Older patients in an emergency room are less likely to receive adequate pain treatment than younger people are, even when pain levels are the same, according to a seven-year study published online in the Annals of Emergency Medicine.

"We were interested in learning why older adults often receive less pain medication in the ER," says Timothy Platts-Mills, MD, lead author of the study and an assistant professor at the University of North Carolina School of Medicine in Chapel Hill. "Other studies had reported on treatment disparities, and we wanted to find out more."

So Dr. Platts-Mills and his colleagues examined hospital survey data on more than 88,000 pain-related emergency room visits across the United States from 2003 to 2009 – a representative sampling of 43 million actual pain-related visits during that period.

After taking into account gender, race, pain severity and other factors, they found that just 49 percent of adults older than age 75 were given pain medication compared with 65 percent of people aged 35 to 54. Even when reporting severe pain, older adults were 12 percent less likely to receive pain-relieving drugs than middle-aged patients with similar symptoms.

"The data doesn’t tell us why this is happening," Dr. Platts-Mills says, "but there are probably multiple causes."

Generational differences

One factor, he believes, is generational. "This is the generation that grew up in the Depression and fought in World War II. They're less likely to make requests of physicians, less likely to complain and less likely to accept pain medication. Our study didn't show whether some patients who were offered analgesics declined to take them."

Heather Whitson, MD, an assistant professor of medicine at the Duke University Aging Center in Durham, N.C., who was not involved in the study, agrees that generational differences may play a role.

"Older adults tend to understate their pain – out of stoicism and also out of deference to authority. They want to be good patients, and asking for pain relief requires an assertiveness they may not feel comfortable with."

She adds that age-related problems with memory, hearing and vision can be barriers to good communication between providers and patients, too.

Drug concerns

Worries about drug interactions and side effects may also contribute to undertreatment, Dr. Platts-Mills says.