’s Opioid Action Plan was released in June 2017 with community partners to combat the opioid crisis. Since the plan was launched in 2017, opioid dispensing has decreased by 34 percent. Prescriptions for drugs used to treat opioid use disorders increased by 33 percent in that time frame, and opioid use disorder treatment specifically for uninsured and Medicaid beneficiaries is up by 48 percent. In addition, North Carolina has received more than $70 million in federal funding, which has provided treatment for over 21,000 people” (NCDHHS, 2021). The plan focuses on three areas to fight the epidemic: prevention, reducing harm, and connecting to care. I would first like to share a few statistics regarding opioid addiction in general in the elderly population. “Elderly adults with Medicare and other public insurance coverage were more likely to fill at least 1 opioid prescription (24.4 percent) and to have 4 or more opioid prescription fills (11.2 percent) than those with Medicare only (18.8 and 7.6 percent) and those with Medicare and private insurance coverage (18.9 and 6.1 percent). Elderly adults who were poor (9.5 percent) or low income (11.3 percent) were more likely than middle-income (6.8 percent) and high-income (4.5 percent) elderly adults to obtain 4 or more opioid prescription fills during the year (Miller, 2018). Now, I would like to discuss statistics of the opioid epidemic for the elderly population in North Carolina. “There are three reasons why aging Baby Boomers are more likely to use illicit drugs. One is cultural: Baby boomers grew up in an era when illicit drugs were widely available, and their use had a certain allure. Another reason is economic: Boomers are increasing their use of illicit drugs because the recession and its aftermath have heightened their anxiety about job security and retirement savings. A third reason is emotional: Aging boomers may turn to illicit drugs to cope with grief and loss issues such as the death of a spouse or the end of a career. Of adults age 50 and older: 54% used marijuana, 28% misused prescription drugs, and 17% used other illicit drugs” (NCDHHS, 2021). 

There are many resources available in my community to help those with substance abuse problems. The substance abuse services in North Carolina cover a variety of support and education aimed towards drug and alcohol prevention, intervention, and treatment. There are many recovery facilities located around North Carolina such as Mountainview Recovery, Red Oak Recovery, and Port Health. There are plenty of services specific to the elderly as well such as DRS (1-800-304-2219). Thanks for allowing me to share this post regarding pain, treatment, and opioid pandemic in the elderly population. Have a blessed week class.