Integrating nonpharmacologic and alternative strategies into a comprehensive management approach for older adults...

The U.S. population aged >or=65 years is estimated to grow from 35 million in 2000 to 71.5 million in 2030, and the number of those aged >or=85 years is expected to increase from 5.3 million in 2006 to 21 million in 2050. Due to this demographic shift, the complexities of chronic pain management in the elderly will become increasingly important, necessitating a deeper understanding in the medical community of both the normal physiologic changes that occur with aging and the increased risks and vulnerabilities to pain that may be related to illness, comorbidities, or cognitive impairment. A number of factors complicate treating pain in the elderly. First, the cause of pain is often a condition that is typically not reversible. Second, effective treatment can be hampered by side effects of medications and complications from polypharmacy. Furthermore, depression, behavioral changes, and cognitive impairment commonly complicate therapy and make assessment more difficult. Both inappropriate prescribing and medication underuse are common in the elderly, as is the undertreatment of pain in this patient population in different care settings. The goal of this paper was to review appropriate use of nonpharmacologic, complementary, and alternative therapies for the comprehensive management of pain in older adults.