title: Treating persistent pain in the elderly: how do we proceed?
abstract: OBJECTIVE
  To describe a performance improvement initiative conducted in accordance with the American Geriatrics Society (AGS) guideline regarding pharmacological management of persistent pain in older adults.
  
  
  METHODS
  Medical units of a tertiary care teaching hospital.
  
  
  METHODS
  Elderly patients were included if treated for conditions associated with persistent pain.
  
  
  METHODS
  Using three phases, the pharmacological management of persistent pain in older adults was evaluated before and after health care provider education on the AGS guideline recommendations. Educational seminars, in-service training, and handout materials focused on addressing specific shortfalls identified during the initial evaluation.
  
  
  METHODS
  Appropriate use of nonsteroidal anti-inflammatory agents (NSAIDs) and cyclooxygenase-2 selective inhibitors (coxibs), utilization of proper pain assessment tools, types of opioids used, and associated adverse effects.
  
  
  RESULTS
  A total of 50 patients with comparable demographics were included in each phase. Following education, there was an improvement in the appropriate use of pain-assessment tools in cognitively impaired older adults. There was a trend toward improvement in the use of NSAIDs and coxibs, but there was no change in practice regarding the frequency of opioid use, combining long- and short-acting opioid preparations, or preventing opioid-induced constipation.
  
  
  CONCLUSIONS
  Although findings from this study aided in recognizing areas for improvement in the management of persistent pain in older adults, further education of health care professionals is needed to ensure the safe and effective management of persistent pain.
authors.affiliation: Department of Pharmacy Services, Long Island Jewish Medical Center, New Hyde Park, NY, USA. lcorrado@nshs.edu
authors.forename: Lauren
authors.initials: L
authors.lastname: Corrado-McKeon
authors.forename: Maha
authors.initials: M
authors.lastname: Saad
authors.forename: Tanveer
authors.initials: T
authors.lastname: Mir
authors.forename: Tara
authors.initials: T
authors.lastname: Liberman
authors.forename: Tara
authors.initials: T
authors.lastname: Cleary
authors.forename: Celia
authors.initials: C
authors.lastname: Lu
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors