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The literature review was conducted to explore those factors which complicate pain management in older people to inform future research, education and nursing practice in this area.Acute pain management in hospitalized older people is complex because of the physiological changes of ageing, pharmacological factors and under-representation of this patient group in reported research about assessing acute pain.A review of the literature was undertaken using electronic databases and specified search terms, some hand searching was also used and included the grey literature, textbooks and conference proceedings. A computerized literature search was carried out using CINAHL, Bandolier, Cochrane, Medline, the British Nursing Index and the International Association for the Study of Pain website for the period 1992–2004. The search terms were acute pain, older people, elder care, pain assessment and acute pain services. Thirty-seven research-based reviews and published studies and 17 policy documents were included.Managing acute pain well in older adults involves understanding the influence of a series of integrated factors: attitudes and beliefs, physiological ageing processes, pharmacological factors and the social construction of the older person in healthcare contexts.This review offers new insight into those factors which, taken together, add complexity to managing acute pain in older people well. Moreover, nurses are the professional group mainly responsible for assessing pain, administering and now prescribing analgesia and evaluating the quality of pain relief in older people. On this basis, they are also the group most likely to effect improved patient outcomes.