Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey

Abstract

Study objective: The purpose of this study is to determine whether older adults presenting to the emergency department (ED) with pain are less likely to receive pain medication than younger adults.

Methods: Pain-related visits to US EDs were identified with reason-for-visit codes from 7 years (2003 to 2009) of the National Hospital Ambulatory Medical Care Survey. The primary outcome was the administration of an analgesic. The percentage of patients receiving analgesics in 4 age groups was adjusted for measured covariates, including pain severity.

Results: Pain-related visits accounted for 88,031 (46.9%) ED visits by patients aged 18 years or older during the 7-year period. There were 7,585 pain-related ED visits by patients aged 75 years or older, representing an estimated 3.65 million US ED visits annually. In comparing survey-weighted unadjusted estimates, pain-related visits by patients aged 75 years or older were less likely than visits by patients aged 35 to 54 years to result in administration of an analgesic (49% versus 68.3%) or an opioid (34.8% versus 49.3%). Absolute differences in rates of analgesic and opioid administration persisted after adjustment for sex, race/ethnicity, pain severity, and other factors and multiple imputation of missing pain severity data, with visits by patients aged 75 years and older being 19.6% (95% confidence interval 17.8% to 21.4%) less likely than visits by patients aged 35 to 54 years to receive an analgesic and 14.6% (95% confidence interval 12.8% to 16.4%) less likely to receive an opioid.

Conclusion: Patients aged 75 years and older with pain-related ED visits are less likely to receive pain medication than patients aged 35 to 54 years.

Copyright © 2011. Published by Mosby, Inc.

Figures

Figure 1

Percentage of Emergency Department Pain-Related Visits by Adults in Which Any Analgesic or an Opioid was Administered by Patient Age in 5 Year Increments, NHAMCS 1999–2008.

Figure 2

Figures 2a, 2b. Percentage of Emergency Department Pain-Related Visits in Which an Analgesic (a) and an Opioid (b) were Prescribed, by Age Category and Survey Year, NHAMCS 1999–2008.

Figure 2

Figures 2a, 2b. Percentage of Emergency Department Pain-Related Visits in Which an Analgesic (a) and an Opioid (b) were Prescribed, by Age Category and Survey Year, NHAMCS 1999–2008.