Clinical Geriatrics

Introduction
Persistent pain is a common problem in older adults, affecting 25-50% of community-dwelling elderly persons and 45-80% of older residents of long-term care facilities.¹ Several painful conditions occur more commonly in older than in younger adults and often go unrecognized. These include polymyalgia rheumatica, giant cell arteritis, fibromyalgia, myofascial pain syndrome, peripheral vascular disease, and leg cramps. These conditions may coexist with other painful disorders, and when untreated, may lead to a decline of functional status and quality of life, depression, falls, and increased healthcare utilization.¹ The purpose of this article is to review the assessment, clinical manifestations, and treatment of these disorders.

Introduction
Pain is common in the elderly patient, but it is greatly undertreated. Proper pain management can be complicated and can require a multitude of treatment options and modalities. Pain is the most common reason for physician visits annually,¹ with the annual cost in the United States to be more than $50 billion.^2,3 As the U.S. population ages, this number is projected to rise. The need for all physicians to become better equipped for diagnosing and treating pain is apparent.

Introduction
The opioid analgesics are among the oldest of drugs in use today, with evidence of use dating back thousands of years. These agents mimic the endogenous opioid peptides and act by reducing neuronal excitability (by hyperpolarizing the neuron via enhancement of potassium ion influx) and inhibiting neurotransmitter release (by reducing calcium ion influx). Their effects are mediated by binding to specific receptors in the central and peripheral nervous systems (Table I).¹

In this two-part article, some general concepts underlying the use of opioid analgesics

Hallucination is defined as “false sensory perception not associated with real external stimuli.” Hallucinations in patients with PD are reported as visual hallucinations in 30%,1 auditory hallucinations in 10%,2 and, rarely, tactile hallucinations.3

Visual hallucinations experienced by patients with PD are complex. They occur when the patients are awake and alert,2,4 as opposed to hypnogogic hallucinations. Hallucinations can occur at any time of the day or night, but are more common at nighttime. Initially, patients may be aware of the nonreality of these experiences but gradually bec

This continuing medical education activity is sponsored by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Evaluation and Treatment of Depression in Patients with Cognitive Impairment,” which appears on pages 39-45 in this issue of Clinical Geriatrics.

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