SHM Converge Scientific Abstract ePoster Gallery-Pain Assessment and Opioid Administration in Older, Hospitalized Adults

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This retrospective EHR study examined pain assessment and opioid administration among 27,857 hospitalizations of adults age 65 and older on a hospital medicine service at a single academic center from 2013–2021. The authors analyzed 1,378,215 pain assessments to compare self-reported pain tools (such as the Numeric Rating Scale) with behavioral pain tools, and to identify factors associated with opioid administration measured in morphine milligram equivalents.<br /><br />Overall, 77% of pain assessments were self-reported, most commonly using the numeric rating scale. However, use of numeric ratings was less common in older patients and those with sensory impairments. End-of-life status had the lowest odds of receiving a numeric pain score.<br /><br />In adjusted models, even after accounting for pain score and other clinical factors, older age, dementia or mild cognitive impairment, and limited English proficiency were associated with fewer opioids administered. Specifically, patients with dementia/cognitive impairment and those with limited English proficiency received significantly fewer morphine milligram equivalents. Older age showed a graded association with lower opioid use, especially in the 75–84 and 85+ age groups.<br /><br />The study suggests that pain assessment and treatment may be inconsistent across vulnerable older adult populations, raising concern for both underassessment and undertreatment of pain. The authors plan further work using multilevel modeling and qualitative studies to better understand how clinician, patient, and system-level factors contribute to these differences and to identify ways to improve pain care.

Asset Subtitle

Aksharananda Rambachan

Meta Tag

Author List Aksharananda Rambachan, Leah Karliner, Margaret C. Fang, Torsten Neilens, Tung Nguyen

Category Research

Concept Pain Assessment

Concept Opioid Administration

Concept Verbal Numeric Scale

Concept Morphine Milligram Equivalent

Concept Dementia

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Aksharananda Rambachan

Track Outcomes Research

Keywords

pain assessment

opioid administration

older adults

electronic health records

numeric rating scale

dementia

limited English proficiency

hospital medicine

morphine milligram equivalents

retrospective study

Pain Assessment

Opioid Administration

Verbal Numeric Scale

Morphine Milligram Equivalent

Dementia