Division of Hospital Medicine, Department of Medicine, UCSF, San Francisco, California, USA.
Center for Aging in Diverse Communities, Department of Medicine, UCSF, San Francisco, California, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3000-3010. doi: 10.1111/jgs.19076. Epub 2024 Jul 12.
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.
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).
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.
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.
疼痛普遍存在，但研究不足。本研究的目的是分析在关注人口统计学和老年医学相关变量的情况下，住院老年患者的疼痛评估和管理方面的不平等现象。
这是一项回顾性队列研究，纳入了 2013 年 1 月至 2021 年 9 月期间在旧金山加利福尼亚大学医学中心综合医学科住院的所有 65 岁及以上的成年人。主要暴露因素包括（1）人口统计学变量，包括种族/族裔和英语水平有限（LEP）状况，以及（2）老年医学相关变量，包括年龄、痴呆或轻度认知障碍诊断、听力或视力障碍、临终关怀和老年医学咨询参与情况。主要结局包括（1）接受数字疼痛评估与其他评估的调整比值比，以及（2）接受吗啡毫克当量（MME）测量的阿片类药物管理。
共纳入 15809 例患者，共 27857 例住院患者，共进行了 1378215 次疼痛评估，平均年龄为 77.8 岁。患者中 47.4%为白人，26.3%为 LEP，49.6%为男性，50.4%为女性。与白人患者相比，亚洲人（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）患者接受数字评估的可能性较低。与英语为母语的患者相比，LEP 患者（OR 0.70，95%CI 0.66-0.74）接受数字评估的可能性较低。有痴呆症、听力障碍、75 岁以上和临终关怀的患者都不太可能接受数字评估。与白人患者（86MME，95%CI 77-96）相比，亚洲患者（55MME，95%CI 46-65）接受的阿片类药物较少。LEP、痴呆症、听力障碍和 75 岁以上的患者接受的阿片类药物也明显较少。
少数族裔和具有老年医学相关疾病的住院老年综合医学科患者在疼痛评估和管理方面存在独特的不平等现象。这些发现引发了对疼痛评估不足和治疗不足的担忧。
