The elderly

Much of the previous discussion (patients in whom communication is difficult) applies. In addition, it is important to remember:

  • Verbal descriptor scales may be more reliable than visual analogue scales
  • Opiate requirements in general are less but significant inter-patient variability persists
  • NSAIDs should be avoided. If you must, try a short course of ibuprofen 200 mg three times a day, consider gastroprotection and make them aware of the side-effects



  • Carefully titrated IV morphine for severe pain, starting with a lower initial bolus, e.g. 2 mg and allowing three to four minutes between top-up doses
  • Paracetamol as the non-opiate of choice

Learning Bite

NSAIDs should be avoided in the elderly. Start with a lower initial bolus of 2 mg of titrated IV morphine for severe pain in the elderly.