The quality of emergency department pain care for older adult patients.
OBJECTIVE
To determine whether there are differences in emergency department (ED) pain assessment and treatment for older and younger adults.


METHODS
Retrospective observational cohort.


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


METHODS
Adult patients with conditions warranting ED pain care.


METHODS
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).


CONCLUSIONS
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.
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. ula.hwang@mountsinai.org
Ula
U
Hwang
Lynne D
LD
Richardson
Ben
B
Harris
R Sean
RS
Morrison
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D011787:Quality of Health Care; D012189:Retrospective Studies