Nurses, among other health professionals, consistently underrate pain in patients of all ages. Pain management in elderly orthopaedic patients is an exceptional nursing challenge. Physiologic, psychosocial, and cognitive changes that occur with the normal aging process can impact the pain experience and management of pain. This article reviews issues of psychosocial development in the elderly, common physiologic changes that occur with age, and current trends in pain assessment and management in elderly orthopaedic patients.