Nyeri pada individu lanjut usia: perubahan fisiologis serta pilihan analgesik yang rasional

https://doi.org/10.22146/bns.v19i2.69194

Whisnu Nalendra Tama(1*), Abdullah Syafiq Edyanto(2), Yudiyanta Yudiyanta(3)

(1) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


The etiology of pain in the elderly includes degenerative changes, metabolic disorders, and malignancy. In general, the elderly pain threshold increases, but pain tolerance threshold decreases. Pain assessment plays an important role in satisfactory pain management. However, the elderly is often uncooperative and have cognitive impairment. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and DOLOPLUS 2 methods can be used to assess pain in the elderly.

The aging process can cause pharmacokinetic and pharmacodynamic changes in the elderly. Delayed gastric emptying, decreased liver function, decreased plasma protein binding, as well as decreased muscle mass and fat affect pharmacokinetic changes in the elderly. Pharmacodynamic changes in the elderly include a decrease in the number of neurons in the pain modulation system and changes in the number and function of receptors. Pharmacokinetic and pharmacodynamic changes in the elderly need to be considered to prevent side effects occurrence.

The combination of pharmacological and non-pharmacological therapies can be used in the elderly pain management. Various types of pharmacological therapies can be used, including non-opioid analgesics—including non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol—, opioids, and adjuvant drugs such as antiepileptics and antidepressants. This literature review aims to discuss various changes in the elderly that can affect pain management as well as an overview of appropriate analgesic selection for older adults.

 

ABSTRAK

 

Etiologi nyeri pada lansia meliputi perubahan degeneratif, gangguan metabolik, dan keganasan. Secara umum pada lansia ambang batas deteksi nyeri meningkat, tetapi ambang toleransi menurun. Penilaian nyeri memegang peranan penting dalam keberhasilan manajemen. Namun demikian, lansia sering tidak kooperatif dan terjadi gangguan kognitif. Metode Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) dan DOLOPLUS 2 dapat digunakan untuk penilaian nyeri pada lansia.

Proses penuaan dapat menyebabkan perubahan farmakokinetik maupun farmakodinamik pada lansia. Perlambatan pengosongan lambung, penurunan fungsi hepar, penurunan afinitas terhadap protein pengikat di plasma, serta penurunan massa otot dan lemak mempengaruhi perubahan farmakokinetik pada lansia. Perubahan farmakodinamik pada lansia meliputi penurunan jumlah neuron pada sistem modulasi nyeri serta perubahan jumlah dan fungsi reseptor. Perubahan farmakokinetik dan farmakodinamik pada lansia perlu menjadi pertimbangan untuk mencegah risiko efek samping.

Kombinasi terapi farmakologi dan nonfarmakologi dapat digunakan sebagai manajemen nyeri. Berbagai jenis terapi farmakologis dapat digunakan, antara lain analgesik nonopioid—termasuk non-steroidal anti-inflammatory drugs (NSAID) dan parasetamol—, opioid, serta obat ajuvan seperti antiepilepsi dan antidepresi. Tinjauan pustaka ini bertujuan untuk membahas berbagai perubahan dalam individu lanjut usia yang dapat mempengaruhi manajemen nyeri serta gambaran umum pemilihan obat analgesik yang tepat bagi kelompok tersebut.


Keywords


pain management; elderly; analgesics

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DOI: https://doi.org/10.22146/bns.v19i2.69194

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