Abstract
Individuals age at varying rates and along physical, cognitive, psychosocial, and sociocultural trajectories.Thus, the elderly comprise the most heterogeneous segment of the population. An understanding of the aging process therefore is crucial as the framework for understanding pain in the elderly.Although pain is not a natural consequence of aging, many elderly persons have health conditions that cause pain. Some elderly persons have cognitive conditions that impair their ability to communicate pain.The psychosocial circumstances of the elderly, particularly dependency issues, have implications for treatment design and goal setting. Sociocultural factors can contribute to misunderstandings between elderly persons and the typically younger clinicians who treat their pain. Beyond treatment efforts, the processes of aging have implications for our study and understanding of pain. Relevant issues include ageism, the definition of pain, association between pain and suicide in the elderly, and distinction between age differences (intercohort variability) and age effects (intra-individual change across the life span).
Similar content being viewed by others
References and Recommended Reading
MacFayden D: International demographic trends. In Improving the Health of Older People: A World View. Edited by Kane RL, Evans JG, MacFayden D. New York: Oxford University Press; 1990:19–29.
Spacapan S, Oskamp S: Introduction to the social psychology of aging. In The Social Psychology of Aging. Edited by Spacapan S, Oskamp S. Newbury, CA: Sage; 1989:9–24.
Gatz M: Clinical psychology and aging. In The Adult Years: Continuity and Change. Edited by Storandt M, VanderBos GR. Washington, DC: American Psychological Association; 1989:83–114.
Hendricks J: The social construction of ageism. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:51–68.
Dreyer PH: Postretirement life satisfaction. In The Social Psychology of Aging. Edited by Spacapan S, Oskamp S. Newbury, CA: Sage; 1989:109–134.
Siegler IC: Developmental health psychology. In The Adult Years: Continuity and Change. Edited by Storandt M, VanderBos GR. Washington, DC: American Psychological Association; 1989:119–142.
Neugarten BL, Neugarten DA: Policy issues in an aging society. In The Adult Years: Continuity and Change. Edited by Storandt M, VanderBos GR. Washington, DC: American Psychological Association; 1989:147–167.
German PS: Prevention and chronic disease in older individuals. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:95–108.
Friedhoff AJ: Consensus development conference statement: diagnosis and treatment of depression in late life. In Diagnosis and Treatment of Depression in Late Life. Edited by Schneider LS, Reynolds CF, Lebowitz BD, Friedhoff AJ. Washington, DC: American Psychiatric Press; 1994:493–511.
Liberto JG, Oslin DW, Ruskin PE: Alcoholism in the older population. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks CA: Sage; 1996:324–348.
Buck C, Baker P, Base M, Donner A: The prognosis of hypertension according to age at onset. Hypertension 1987, 9:204–208.
Whitbourne SK: Psychological perspectives on the normal aging process. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:3–35.
Ivy GO, MacLeod CM, Petit TL, Markus EJ: A physiological framework for perceptual and cognitive changes in aging. In The Handbook of Aging and Cognition. Edited by Craik FIM, Salthouse TA. Hillsdale NJ: Lawrence Erlbaum Associates; 1992:273–314.
Ferrell BA: Overview of aging and pain. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:1–10.
Finch CE: Progress in the biology of aging. In Improving the Health of Older People: A World View. Edited by Kane RL, Evans JG, MacFayden D. New York: Oxford University Press; 1990:128–142.
German PS: Prevention and chronic disease in older individuals. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:95–108.
Dolce JJ, Dickerson PC: Pain management. In Handbook of Clinical Behaviour Therapy with the Elderly Client. Edited by Wisocki PA. New York: Plenum Press; 1991:383–402.
Ross MM, Crook JM: Pain in later life: present state of know- ledge. In Chronic Pain in Old Age: An Integrated Biopsychsocial Perspective. Edited by Roy R. Toronto: University of Toronto Press; 1995:3–19.
