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- Title
Disparities in Acute Pain Treatment by Cognitive Status in Older Adults With Hip Fracture.
- Authors
Chang, Andrew K; Edwards, Robert R; Morrison, R Sean; Argoff, Charles; Ata, Ashar; Holt, Christian; Bijur, Polly E
- Abstract
<bold>Background: </bold>We examined the disparities in emergency department (ED) pain treatment based on cognitive status in older adults with an acute hip fracture.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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.
- Subjects
BRONX (New York, N.Y.); NEW York (State); HIP fractures; OLDER people; HIP joint injuries; PAIN management; COGNITION disorders; HOSPITAL emergency services; THERAPEUTIC use of narcotics; PAIN; PAIN measurement; ANALGESICS; MORPHINE; RESEARCH funding; DISEASE complications
- Publication
Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 2020, Vol 75, Issue 10, p2003
- ISSN
1079-5006
- Publication type
journal article
- DOI
10.1093/gerona/glz216