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The Quality of Emergency Department Pain Care for Older Adult Patients

Authors

  • Ula Hwang MD, MPH,

    1. From the Department of Emergency Medicine
    2. Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York
    3. Geriatric Research, Education and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York
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  • Lynne D. Richardson MD,

    1. From the Department of Emergency Medicine
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  • Ben Harris MD,

    1. Department of Emergency Medicine, Advocate Christ Medical Center, University of Illinois, Oak Lawn, Illinois
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  • R. Sean Morrison MD

    1. Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York
    2. Geriatric Research, Education and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York
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Address correspondence to Ula Hwang, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029. E-mail: ula.hwang@mountsinai.org

Abstract

OBJECTIVES: To determine whether there are differences in emergency department (ED) pain assessment and treatment for older and younger adults.

DESIGN: Retrospective observational cohort.

SETTING: Urban, academic tertiary care ED during July and December 2005.

PARTICIPANTS: Adult patients with conditions warranting ED pain care.

MEASUREMENTS: Age, Charlson comorbidity score, number of prior medications, sex, race and ethnicity, triage severity, degree of pain, treating clinician, and final ED diagnosis. Pain care process measures were pain assessment and treatment and time of activities.

RESULTS: One thousand thirty-one ED visits met inclusion criteria; 92% of these had a documented pain assessment. Of those reporting pain, 41% had follow-up pain assessments, and 59% received analgesic medication (58% of these as opioids, 24% as nonsteroidal anti-inflammatory drugs (NSAIDs)). In adjusted analyses, there were no differences according to age in pain assessment and receiving any analgesic. Older patients (65–84) were less likely than younger patients (18–64) to receive opioid analgesics for moderate to severe (odds ratio (OR)=0.44, 95% confidence interval (CI)=0.22–0.88) and were more likely to more likely to receive NSAIDs for mild pain (OR=3.72, 95% CI=0.97–14.24). Older adults had a lower reduction of initial to final recorded pain scores (P=.002).

CONCLUSION: There appear to be differences in acute ED pain care for older and younger adults. Lower overall reduction of pain scores and less opioid use for the treatment of painful conditions in older patients highlight disparities of concern. Future studies should determine whether these differences represent inadequate ED pain care.

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