Cognitive dysfunction may complicate assessment of pain in elderly patientsBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7107.551 (Published 30 August 1997) Cite this as: BMJ 1997;315:551
- a Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster LA1 4RP
- b Department of Anaesthesia, South Cleveland Hospital, Middlesbrough TS4 3AF
Editor—Henry McQuay and colleagues' inclusion of the biopsychosocial model of pain (the model that describes pain as having affective, cognitive, and behavioural dimensions) is of particular interest in the acute setting.1 In drawing attention to the difficulties of assessing pain in babies and unconscious patients, however, they seem less concerned about another group—namely, those elderly patients in whom cognitive dysfunction complicates the assessment of pain. The problems of elderly patients are seen as ones of pharmacology alone.
The International Association for the Study of Pain has focused recently on the specific problem of managing pain in elderly patients, publishing a monograph2 and several articles in its journal, Pain. These go beyond the purely pharmacological approach and invite readers to consider the effects of cognitive impairment and culture on elderly people's experience of pain.
The message we should be heeding from the International Association for the Study of Pain is that elderly patients, like babies and unconscious patients, may suffer silently. Unlike the two other groups, however, elderly surgical patients are not yet looked after by specially trained staff in high dependency units. There are far too many of them for such an ideal to be practical.