The Aging Adult
No evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one's later years.
Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include pathologies such as arthritis, osteoarthritis, osteoporosis, peripheral vascular disease, cancer, peripheral neuropathies, angina, and chronic constipation.
People with dementia do feel pain. The somatosensory cortex is generally unaffected by dementia of the Alzheimer type. Sensory discrimination is preserved in cognitively intact and impaired adults.1 Because the limbic system is affected by Alzheimer disease, current research focuses on how the person interprets and reports these pain messages.24 See further discussion on pain assessment with dementia on p. 170.
Gender Differences
Gender differences are influenced by societal expectations, hormones, and genetic makeup. Traditionally, men have been raised to be more stoic about pain and more affective or emotional displays of pain are accepted for women. Hormonal changes are found to have strong influences on pain sensitivity for women. Women are two to three times more likely to experience migraines during childbearing years, are more sensitive to pain during the premenstrual period, and are six times more likely to have fibromyalgia.18 With recent findings from the Human Genome