Pain management inequities by demographic and geriatric-related variables in older adult inpatients

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-12 DOI:10.1111/jgs.19076

Aksharananda Rambachan MD, MPH, Torsten B. Neilands PhD, Leah Karliner MD, MAS, Kenneth Covinsky MD, MPH, Margaret Fang MD, MPH, Tung Nguyen MD

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引用次数: 0

Abstract

Background

Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables.

Methods

This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME).

Results

A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70–0.80), Latinx (OR 0.90, 95% CI 0.83–0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64–0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66–0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77–96), Asian patients (55 MME, 95% CI 46–65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids.

Conclusion

Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.

Abstract Image

查看原文本刊更多论文

按人口统计学和老年病学相关变量划分的老年住院患者疼痛管理不平等现象。

背景介绍疼痛无处不在，但研究却不足。本研究旨在分析住院老年人疼痛评估和管理中的不平等现象，重点关注人口统计学和老年医学相关变量：这是一项回顾性队列研究，从 2013 年 1 月到 2021 年 9 月，研究对象是加州大学旧金山分校医疗中心普通内科服务中所有 65 岁或以上的成年人。主要暴露因素包括：（1）人口统计学变量，包括种族/民族和英语水平有限（LEP）状态；（2）老年病相关变量，包括年龄、痴呆或轻度认知障碍诊断、听力或视力障碍、临终关怀和老年病咨询参与。主要结果包括：（1）数字疼痛评估与其他评估的调整几率；（2）以吗啡毫克当量（MME）衡量的调整后阿片类药物用量：共有 15,809 名患者接受了 27,857 次住院治疗，1,378,215 次疼痛评估，平均年龄为 77.8 岁。患者中 47.4% 为白人，26.3% 患有 LEP，49.6% 为男性，50.4% 为女性。与白人患者相比，亚裔（OR 0.75，95% CI 0.70-0.80）、拉丁裔（OR 0.90，95% CI 0.83-0.99）和夏威夷原住民或太平洋岛民（OR 0.77，95% CI 0.64-0.93）患者进行数字评估的几率较低。与讲英语的患者相比，有 LEP（OR 0.70，95% CI 0.66-0.74）的患者进行数字评估的几率较低。痴呆症患者、听力受损患者、75 岁以上患者和临终患者接受数字评估的几率都较低。与白人患者（86 MME，95% CI 77-96）相比，亚裔患者（55 MME，95% CI 46-65）接受阿片类药物治疗的比例较低。有语言障碍、痴呆症、听力障碍和 75 岁以上的患者接受阿片类药物治疗的次数也明显较少：结论：来自少数群体和患有老年病的住院老年普通内科病人特别容易受到不公平疼痛评估和管理的影响。这些发现引起了人们对疼痛评估不足和治疗不当的担忧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.