Il dolore cronico nel paziente anziano

Objective. To analyze the prevalence of persistent pain in the elderly and estimate its impact on patients' usual daily activities and depression symptoms. Methods. 227 patients at the Geriatric Unit, Ospedale Maggiore Policlinico di Milano, or their caregivers filled up a questionnaire about presence of pain and its impact on functional autonomy. Further information was gathered from the charts and, 3 months later, patients and caregivers underwent a follow-up evaluation by phone interview. Results. 75% of patients reported persistent pain, occurring daily in 70% of subjects. Average intensity was 6.5 (on a 0-10 range) and it affected patients' common daily activities and was associated with depressive symptoms. 52% of patients did not use analgesics, NSAIDs were the most common class of analgesics (16%). The lower prevalence of pain among patients with dementia is likely associated with undervaluation by caregivers. Pain and depression do not correlate, whilst a greater use of antidepressants (SSRI) was observed among patients without pain. Conclusions. Persistent pain in the elderly seems to be poorly diagnosed and treated despite its influence on patients' mood and daily activities. Common acceptance of pain and scepticism towards analgesics, especially for patients that already assume several drugs, may contribute to the under-treatment of persistent pain. Lack of communication might further complicate the assessment in patients with dementia. In depressed patients, antidepressant treatment seems to avoid the risk of developing pain.