Patient involvement in medical decision-making and pain among elders: physician or patient-driven?

A cross-sectional population-based survey of 3,135 persons age 65 and older was conducted in the 108-county region comprising West Texas. The survey included self-reports of frequent pain and, among those with frequent pain, the severity of pain.Findings from multivariate logistic regression analyses showed that higher patient-driven participation in decision-making was associated with lower odds (OR, 0.82; 95% CI, 0.75–0.89) of frequent pain, but was not significantly associated with severe pain. Physician-driven participation was not significantly associated with frequent or severe pain.The findings suggest that patients may need to initiate involvement in medical decision-making to reduce their chances of experiencing frequent pain. Changes to other modifiable health care characteristics, including access to a personal doctor and health insurance coverage, may be more conducive to limiting the risk of severe pain.Persons age 65 years and older commonly endure a multitude of chronic and debilitating conditions which contribute to persistent pain [1]. Estimates of the prevalence of pain among the community-dwelling elderly range between 25% and 50% [2,3]. Pain has been found to have a substantial effect on health-related quality of life [2], the use of over the counter and prescription drugs [1,4], and the utilization of medical care [5]. As the number of elderly persons in the United States rises, more research is needed to determine how the delivery of medical care could be altered to limit the onset of pain and its subsequent burden on health status and the health care system.Increasing patients' involvement in the medical decision-making process is one potentially fruitful means of improving pain management. Several studies suggest that patients, especially those with chronic conditions, who have opportunities to participate in care have more positive health outcomes than those who do not [6,7]. While other studies have pointed out that the positive correlation