Older and Better: A Narrative Review of Successful Aging and Adaptation to Pain in Late Life.

Abstract

"Invariably, the self-assessed QoL was far better than I, as a physician, would have anticipated from the diseases and disabilities that you reported." -Ben Eiseman, MD, based on a survey of his octogenarian Yale University classmates.

Background: Chronic pain control is a high priority for the elderly; it is one of the most frequently encountered medical problems in this group. Chronic pain affects 60%-75% of people aged 65 years and older. Chronic pain's prevalence is even higher in those living in assisted living or nursing homes. Based on epidemiological data, the prevalence of chronic pain is directly proportional to age and is especially so in women. At least one in 3 patients over age 65 report significant ongoing pain that is often inadequately treated. Despite this high prevalence of chronic pain in older persons, aging research sheds light on how this suffering may be reduced. Healthy aging is not an oxymoron. Successful aging and adaptation to chronic pain involve similar medical, temperamental, behavioral, and cultural factors. Older patients with chronic pain face well-documented cultural bias, fear, and clinical pessimism; but adaptive coping is a realistic expectation.

Objectives: This narrative review aims to summarize the available literature on strategies used by older persons to optimize adaptation to late-life pain.

Study design: This is a narrative review of a PubMed literature search 1947 to March 4, 2024.

Methods: A PubMed literature search covering years 1947 to March 4, 2024 was performed using permutations of the search terms pain, chronic pain, persistent pain, aging, elderly, and coping. Relevant articles were also obtained from careful review of the references in articles identified in the search.

Results: I summarized the available literature on strategies used by older persons to optimize adaptation to late-life pain. There are distinct differences between older persons and younger persons in the strategies they use to cope with chronic pain. Furthermore, I identified significant overlap between strategies and actions used by older persons to cope with pain and those strategies and actions used to successfully adapt to the aging process; these commonalities demonstrate a linkage of these adjustment processes and have clinical utility. Also presented are 2 cases that demonstrate the relevance of these factors for treating elderly patients with chronic pain.

Limitations: The literature search was limited to PubMed, which excluded psychology databases.

Conclusions: Chronic pain is common in the elderly and is not adequately treated. Data indicate that older persons can benefit from guidance toward distinct attitudes and actions they can employ to cope with persistent pain. Epidemiologic and aging literature describe attitudes and behaviors that facilitate health and wellbeing during aging. Data from gerontology and from research on chronic pain in elderly patients converge upon factors that are common to better adaptation to both aging and late-life pain. I describe these common factors, which I categorize as treatment-factors, traits, attitudes, and actions. Two cases are presented to demonstrate these concepts.