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Older Adults Less Likely to Effective Receive Pain Relief during Emergency Department Visits
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When a team of researchers reviewed more than 1,000 visits by adults seeking emergency department (ED) treatment for pain, they learned that people aged 65 to 84 were less likely than younger adults (aged 18 to 64) to receive opioid pain medication for moderate to severe pain. Older adults also experienced poorer pain relief after treatment than younger adults did.
New Research in the Journal of the American Geriatrics Society
The researchers reviewed 1,031 ED visits by adults seeking treatment for pain, and examined the differences in pain treatment between older and younger adults.
The researchers were from the Department of Emergency Medicine, Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY; Geriatric Research Education and Clinical Center (GRECC), James J. Peters Veterans Administration Medical Center, Bronx, NY; and the Department of Emergency Medicine, Advocate Christ Medical Center, University of Illinois, Oak Lawn, IL.
When it came to receiving medication for moderate pain, opioids were given to 45% of younger adults; in contrast, opioids were given to 31% of older adults. Forty-five percent of younger patients got opioids for severe pain, compared to 41% of older adults. The researchers also learned that 23% of older adults experiencing moderate pain were given non-steroidal anti-inflammatory drugs (NSAIDs), compared to just 3% of younger adults. For severe pain, 15% of younger adults got NSAIDs, compared to 18% of older adults.
For their study, the researchers classified morphine, codeine, oxycodone, propoxyphene and hydromorphone (brand names of these drugs include Darvon, Dilaudid, and Oxycontin) as "opioid" (narcotic) medications. They classified aspirin, ibuprofen, naproxen and drugs such as Celebrex as non-steroidal anti-inflammatories (NSAIDs). Acetaminophen (Tylenol) and antacids and other drugs used for abdominal pain were classed as "other pain medicine."
The researchers noted that NSAIDs should be used "with extreme caution" in older adults, because these drugs have been linked to kidney problems and an increased risk of internal bleeding. They also said that opioids are the preferred treatment for older adults with moderate to severe pain; these pain relievers are recommended by expert groups, including the American Pain Society and the American Geriatrics Society. Although no patients were discharged from the ED in severe pain, 45% of older adults were discharged in moderate pain, compared to 37% of younger adults. Older adults also experienced less of a reduction in their pain scores after treatment than younger adults.
The fear of complications or overdosing might be why older adults don't receive opioid pain medication in the ED as often as younger adults do, said study co-author Ula Hwang, MD, MPH, assistant professor of emergency medicine, geriatrics and palliative medicine at The Mount Sinai Medical Center, Bronx, NY. "Patients may also have misconceptions about using opioid medications and may believe they shouldn't take 'narcotic' drugs for pain," added Dr. Hwang.
In general, the results of their study indicate that "Older adults who come to the ED with all types of pain may not receive pain care that's as effective as the pain care younger adults receive," said Dr. Hwang. "This may be because older adults receive fewer opioid medications. In some cases, older adults might receive medications for their pain such as ibuprofen (NSAIDs), when their pain could be better treated with other drugs, such as acetaminophen or an opioid," Dr. Hwang added.
What Should I Do?
"Older adults do not have to tolerate pain," said Dr. Hwang. "If you're in pain while in the ED, you should speak up for yourself-or have a caregiver advocate for you. Let the emergency clinician know you're in pain and would like to receive pain medication," suggested Dr. Hwang.
This summary is from the full report titled, "The Quality of Emergency Department Pain Care for Older Adult Patients ." It is in the November 2010 issue of the Journal of the American Geriatrics Society. The report is authored by Ula Hwang, MD, MPH; Lynne D. Richardson, MD; Ben Harris, MD; and R. Sean Morrison, MD.