Pain is uncomfortable for everyone – but why are older people less likely to report pain when they have it?

The mechanism by which pain is perceived is very complex. There does appear to be some age related changes, but older people don’t perceive pain any less than younger people.

That said older people in general may be less sensitive to low levels of stimuli – thus, have a higher pain threshold. But they tend to be more sensitive to higher levels of stimuli – meaning they have a lower ability to tolerate more severe pain.

Regardless of the changes in a person’s perception, what is important to take note of is their report or experience of pain.

Pain is what the resident says it is and therefore this is what must be treated.

And when a person doesn’t report their pain, there can be a number or reasons why;

They believe that pain is a normal part of ageing

If the resident holds this belief, they may accept the pain as being normal rather than asking for help and pain relief.

They may not know the source of their pain and simply believe there is nothing to do but to accept it.

Pain is not a normal part of ageing, and if an older person is experiencing pain then they should seek support and comfort.

They believe that their pain cannot be relieved

Some older people struggle with their pain because they think there is no other option. They may not know what pain relief can be offered to them and what their options are.

Fear of disease progression

They may fear that the pain is a sign of disease progression or decline, for example if the resident has cancer or some other terminal condition.

Pain is a sign of actual or potential tissue damage – and for older people it brings up the fear that the end may be near for them.

Fear of side effects or addiction to strong medications

Pain management can include, but not always, some form of drug therapy. Though most older people may already be on some sort of medication – maybe for blood pressure or diabetes, or other conditions – the idea of pain treatment can make people worry that they could get addicted to the medication.

People will become physically dependent on strong opioids, but this is not the same as psychological addiction.  Strong pain medicines should not be stopped suddenly.

All medication comes with warnings or side effects, which include headaches, nausea, vomiting or sedation; which usually settle after a few days. Constipation is the most common side effect of strong opioids, and needs to be managed, including increased fibre and fluids, and laxatives.

Residents should always be monitored, and if there are any side effects, a health professional should be notified immediately.

Different vocabulary for pain

Some older people may not acknowledge pain, because they use other words to describe what they are feeling.

While some people say “pain”, others may say “hurting”, “aching” or “discomfort”. People who are bilingual may use words from their own language as they do not know how to convey pain in English.

Stoicism

They may have attitudes which makes them reluctant to complain when struggling with pain, and therefore choose not to ask for help.

Older people come from a different generation – one where talking about pain may be a sign of weakness.

They have carried these attitudes with them as they’ve aged and hold the belief still.

Some people believe that being in pain is better than seeming helpless and weak – but this mentality will not relieve their painful struggle.

Impaired verbal communication

They may have reduced communication skills due to sensory and/or cognitive impairment, this could be for any number of reasons, but the most common is dementia.

Because of these impairments, their ability to communicate their pain is also affected.

When a person would normally tell you they are in pain, the older person may not be able to.

Rather, their expression will come from their behaviour – look for agitation, aggression or refusal to do things as they normally would as a sign that they might be in pain.

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