The Heller School for Social Policy and Management, Brandeis University

National Program on Women & Aging
 

Women & Aging Letter
Excerpt - October 1998

Health News For Women
Volume 3, Number 3
 

Pain

In recent years there has been rising interest by the medical research community regarding issues of pain as people grow older. New research seems to indicate that older people react very differently to pain contrary to past views that emphasized similarities between the young and old.

Pain, of course, is a complex experience and difficult to measure. Moreover, most research studies in the past have not taken into account many pain problems that are very common. For example, the pain and suffering associated with fractures and cancer are usually omitted from research studies on pain.

There are now available a number of studies of pain prevalence that indicate that the prevalence of pain increases from the early adult years up to approximately 60 years of age. After age 60, complaints of pain seem to reach a plateau and may even decline in extreme old age. These findings, however, are controversial.

What is pretty clear from the research to date is that the threshold of pain for older people is typically higher than for younger people. This has important implications for the physician. Reports of even mild pain by older people may indicate the existence of a major medical problem.

As we get older, we may have more difficulty getting the medical care system to deal with our pain. There is currently a reluctance on the part of many primary care physicians to refer older patients to pain clinics. These specialized health care units use people from many professions to combat serious pain problems using a variety of techniques.

It has been suggested by Professor Robert Helme of the National Ageing Research Institute in Australia that this reluctance of physicians to refer older patients to pain clinics arises for two reasons: the health care provider's perception that older people's pain is different (perhaps more manageable) or pain clinics do not work as well for older patients.

But such physician views appear uninformed. Professor Helme points out that more than a dozen studies have reported widespread success in treating older people in multi-disciplinary pain clinics. One study in Australia reported that over 95 percent of patients showed significant improvement at discharge.

The big lesson that comes from the research to date on pain is for people not to accept pain as something they necessarily have to live with. And if health professionals seem to take little interest and action to deal with it, one should consider seeking alternative care.

[Ed: The above discussion is based on an article by Robert D. Helme en-titled Pain in the Elderly, appearing in a Supplement to The Australian Journal of Ageing vol. 17-1, 1998.]

 
New Medicare Choices

Currently, if you are covered by Medicare you have two choices: traditional Medicare Part A (with optional Part B) and "Medigap" coverage or, alternatively, coverage by an HMO (Health Maintenance Organization) that contracts with Medicare. Starting in 1999 there are four additional options:

  • Coverage by a Provider-Sponsored Organization (PSO).
  • Private fee-for-service plans offered by insurance companies that have contracted with Medicare to provide basic services.
  • Medical Savings Accountsthat are complemented by a high deductible insurance policy, with differences be-tween Medicare payments to the insurance company and the company premium deposited into a tax-deferred account (which can be used at a later time for tax-qualified medical expenses).
  • Preferred Provider Organizationwhere beneficiaries may use any doctor or hospital but are charged less if they use those on an approved list.