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Role of Pain Medications, Consultants, and Other Services in Improved Pain Control of Elderly Adults with Cancer in Geriatric Evaluation and Management Units

Authors

  • Ryan Nipp MD,

    1. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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  • Richard Sloane MPH,

    1. Center for the Study of Aging, Duke University Medical Center, Durham, North Carolina
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  • Arati V. Rao MD,

    1. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
    2. Division of Cell Therapy and Transplantation, Duke University Medical Center, Durham, North Carolina
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  • Kenneth E. Schmader MD,

    1. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
    2. Center for the Study of Aging, Duke University Medical Center, Durham, North Carolina
    3. Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
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  • Harvey J. Cohen MD

    Corresponding author
    1. Center for the Study of Aging, Duke University Medical Center, Durham, North Carolina
    • Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Address correspondence to Dr. Harvey J. Cohen, Duke University—Center for Aging, Box 3003, DUMC, Durham, NC 27710. E-mail: harvey.cohen@duke.edu

Abstract

Objectives

To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control.

Design

Secondary data analysis from a randomized two-by-two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither.

Setting

Eleven Veterans Affairs Medical Centers.

Participants

Ninety-nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care.

Measurements

Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission.

Results

Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care.

Conclusion

Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.

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