Pain management in older people

2010 ◽  
Vol 20 (3) ◽  
pp. 183-192 ◽  
Author(s):  
Gary McCleane
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Elderly Patients ◽  
Older People ◽  
Older Patients ◽  
Medicinal Products ◽  
Younger Patients ◽  
Analgesic Drugs ◽  
Provide Pain Relief

SummaryAt times providing pain relief in elderly patients can prove troublesome. Their tolerance and perception of pain can differ from that of younger patients, while the incidence of pain is above that found in those of less advanced years.Conventional approaches to providing pain relief can be successful, but the tolerance to the side-effects of those drugs used to provide pain relief can be less. Furthermore, polypharmacy can have implications for the range of analgesic drugs that can be considered. Fortunately there are an increasing range of medicinal products with reduced potential for side-effects that can be considered when treating older patients with pain.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

scholarly journals POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY

2005 ◽  
Vol 12 (03) ◽  
pp. 340-345
Author(s):  
ROBINA FIRDOUS
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Opioid Receptors ◽  
Acute Pain ◽  
Alternate Route ◽  
Parenteral Route ◽  
Group I ◽  
Post Operative Pain

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.

scholarly journals Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

2021 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Tanudeep Kaur ◽  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Emotional Experience ◽  
Postoperative Pain Management ◽  
Economic Benefits ◽  
High Dose ◽  
Postoperative Patient ◽  
Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

Presentation of stroke in the older person

2020 ◽  
pp. 25-32
Author(s):  
Jagdish Sharma
Keyword(s):  
Older People ◽  
Ischaemic Stroke ◽  
Older Patients ◽  
Clinical Presentation ◽  
Cerebral Haemorrhage ◽  
Older Person ◽  
Younger Patients ◽  
Age Related ◽  
Atypical Presentations ◽  
Symptoms And Signs

‘Presentation of stroke in the older person’ outlines the varied patterns of clinical presentation of stroke in the older person, looking at common and the less common syndromes. Symptoms and signs in older people can be very subtle, often difficult to diagnose, and challenge even the most astute of clinicians. Most stroke presentations in older patients are similar to those in younger patients with respect to Oxford Community Stroke Project classification. However, atypical presentations can lead to diagnostic challenges in older patients due to the interaction between age-related cerebral and circulatory changes and comorbidities. The presentation of ischaemic stroke with its different vascular patterns, is discussed. Cerebral haemorrhage is explored in the context of its presentation patterns.

scholarly journals Systemic Therapy for Elderly Patients with Gastrointestinal Cancer

2011 ◽  
Vol 5 ◽  
pp. CMO.S6983 ◽  
Author(s):  
Joleen M. Hubbard ◽  
Axel Grothey ◽  
Daniel J. Sargent
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Older Patients ◽  
The Elderly ◽  
Age Group ◽  
Gastrointestinal Cancers ◽  
Younger Patients ◽  
Multiple Trials

The majority of patients with gastrointestinal cancers are over the age of 65. This age group comprises the minority of the patients enrolled in clinical trials, and it is unknown whether older patients achieve similar results as younger patients in terms of survival benefit and tolerability. In addition, there are few studies specifically designed for patients over 65 years. Subset analyses of individual trials and studies using pooled patient data from multiple trials provide some understanding on outcomes in older patients with gastrointestinal cancers. This article reviews the evidence on chemotherapeutic regimens in the elderly with colorectal, pancreatic, and gastroesophageal cancers, and discusses a practical approach to provide the best outcomes for older patients.

scholarly journals Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients

2017 ◽  
Vol 126 (4) ◽  
pp. 1201-1211 ◽  
Author(s):  
Benjamin Brokinkel ◽  
Markus Holling ◽  
Dorothee Cäcilia Spille ◽  
Katharina Heß ◽  
Cristina Sauerland ◽  
...  
Keyword(s):  
General Population ◽  
Elderly Patients ◽  
Older Patients ◽  
The Elderly ◽  
Spinal Tumors ◽  
Subtotal Resection ◽  
High Grade ◽  
Younger Patients ◽  
Age And Sex

