To the Editor: The articles by Melding1 and McClean and Higginbotham2 highlight the important problem of chronic pain in residential care.

We have conducted two studies to investigate factors related to depression in residential care. In our first study, in 1994, we approached a random one-in-two sample of the non-nursing-home population of a Sydney retirement village (n = 1466). We excluded residents who were under 65 years, had severe dementia, were away from the village at the time of the survey, or were too deaf or ill to participate. Of 610 eligible residents, 513 participated (response rate, 84%). Of these, 42.1% lived in hostels and 57.9% in independent living units. In a second, similar study, in 2000–2001, we surveyed residents of three Sydney aged-care hostels (n = 205). Of 159 eligible residents, 148 (93%) participated.

In both studies, residents were asked how often over the previous six months they had experienced recurring pain and asked to rate the severity of pain at its worst (see Box). Using the Geriatric Depression Scale (GDS),3 Study 1 found that residents reporting frequent/constant pain were significantly more likely to be depressed (ie, to have a GDS score ≥ 11) than people reporting rare/occasional pain; similarly, people who felt rare/occasional pain were more likely to be depressed than those with no pain (odds ratio, 1.44; 95% CI, 1.13–1.83). In Study 2, there was a non-significant association between frequent pain and depression (odds ratio, 1.47; 95% CI, 0.96–2.24).

We implemented pain management programs at each facility. In Study 1, the program was part of a multifaceted intervention for depression,4 but residents could attend whether depressed or not. Based on general practitioner referral, the program provided interdisciplinary assessments by a visiting rehabilitation specialist together with a physiotherapist, occupational therapist and registered nurse from the facility. Consultative psychiatric input was also available. Neuropathic and musculoskeletal pain were the most common reasons for referral. Recommended interventions included drug treatment, exercise and preventive measures. Our impression was that they were well received by residents and GPs.

In Study 2, residents with chronic pain were referred to a physiotherapist specialising in pain management and reported that this was beneficial. A clinical psychologist also offered to assist, but residents were reluctant to accept this form of help. Our impression was that psychological assistance would have been better received as part of an interdisciplinary pain management program.

Older people in residential care may find it difficult to travel to hospital-based pain management programs. Our experience indicates that it is feasible to conduct pain management programs in residential care. However, improving pain management is not only a matter of pharmacological interventions. If we are serious about achieving adequate standards of pain management in residential-care facilities in Australia, resources should also be devoted to providing accessible interdisciplinary pain management programs and to changing the attitude that pain is an inevitable part of old age.