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Francesco Landi, MD, PhD; Graziano Onder, MD; Matteo Cesari, MD; Giovanni Gambassi, MD; Knight Steel, MD; Andrea Russo, MD; Fabrizia Lattanzio, MD, PhD; Roberto Bernabei, MD; for the SILVERNET-HC Study Group

Arch Intern Med. 2001;161:2721-2724.

Background  Pain is a common problem among older people living in different community settings. As indicated by the World Health Organization (WHO), pain can be relieved using pharmacologic agents. However, pain continues to be addressed inadequately.

Objectives  To describe the prevalence of pain in frail elderly people living in the community and to evaluate the adequacy of pain management.

Methods  We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home health care programs. Twelve home health care agencies participated in the project evaluating the implementation of the Minimum Data Set for Home Care instrument. We enrolled 3046 patients, 65 years and older, in the present study. The main outcome measures were the prevalence of daily pain and analgesic treatment.

Results  A total of 1341 individuals (39%, 49%, and 41% of those aged 65-74, 75-84, and 85 years, respectively) reported daily pain. Of patients with daily pain, 25% received a WHO level 1 drug; 6%, a WHO level 2 drug; and 3%, a WHO level 3 drug (eg, morphine sulfate). Patients 85 years or older were less likely to receive analgesics compared with the younger patients (univariate odds ratio, 0.73; 95% confidence interval [CI], 0.60-0.89). Another independent predictor of failing to receive any analgesic was low cognitive performance (adjusted odds ratio, 0.80; 95% CI, 0.69-0.93).

Conclusions  Daily pain is prevalent among frail elderly patients living in the community and is often untreated, particularly among older and demented patients.

From the Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore (Drs Landi, Onder, Cesari, Gambassi, Russo, and Bernabei), and Pfizer Italiana SpA (Dr Lattanzio), Rome, Italy; and the New Jersey Medical School and Homecare Institute, Hackensack University, Hackensack, NJ (Dr Steel). A complete list of participants in the Silver Network Home Care (SILVERNET-HC) Study Group was published previously (Aging Clin Exp Res. 1999;11:272 and Anziani Oggi. 2000;3-4:152).

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