Harkins SW, Lagua BT, Price DD, Small RE: Geriatric pain. In Chronic Pain in Old Age: An Integrated Biopsychsocial Perspective. Edited by Roy R. Toronto: University of Toronto Press; 1995:127–159.
Segal ES: Common medical problems in geriatric clients. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:451–467.
Evans JG. How are the elderly different? In Improving the Health of Older People: A World View. Edited by Kane RL, Evans JG, MacFayden D. New York: Oxford University Press; 1990:50–68.
Pawlson LG: Chronic illness: implications of a new paradigm for health care. J Quality Improvement 1994, 20:33–39.
Satin DG: The interdisciplinary, integrated approach to professional practice with the aged. In The Clinical Care of the Aged Person: An Interdisciplinary Perspective. Edited by Satin DG. New York: Oxford University Press; 1994:391–403.
Zeiss AM, Steffen AM: Interdisciplinary health care teams: the basic unit of geriatric care. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:423–450.
Turk DC: Biopsychosocial perspective on chronic pain. In Psychological Approaches to Pain Management: A Practitioner’s Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford Press; 1996:3–32.
Farrell MJ, Gibson SJ, Helme RD: Chronic nonmalignant pain in older people. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:81–90.
Gibson SJ, Farrell MJ, Katz B, Helme RD: Multidisciplinary management of chronic nonmalignant pain in older adults. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:91–100. Treatment of chronic nonmalignant pain in the elderly is addressed. Outcome studies are reviewed, and caveats based on clinical experience are discussed.
Gagliese L, Melzack R: Chronic pain in elderly people. Pain 1997, 70:3–14. Commonly used assessment instruments and patterns of age differences in the experience of chronic pain are discussed. The literature on treatment effectiveness is reviewed.
Hansson RO: Old age: testing the parameters of social psychological assumptions. In The Social Psychology of Aging. Edited by Spacapan S, Oskamp S. Newbury, CA: Sage; 1989:25–52.
Keefe FJ, Beaupre PM, Weiner DK, Siegler IC. Pain in older adults: a cognitive-behavioural perspective. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:11–20.
Maddox GL, ed: Encyclopedia of Aging, edn 2. New York: Springer; 1995.
Cook A, Roy R: Attitudes, beliefs and illness behaviour. In Chronic Pain in Old Age: An Integrated Biopsychcosocial Perspective. Edited by Roy R. Toronto: University of Toronto Press; 1995:20–37.
Herr KA, Mobily PR: Pain management for the elderly in alternate care settings. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:101–110.
Black JS, Kapoor W: Health promotion and disease prevention in older people: our current state of ignorance. J Am Geriatr Soc 1990, 38:168–172.
Crenshaw B: The complexities of cognitive impairment and the process of aging. In Handbook of Clinical Behaviour Therapy with the Elderly Client. Edited by Wisocki PA. New York: Plenum Press; 1991:141–168.
Grams A, Albee GW: Primary prevention in the service of aging. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:5–35.
Pasero C, McCaffery M: Postoperative pain in the elderly. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:45–68.
Stein WM: Cancer pain in the elderly. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:69–80.
Simonsick EM: Demography of productive aging. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:69–90.
Salthouse TA: Age-related changes in basic cognitive processes. In The Adult Years: Continuity and Change. Edited by Storandt M, VanderBos GR. Washington, DC: American Psychological Association; 1989:9–40.
Light L: The organization of memory in old age. In The Handbook of Aging and Cognition. Edited by Craik FIM, Salthouse TA. Hillsdale, NJ: Lawrence Erlbaum Associates; 1992:111–166.
Dixon RA: Promoting competence through compensation. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:220–238.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.
Youngjohn JR, Crook III TH: Dementia. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:239–254.
Nebes RD: Cognitive dysfunction in Alzheimer’s disease. In The Handbook of Aging and Cognition. Edited by Craik FIM, Salthouse TA. Hillsdale, NJ: Lawrence Erlbaum Associates; 1992:373–446.
