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Medication Management in the Elderly Population: In Search of the Right Balance

This issue of Pain Practice focuses on the treatment of pain in the elderly population in three papers. Physicians face many dilemmas when prescribing medications to this group of patients. The increasing life expectancy confronts health care providers with the challenge of preserving health and quality of life of older citizens. By 2050, the number of people in the EU aged 65 and above is expected to grow by 70% and the number of people aged over 80 by 170%. These figures indicate that besides the increase of the elderly population also the number of frail elderly with multimorbidity and polypharmacy will increase. As Pergolizzi et al. pointed out in their paper, we recognize that there is no universal accepted definition for the term ‘‘polypharmacy.’’ It can be used to indicate a high number of medications (usually more than five), but polypharmacy can also indicate that different drugs are used inappropriately especially for different concomitant comorbidities. The latter is, in our view, more relevant in elderly patients, since symptom control, like pain, may require the use of drugs with a different mechanism of action. This makes the number of medications per se less relevant. When thinking about polypharmacy only in terms of numbers of medications, there is a risk of under prescribing medications for symptom control. Many elderly patients experience pain requiring treatment with more than one medication to improve their quality of life.