Older ER patients less likely to get pain treated
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Friday, November 11, 2011
By Kerry Grens
NEW YORK (Reuters Health) - People over age 75 who visit the emergency department with complaints of pain are about 20 percent less likely to have their pain treated than middle-aged patients, according to a new study.
Even among patients with severe pain, those aged 35 to 54 were 12 percent more likely to receive a pain killer than patients over 75.
"The data from the study don't tell us why this is happening," said lead author Dr. Timothy Platts-Mills, a professor at the University of North Carolina.
"As an emergency physician, I would say the most likely thing is some combination of the concern on the part of patients and physicians regarding side effects," he speculated.
Older patients tend to be on more medications than younger patients, and are considered more vulnerable to the side effects of some drugs, particularly anti-inflammatory medications called NSAIDs.
"Studies have thrown a lot of doubt in the minds of clinicians in using (pain killers) in older adults," said Dr. Ula Hwang, a researcher at Mount Sinai School of Medicine, who was not involved in the study. "My concern is this is going to magnify any disparities that might already exist."
Platts-Mills and his colleagues went through hospital survey data on more than 88,000 pain-related emergency department visits across the United States, spanning seven years.
The sample was intended to be representative of an estimated 43 million actual pain-related hospital visits each year during the study period.
Among the over-75 group, 47 out of every 100 received a pain killer or a prescription for one, versus 67 out of every 100 people between ages 35 and 54.
For patients with severe pain, 65 out of every 100 older patients received a pain killer compared to 77 out of every 100 in the middle-aged group.
"It's possible that what we see here is older adults who have pain shouldn't have gotten pain medication" because the risks outweigh the benefits, Platts-Mills told Reuters Health. "It's possible, but I don't think that's the case."
Though pain drugs could interfere with some diseases or medications, Platts-Mills said there are ways to safely treat patients' pain by using smaller doses and avoiding certain drugs.
It's possible that emergency physicians have some bias that would make them less likely to treat older patients' pain, said Hwang.
And patients themselves might be wary of using medications that could make them less functional or more prone to falling.
Among patients in the study sample, those over age 75 made 7,585 pain-related emergency department visits, representing some 3.65 million U.S. actual visits a year. About two thirds called their pain "moderate" or "severe."
Platts-Mills is continuing with research to understand the barriers that prevent older patients from receiving pain treatment as often as younger ones.
SOURCE: Annals of Emergency Medicine, online October 26, 2011.
NEW YORK (Reuters Health) - People over age 75 who visit the emergency department with complaints of pain are about 20 percent less likely to have their pain treated than middle-aged patients, according to a new study.
Even among patients with severe pain, those aged 35 to 54 were 12 percent more likely to receive a pain killer than patients over 75.
"The data from the study don't tell us why this is happening," said lead author Dr. Timothy Platts-Mills, a professor at the University of North Carolina.
"As an emergency physician, I would say the most likely thing is some combination of the concern on the part of patients and physicians regarding side effects," he speculated.
Older patients tend to be on more medications than younger patients, and are considered more vulnerable to the side effects of some drugs, particularly anti-inflammatory medications called NSAIDs.
"Studies have thrown a lot of doubt in the minds of clinicians in using (pain killers) in older adults," said Dr. Ula Hwang, a researcher at Mount Sinai School of Medicine, who was not involved in the study. "My concern is this is going to magnify any disparities that might already exist."
Platts-Mills and his colleagues went through hospital survey data on more than 88,000 pain-related emergency department visits across the United States, spanning seven years.
The sample was intended to be representative of an estimated 43 million actual pain-related hospital visits each year during the study period.
Among the over-75 group, 47 out of every 100 received a pain killer or a prescription for one, versus 67 out of every 100 people between ages 35 and 54.
For patients with severe pain, 65 out of every 100 older patients received a pain killer compared to 77 out of every 100 in the middle-aged group.
"It's possible that what we see here is older adults who have pain shouldn't have gotten pain medication" because the risks outweigh the benefits, Platts-Mills told Reuters Health. "It's possible, but I don't think that's the case."
Though pain drugs could interfere with some diseases or medications, Platts-Mills said there are ways to safely treat patients' pain by using smaller doses and avoiding certain drugs.
It's possible that emergency physicians have some bias that would make them less likely to treat older patients' pain, said Hwang.
And patients themselves might be wary of using medications that could make them less functional or more prone to falling.
Among patients in the study sample, those over age 75 made 7,585 pain-related emergency department visits, representing some 3.65 million U.S. actual visits a year. About two thirds called their pain "moderate" or "severe."
Platts-Mills is continuing with research to understand the barriers that prevent older patients from receiving pain treatment as often as younger ones.
SOURCE: Annals of Emergency Medicine, online October 26, 2011.
Reuters Health
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