One of the main nursing responsibilities is to ensure patient wellbeing and comfort. In particular, comfort is closely related to nursing practices (1). Comfort is defined as relief from pain, and emotional and physical distress (2). However, hospitalized elderly patients often undergo several nursing procedures interventions during hospitalization, which are crucial for addressing their complex health needs (3). This extensive attention often exerts a toll, primarily in the form of pain (3). Effectively managing pain in this demographic group extends beyond clinical considerations because it represents a profound moral and ethical imperative given the distinctive challenges encountered by elderly individuals in hospital settings (4). These challenges include a higher prevalence of acute and chronic diseases, age-related physiological alterations, and cognitive impairment or delirium, which can seriously affect pain management (5).

Pain perception represents an intrinsic facet of human experience, which defies simplification as it is a profound subjective phenomenon shaped by an array of determinants (6). Psychological, physiological, and sociocultural factors contribute significantly to shaping how individuals perceive and cope with pain (7, 8). For elderly patients whose experiences of pain are often compounded by these multifarious factors, a tailored and specialized approach to pain management is essential.

During their hospital stay, elderly individuals undergo nursing procedures aimed at addressing their clinical condition (9). Nursing procedures encompass both basic (e.g., fundamentals of care) and advanced activities. The most frequently painful procedures in older adults include mobilization, wound dressing, bladder catheterization, and needle-related procedures, which are emerging as the most common sources of pain among elderly patients. These indispensable procedures, which are crucial during hospitalization, frequently induce discomfort (10). Unfortunately, inadequate pain management frequently persists, leading to heightened anticipatory responses to pain stimuli during subsequent procedures (11). This aspect has been widely explored in different types of patients, such as pediatric (12, 13), but evidence in elderly patients is still lacking.

From this perspective, recognizing the pivotal importance of the comfort of elderly patients and the inherently subjective nature of pain perception, it is imperative to identify effective pain management strategies customized to the unique needs and preferences of each individual patient (14). Such strategies should encompass a comprehensive spectrum spanning both pharmacological and non-pharmacological interventions (15). By addressing these pain experiences more frequently and empirically, healthcare providers can significantly improve the overall quality of life of elderly patients during their hospitalization (16).

While the comfort of older adults during hospitalization is a key concept, there is limited literature and insufficient evidence to indicate the optimal strategies for each individual nursing procedure that may cause discomfort. Furthermore, this issue is underemphasized in clinical practice, often relegated to a secondary consideration at the expense of providing quality, patient-centered care tailored to the specific needs of each hospitalized patient.

The aim of this article is to delve into the critical significance of managing acute procedure-related pain, presenting a compendium of efficacious strategies aimed at bridging the existing gap in pain management in hospitalized elderly individuals. From this perspective, this paper examines the challenges related to pain management in this specific population group, presenting evidence-based approaches that can be easily integrated among the acts of care by nurses, in order to enhance the quality of care provided to elderly patients during their hospital stay.

Effective management of pain during routine nursing procedures, such as blood draws, peripheral venous catheter placement, injections, urinary catheterization, tube insertions, and wound dressing changes, is essential for optimizing patient comfort and overall quality of healthcare delivery (3, 17).

The literature provides valuable insights into various strategies adopted by nurses, including non-pharmacological and technological approaches, to enhance patient experiences and minimize pain perception (18, 19).

These strategies encompass the nuances of evidence-based approaches, with different levels of invasiveness for elderly patients, as shown in Figure 1.

In the context of pain management during nursing procedures, there are a plethora of techniques and strategies to reduce discomfort in elderly patients (Figure 1). These techniques and strategies encompass different approaches that fit tailored and personalized care. The key concept of pain management emphasizes the importance of a patient-centered approach, highlighting the multitude of factors that influence treatment decisions within each individual's unique clinical and social context (52). This involves meticulous evaluation of pain levels, consideration of medical history, and recognition of individual needs and preferences (53). In this landscape, it is crucial to acknowledge the subjective nature of pain perception and to recognize other contributing factors, such as anxiety, which can amplify pain experience (52). In this perspective, the inclusion of non-pharmacological strategies in the nursing care plan, such as distraction techniques, is advisable. These dynamic strategies are continually evolving, alongside technological advancements and ongoing research. The overarching goal remains consistent with alleviating pain and enhancing the overall comfort of elderly patients. Healthcare providers can deliver high-quality care while prioritizing patient comfort by effectively managing acute pain and minimizing distress during procedures.

However, the existing literature and evidence concerning this topic are still lacking, underscoring the need for further exploration. Older adults are exposed to altered peripheral nerve conductivity, leading to a higher likelihood of developing pain (54). Moreover, aging is characterized by a low-grade inflammatory condition, known as “inflammation,” which affect the nociceptive system (55). Furthermore, the pharmacodynamics of analgesics are altered in older people as age-related changes in pain processing (56), enhancing the importance of non-pharmacological approaches.

Therefore, in general, managing pain related to nursing procedures involves integrating technical-operational skills with relational-communication abilities. Nevertheless, one of the key nursing interventions is advocacy, which implies both ethical and clinical relevance in nursing practice (57). Advocacy can enhance the overall quality of life of elderly patients by effectively documenting and reporting procedural pain, evaluating pain care skills, and identifying educational needs among the working group (57). We should not forget that pain management in elderly people who are unable to verbalize must be oriented to interventions that prevent the experience of pain before the beginning of a medical or nursing procedure (56).

This paper aims to represent a call to action at all levels, from the patient to healthcare management, through caregivers and individual healthcare professionals, advocating for an improvement in the quality of the evidence available on this increasingly discussed topic. By fostering a deeper understanding of pain management strategies and their impact on patient outcomes, we can collectively contribute to advancements in nursing practices and enhance the quality of care delivered to patients.

CM: Conceptualization, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing. YL: Conceptualization, Methodology, Visualization, Writing – original draft, Writing – review & editing. CA: Visualization, Writing – review & editing. CC: Writing – review & editing. CB: Writing – review & editing. KE: Writing – review & editing. PI: Writing – review & editing. SB: Methodology, Supervision, Writing – review & editing. LR: Conceptualization, Methodology, Project administration, Supervision, Writing – review & editing.