Kee WG, Middaugh SJ, Pawlick KL: Persistent pain in the older adult: evaluation and treatment. In Psychological Approaches to Pain Management: A Practitioner’s Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford Press; 1996:371–402. A substantial body of research exists that supports the effectiveness of multidimensional treatment for elderly persons with chronic nonmalignant pain. The literature is reviewed, and significant clinical issues related to the assessment and treatment of chronic pain in the elderly are discussed.
Melzack R, Wall P: Pain mechanisms: a new theory. Science 1965, 50:971–979.
Mersky H: The definition of pain. Euro J Psychiatry 1991, 6:153–159.
McCaffery M, Beebe A: Pain Clinical Manual for Nursing Practice. St Louis: C.V. Mosby Co.; 1989.
Anand KJS, Craig KD: New perspectives on the definition of pain (editorial). Pain 1996, 67:3–6.
Parmelee PA, Smith B, Katz IR: Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc 1993, 46:517–522.
Simons W, Malabar R: Assessing pain in elderly patients who cannot respond verbally. J Adv Nurs 1995, 22:663–669.
Cohen-Mansfield J, Billig N, Lipson S, et al.: Medical correlates of agitation in nursing home residents. Gerontology 1990, 36:150–158.
Cohen-Mansfield J, Werner P, Marx MS: Screaming in nursing home residents. J Am Geriatr Soc 1990, 38:785–792.
Marzinski LR: The tragedy of dementia: clinically assessing pain in the confused, nonverbal elderly. J Gerontological Nurs 1991, 17:25–28.
Parke B: Pain in the cognitively impaired elderly. Can Nurse 1992, 88:17–20.
Hurley AC, Volicer BJ, Hanrahan PA, et al.: Assessment of discomfort in advanced Alzheimer patients. Res Nurs Health 1992, 15:369–377.
Farrell MJ, Katz B, Helme RD: The impact of dementia on the pain experience. Pain 1996, 67:7–15. The impact of dementia on the experience of pain has received little attention. The literature is reviewed and future directions for the study of pain in this population are identified.
Costa PT Jr, McCrae RR: Personality continuity and the changes of adult life. In The Adult Years: Continuity and Change. Edited by Storandt M, VanderBos GR. Washington, DC: American Psychological Association; 1989:45–77.
Cohen S, Syme SL: Issues in the study and application of social support. In Social Support and Health. Edited by Cohen S, Syme SL. Orlando, FL: Academic Press; 1985:3–27.
Gatz M: Questions that aging puts to preventionists. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:36–50.
Chappell NL: Informal social support. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:171–185.
MacRae H: Strong and enduring ties: older women and their friends. Can J Aging 1996, 15:374–392.
Lynott PP, Roberts REL: The developmental stake hypothesis and changing perceptions of intergenerational relations 1971–1985. Gerontologist 1997, 37:394–405.
Thompson LW, Gallagher-Thompson D: Practical issues related to maintenance of mental health and positive well-being in family caregivers. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:129–150.
Meeks S, Murrell SA: Mental illness in late life: socioeconomic conditions, psychiatric symptoms, and adjustment of longterm sufferers. Psychol Aging 1997, 12:296–308.
Lawton MP: Environmental proactivity and affect in older people. In The Social Psychology of Aging. Edited by Spacapan S, Oskamp S. Newbury, CA: Sage; 1989:135–164.
Horgas AL, Wahl H-W, Baltes MM: Dependency in late life. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:54–75. These authors draw on life span developmental psychology as the context for understanding behavioral dependency in the elderly. Biologic, psychologic, and environmental antecedents of dependency dependency are discussed, along with behavioral interventions for modifying dependency among older adults.
Zautra AJ, Reich JW, Newsome JT: Autonomy and sense of control among older adults: an examination of their effects on mental health. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:153–170.
