{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:40:46Z","timestamp":1788896446094,"version":"build-2803163510"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Adequate management of acute pain in the older population is crucial. However, it is inherently complex because of multiple physiological changes that significantly impact both the pharmacokinetics and pharmacodynamics of medications. Current guidelines promote paracetamol as the first-line analgesic for acute pain in older adults, whereas opioids are advised cautiously for moderate to severe acute pain. However, opioids come with a significant array of side effects, which can be more pronounced in older individuals. Ketamine administered via intranasal (IN) and nebulised inhalation in the emergency department for managing acute pain in older patients shows promising potential for improving pain management and reducing opioid reliance Kampan, Thong-on, Sri-on (2024, Age Ageing, 53, afad255). Nebulised ketamine appears superior in terms of adverse event incidence. However, the adoption of IN or nebulised ketamine in older adult acute pain management remains unclear because of the lack of definitive conclusions and clear guidelines. Nevertheless, these modalities can be valuable options for patients where opioid analgesics are contraindicated or when intravenous morphine titration is impractical or contraindicated. Here, we review these concepts, the latest evidence and propose avenues for research.<\/jats:p>","DOI":"10.1093\/ageing\/afae061","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T17:34:31Z","timestamp":1709919271000},"source":"Crossref","is-referenced-by-count":7,"title":["Challenges of acute pain management in older patients"],"prefix":"10.1093","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1673-3420","authenticated-orcid":false,"given":"Bader","family":"Almodibeg","sequence":"first","affiliation":[{"name":"Anaesthesia Technology Department , King Khalid University\u2014College of Applied Medical Sciences, Khamis Mushait, Asir , Saudi Arabia"},{"name":"Epidemiology Group\u2014Institute of Applied Health Sciences , University of Aberdeen\u2014School of Medicine, Medical Sciences and Nutrition, Foresterhill Health Campus, Aberdeen AB25 2ZD , UK"},{"name":"Pain AND Opioids after Surgery (PANDOS) Research Group , European Society of Anaesthesiology and Intensive Care, Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Forget","sequence":"additional","affiliation":[{"name":"Epidemiology Group\u2014Institute of Applied Health Sciences , University of Aberdeen\u2014School of Medicine, Medical Sciences and Nutrition, Foresterhill Health Campus, Aberdeen AB25 2ZD , UK"},{"name":"Pain AND Opioids after Surgery (PANDOS) Research Group , European Society of Anaesthesiology and Intensive Care, Brussels , Belgium"},{"name":"Department of Anaesthesia , NHS Grampian, Aberdeen , UK"},{"name":"IMAGINE UR UM 103 , Anesthesia Critical Care, Emergency and Pain Medicine Division, N\u00eemes University Hospital, Montpellier University, 30900 N\u00eemes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,1]]},"reference":[{"key":"2024040108250247600_ref1","volume-title":"Living Longer: Historical and Projected Life Expectancy in the United States, 1960 to 2060","author":"Medina","year":"2020"},{"key":"2024040108250247600_ref2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/2049463720976155","article-title":"Evidence-based clinical practice guidelines on the management of pain in older people\u2013a summary report","volume":"16","author":"Schofield","year":"2022","journal-title":"Br J Pain"},{"key":"2024040108250247600_ref3","first-page":"403","article-title":"Does pain predict frailty in older men and women? 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