OBJECTIVE The purpose of this study was to compare long-term prognosis after meningioma surgery in elderly and younger patients as well as to compare survival of elderly patients with surgically treated meningioma to survival rates for the general population. METHODS Five hundred meningioma patients (median follow-up 90 months) who underwent surgery between 1994 and 2009 were subdivided into “elderly” (age ≥ 65 years, n = 162) and “younger” (age < 65 years, n = 338) groups for uni- and multivariate analyses. Mortality was compared with rates for the age- and sex-matched general population. RESULTS The median age at diagnosis was 71 in the elderly group and 51 years in the younger group. Sex, intracranial tumor location, grade of resection, radiotherapy, and histopathological subtypes were similar in the 2 groups. High-grade (WHO Grades II and III) and spinal tumors were more common in older patients than in younger patients (15% vs 8%, p = 0.017, and 12% vs 4%, p = 0.001, respectively). The progression-free interval (PFI) was similar in the 2 groups, whereas mortality at 3 months after surgery was higher and median overall survival (OS) was shorter in older patients (7%, 191 months) than in younger patients (1%, median not reached; HR 4.9, 95% CI 2.75–8.74; p < 0.001). Otherwise, the median OS in elderly patients did not differ from the anticipated general life expectancy (HR 1.03, 95% CI 0.70–1.50; p = 0.886). Within the older patient group, PFI was lower in patients with high-grade meningiomas (HR 24.74, 95% CI 4.23–144.66; p < 0.001) and after subtotal resection (HR 10.57, 95% CI 2.23–50.05; p = 0.003). Although extent of resection was independent of perioperative mortality, the median OS was longer after gross-total resection than after subtotal resection (HR 2.7, 95% CI 1.09–6.69; p = 0.032). CONCLUSIONS Elderly patients with surgically treated meningioma do not suffer from impaired survival compared with the age-matched general population, and their PFI is similar to that of younger meningioma patients. These data help mitigate fears concerning surgical treatment of elderly patients in an aging society.

scholarly journals Older Patients Are Less Affected by Radiochemotherapeutic Treatment than Younger

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Max J. Weiling ◽  
Wencke Losensky ◽  
Katharina Wächter ◽  
Teresa Schilling ◽  
Fabian Frank ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Older Patients ◽  
Normative Data ◽  
Age Groups ◽  
German Population ◽  
Younger Patients ◽  
Significant Difference

Purpose. The general assumption is that cancer therapy impairs the quality of life in elderly patients more than in younger ones. We were interested in the effects of radiochemotherapeutic treatment on the quality of life of elderly patients compared to younger patients and compared to normative data of a general German population. Methods and Materials. A total of 465 patients completed the EORTC QLQ-C30 questionnaire. Repetitive completion of the questionnaire over time led to 1407 datasets. Our patient cohort contained 197 (42.4%) patients with colorectal cancer followed by 109 (23.4%) patients with head and neck cancer, 43 (9.2%) patients with lung cancer, and 116 (25%) with other types of cancer. Patients were categorized into five age groups, the respective cut-offs being 40, 50, 60, and 70 years. Normative data were drawn from a population study of a general German population. Results. Functional scores and symptom scores were approximately stable between the different age groups. Our data does not suggest a significant difference between the investigated age groups. Advancing age evened out the differences between the normative data of the general German population and the cancer patients in 11 of 15 scores. Conclusions. The general belief about younger patients having fewer physical and psychological problems related to radiochemotherapy needs to be reconsidered. Overall resilience of older patients is apparently underestimated.

scholarly journals Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials

2017 ◽  
Vol 2 (20;2) ◽  
pp. sE33-sE52 ◽  
Author(s):  
Chi-Wai Cheung
Keyword(s):  
Clinical Trials ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Analgesic Efficacy ◽  
Postoperative Pain Management ◽  
Acute Postoperative Pain

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

scholarly journals Multimodal Pain Management in the Setting of Palliative Care

2021 ◽  
Author(s):  
Marija V. Sholjakova ◽  
Vesna M. Durnev
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Additional Treatment ◽  
Therapeutic Approaches ◽  
Multimodal Pain Management ◽  
Addictive Drugs ◽  
Analgesic Therapy ◽  
Good Organization

Pain as an integral part of palliative care (PC) is often present at the end of the life. Today, many different analgesics from opioids and non- opioids origin are in use. The integration of their use is the most effective method for pain relief. The aim of this chapter is to discuss different therapeutic approaches to pain management in palliative care. Palliative care is being confronted between the expectations and the possibilities to provide an efficient relief from the symptoms, the pain and the stress. The possibility to use opioids for pain management, with all side effects, and non-addictive drugs as additional treatment, improves the quality and the duration of life for the patients in palliative care. Since the origin of the pain is different, the use of analgesic therapy should be individualized and adapted to the real need of every person. Finally, only a good organization and institutionalization of palliative care in the society could allow for better prevention of suffering at the end of the life.

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