Blazer II DG: Epidemiology of late life depression. In Diagnosis and Treatment of Depression in Late Life. Edited by Schneider LS, Reynolds CF, Lebowitz BD, Friedhoff AJ. Washington, DC: American Psychiatric Press; 1994:9–19.
Wolfe R, Morrow J, Fredrickson BL: Mood disorders in older adults. In The Practical Handbook of Clinical Gerontology. Edited by Carstensen LL, Edelstein BA, Dornbrand L. Thousand Oaks, CA: Sage; 1996:274–303.
Roy R, Thomas M, Cook A: Social context of elderly chronic pain patients. In Pain in the Elderly. Edited by Ferrell BR, Ferrell BA. Seattle: IASP Press; 1996:111–117.
Markson EW: Issues affecting older women. In Promoting Successful and Productive Aging. Edited by Bond LA, Cutler SJ, Grams A. Thousand Oaks, CA: Sage; 1995:261–278.
Weber G, Derzko C: Health concerns of older women. Rehabil Comm Care Manage 1997, 6:25–31.
Bendlow G: Using visual imagery to explore gendered notions of pain. In Researching Sensitive Topics. Edited by Renzetti CM, Lee RM. Thousand Oaks, CA: Sage; 1993:212–228.
Zalon ML: Pain in frail elderly women after surgery. Image J Nurs Scholarship 1997, 29:21–25.
McIntosh JL, Santos JF, Hubbard RW, Overholser JO: Elder Suicide Research Theory and Treatment. Washington, DC: American Psychological Association; 1994.
Keith J: Consequences for research procedure. In Qualitative Methods in Aging Research. Edited by Gubrium JF, Sankar A. Thousand Oaks, CA: Sage; 1994:105–119.
Knight BG: Psychotherapy with Older Adults. Thousand Oaks, CA: Sage; 1996.
Brislin RW: Applied cross-cultural psychology: an introduction. In Applied Cross-Cultural Psychology. Thousand Oaks, CA: Sage; 1990:9–33.
Birren JE, Schroots JJF: History, concepts and theory in the psychology of aging. In Handbook of the Psychology of Aging, edn 4. Edited by Birren JE, Schaie KW. San Diego: Academic Press; 1996:3–23. The psychology of aging is concerned with patterns of change in individuals as they grow old. The development of this discipline is traced from its roots to its current phase of rapid expansion. Conceptual, methodologic, and contextual issues crucial to understanding the patterns and processes of age-related change are explained.
Collins LM: Measurement of change in research on aging: Old and new issues from an individual growth perspective. In Handbook of the Psychology of Aging, edn 4. Edited by Birren JE, Schaie KW. San Diego: Academic Press; 1996:38–56.
Thomas M: Pain among healthy elderly individuals. In Chronic Pain in Old Age: An Integrated Biopsychosocial Perspective. Edited by Roy R. Toronto:University of Toronto Press; 1995:38–55.
Sorkin BA, Turk DC: Pain management in the elderly. In Chronic Pain in Old Age: An Integrated Biopsychsocial Perspective. Edited by Roy R. Toronto: University of Toronto Press; 1995:56–80.
Schaie KW: Intellectual development in adulthood. In Handbook of the Psychology of Aging, edn 4. Edited by Birren JE, Schaie KW. San Diego: Academic Press; 1996:266–286.
Jaffe DJ, Miller EM: Problematizing meaning. In Qualitative Methods in Aging Research. Edited by Gubrium JF, Sankar A. Thousand Oaks, CA: Sage; 1994:51–64.
Kim U: Indigenous psychology: science and applications. In Applied Cross-Cultural Psychology. Thousand Oaks, CA: Sage; 1990:142–160.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gibson, M.C. Pain in the elderly: Psychosocial issues. Current Review of Pain 2, 29–40 (1998). https://doi.org/10.1007/s11916-998-0060-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11916-998-0060-z