Patients in the Elderly – Risk of Undertreatment

Management of pain in the elderly produces unique challenges. There are numerous barriers and misconceptions about pain that arise both from patients and healthcare personnel.

Physicians may believe that:

  • pain cannot be assessed in cognitively impaired people
  • age is an analgesic, and elderly people have a decreased sensitivity to pain
  • if an older patient is not complaining of pain, he/she is not experiencing pain

Both physicians and patients often believe that increasing levels of pain are a normal function of ageing and therefore have to be accepted.1–3

Other barriers to effective pain management in the elderly include concerns about polypharmacy and increasing side-effects in the elderly. Elderly patients often have multiple morbidities and a high pill load.

Elderly patients are at increased risk of adverse events, and the risk of undertreatment vs adverse events must be carefully considered.4–6



1 Kaye A, et al. Ochsner J. 2010;10:179-87.

2 Herr K. Pain assessment strategies in older patients. J Pain. 2011; 12:3-13.

3 Herr K. Chronic pain: challenges and assessment strategies. J Gerontol Nurs. 2002; 28:20-7.

4 Schmader K et al. Treatment considerations for elderly and frail patients with neuropathic pain. Mayo Clin Proc. 2010; 85(3):S26-S32.

5 Wick J. Adherence Issues in Elderly Patients. Available at:

6 Shock NW. Sci Am. 1962;206:100-10.