TY - JOUR
T1 - Disparities in acute pain treatment by cognitive status in older adults with hip fracture
AU - Chang, Andrew K.
AU - Edwards, Robert R.
AU - Morrison, R. Sean
AU - Argoff, Charles
AU - Ata, Ashar
AU - Holt, Christian
AU - Bijur, Polly E.
N1 - Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: We examined the disparities in emergency department (ED) pain treatment based on cognitive status in older adults with an acute hip fracture. Methods: Observational study in an academic ED in the Bronx, New York. One hundred forty-four adults aged 65 years and older with acute hip fracture were administered the Telephone Interview for Cognitive Status (TICS) while in the ED. The primary outcome was receipt of any parenteral analgesic. The risk factor of interest was cognitive impairment (TICS ≤ 25). Secondary outcomes included receipt of any opioid, receipt of any analgesic, total dose of analgesics in intravenous morphine equivalent units (MEQ), and time to receiving first analgesic. Results: Of the 87 (60%) study patients who were cognitively impaired, 60% received a parenteral analgesic compared to 79% of the 57 cognitively unimpaired patients (RR 0.76 [95% CI 0.61, 0.94]). The effect of cognitive impairment on receiving any opioids (RR: 0.81, 95% CI 0.67, 0.98) and any analgesic (RR: 0.85; 95% CI: 0.71, 1.01) was similar. The median analgesic dose in cognitively impaired patients was significantly lower than in cognitively unimpaired patients (4 MEQ vs 8 MEQ, p = .003). Conclusion: Among older adults presenting to the ED with acute hip fracture, cognitive impairment was independently associated with lower likelihood of receiving analgesia and lower amount of opioid analgesia.
AB - Background: We examined the disparities in emergency department (ED) pain treatment based on cognitive status in older adults with an acute hip fracture. Methods: Observational study in an academic ED in the Bronx, New York. One hundred forty-four adults aged 65 years and older with acute hip fracture were administered the Telephone Interview for Cognitive Status (TICS) while in the ED. The primary outcome was receipt of any parenteral analgesic. The risk factor of interest was cognitive impairment (TICS ≤ 25). Secondary outcomes included receipt of any opioid, receipt of any analgesic, total dose of analgesics in intravenous morphine equivalent units (MEQ), and time to receiving first analgesic. Results: Of the 87 (60%) study patients who were cognitively impaired, 60% received a parenteral analgesic compared to 79% of the 57 cognitively unimpaired patients (RR 0.76 [95% CI 0.61, 0.94]). The effect of cognitive impairment on receiving any opioids (RR: 0.81, 95% CI 0.67, 0.98) and any analgesic (RR: 0.85; 95% CI: 0.71, 1.01) was similar. The median analgesic dose in cognitively impaired patients was significantly lower than in cognitively unimpaired patients (4 MEQ vs 8 MEQ, p = .003). Conclusion: Among older adults presenting to the ED with acute hip fracture, cognitive impairment was independently associated with lower likelihood of receiving analgesia and lower amount of opioid analgesia.
KW - Acute pain
KW - Cognitive impairment
KW - Emergency department
KW - Hip fracture
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U2 - 10.1093/gerona/glz216
DO - 10.1093/gerona/glz216
M3 - Article
C2 - 31560758
AN - SCOPUS:85091806509
SN - 1079-5006
VL - 75
SP - 2003
EP - 2007
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 10
ER -