Pain in special populations: mentally impaired elderly

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ABSTRACT
The management of acute pain in elderly patients can turn out to be a difficult challenge. Aging causes alterations of the general functional status and critical pharmacokinetic and pharmacodynamic changes, increasing the risk of toxicity and drug interactions. Nevertheless, the detrimental effect of pain on well-being and global functions in the elderly suggests that the quality of pain care has to be regarded as the most important element for early recovery of these patients. The para-physiological changes associated with the aging of CNS neurobiology and pain, significantly modify the pain threshold, the tolerance to nociceptive stimuli and, consequently, these changes have their effects on the metabolism of drugs how drugs treatments are metabolized. The difference of pain perception by these patients The difference in pain perception of these patients, must be for the pain therapist the important hint about how differently pain should be evaluated, particularly in patients with cognitive impairments. Assessment of acute pain in elderly people with dementia, and/or other psychological disorders, has practical impacts in term of adequacy and efficacy of the pain treatment. This review will introduce several aspects, from neurobiology of pain in elderly to specific assessments in cognitive impairments, in order to highlight these issues as cornerstones of the better possible care approach to acute pain in elderly.
Keywords: cognitive impairment, elderly, pain.

Also available in : Italiano