retired manCRPS/RSD/Chronic Pain in the Elderly

Just as with children, for a long time it was assumed that CRPS in the elderly runs about the same course as it does in younger folks, but that's turning out not to be true, as it was for children. Whereas children tend to heal quickly, and have the greatest chance at a cure if their illness is diagnosed and treated quickly and aggressively, older folks heal more slowly and may have other illnesses or elder-related issues that make handling CRPS a special challenge.

Also, as folks get older they often find that CRPS renders them unable to do for themselves what they used to take for granted (of course, this happens at all ages, but it's much worse as we age). Thus, many of the links below are to sites designed to help you obtain the best in care for your loved one who can't live alone any more.

Title (& link)
Comments
Adherence to Pharmacological Treatment of Chronic Nonmalignant Pain in Individuals Aged 65 and Older "High pain intensity and non-adherence found in this study suggest that physicians should monitor older patients with chronic nonmalignant pain more closely and pay more attention to patients’ beliefs regarding analgesics to ensure better adherence to pharmacological therapy."
ALFA - Assisted Living
Regulations and Laws
"Members of ALFA exemplify the principles of choice, dignity, and independence for seniors. To support these principles and to enhance quality of life for seniors, ALFA influences public policy, promotes business excellence, and ensures an informed public."
Assessment of patient’s pain-related behavior at physical examination may allow diagnosis of recent osteoporotic vertebral fracture "Pain-related behavior evaluation of patients with osteoporotic VCF during their movements on the examining table may allow to suspect, or even diagnose, the presence of a fracture, particularly in the initial 4 to 6 weeks after the occurrence. Even orthopedic surgeons not particularly familiar with spine care may be able to suspect the injury during physical examination."
Assessment of primary health care received by the elderly and health quality of life: a cross-sectional study "This study showed higher PHC (Primary Health Care) attributes attainment in units with FHS (Family Health Strategy), regardless of the health problem. The degree of orientation to PHC increased the mental component score of quality of life."
Assisted Living Regulations and Laws The Assisted Living Federation of America (ALFA) is committed to maintaining strong resident-centered laws and regulations for assisted living at the state level. As part of that commitment, ALFA monitors legislation and pending regulations in each state and provides state specific resources that are valuable for senior living providers.
Assisted Living Today "In addition to the free information we provide on the topics like elder care and assisted living, we also want to help you connect with senior housing facilities and communities near you. For that reason we’ve created and continue to cultivate our directory of senior care facilities."
Drug Rehabs and Addiction
Treatment by State
"Welcome to Recovery Connection® (RCx) a comprehensive website dedicated to helping people, or their loved ones, in need of help with detox, drug addiction or alcoholism find treatment. Recovery Connection® provides a free 24/7 national helpline."
The Effect of Opioid Therapy
on Endocrine Function
"Opioid endocrinopathy can greatly affect patients, causing reduced sexual function, decreased libido, infertility, mood disorders, osteoporosis, and osteopenia."
A single dose of MPH was able to improve gait function in older adults, especially in complex dual tasks that require higher executive control. This could largely account for the effects of MPH on a sustained attention dual task, but direct effects on the motor system may have also played a role.
"In this cross-sectional nationwide epidemiological study, we showed that chronic pain is a significant problem that is present in 37% of the Portuguese adult general population, is associated with high personal, family, and social burden, and affects in particular the most vulnerable subgroups of the population."
Very useful site from EHealthMedicine, which lists every Medicare Provider and every state. Very good documentation makes it easy to see what plans are available to you in your home state.
CP (chronic pain) is highly prevalent, causes high personal and social burden, and affects particularly the most vulnerable subgroups. Portugal, depending on CP definition, could be placed in the lower prevalence group in Europe. Improvement in pain intensity management and special attention to affective components of CP are recommended.
Chronic fatigue syndrome (CFS) is definitely not the same as CRPS, but there are many similarities. The question was whether older patients have the exact sane illness as younger folks. The conclusion: "Older CFS patients demonstrate a disease phenotype very different from younger patients. The combination of differing underlying pathogenic mechanisms and the physiological aspects of aging result in a greater disease impact in older CFS patients."
"Increasing efforts are now being directed to studies on pain control in the elderly. However, pain management remains inconsistent and suboptimal. This article is an attempt to suggest an informed, comprehensive guide to achieve effective pain control in the presence of these limitations."
"Older adults (aged >65 years) make up a large portion of the population with chronic pain, and their presentation, diagnosis, and treatment tends to be more complicated because of age-related physiological changes and comorbidities."
Psychotropic Drug Metabolism
in Old Age: Principles and
Problems of Assessment
From the multi-edition volume "Psychopharmacology - 4th Generation of Progress", this chapter examines the differences in the way that elderly folks metabolize, excrete, and react to various psychotropic medications, many of which are staples of CRPS pharmacotherapy.
"An approach is outlined which involves: pain assessment, screening for substance abuse potential, deciding whether you are able to treat your patient without help, starting treatment, monitoring effectiveness of pain control and managing opioid-associated side-effects."
Dutch nursing home residents frequently experience neuropathic pain; therefore, neuropathic pain should receive more attention in frail elderly adults.
"Significantly more (44%) of the PSM (pain self-management) group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive-behavioral therapy-based PSM was more effective than exercises and usual care."
"As our loved ones age their needs change. For some, they are able to live out their retirement years playing golf and enjoying a healthful life, while other require a more advanced level of care, dictated by health and safety concerns."

Note: There are about a dozen articles in the Library on elders with CRPS, as well.