The elderly who go to a hospital emergency room in pain are less likely to get medication for it than younger people in similar distress, reported in the Annals of Emergency Medicine.
An analysis of a seven-year national study of E.R. patient data concluded that of patients over 75 years old, who were in pain, only 49 percent were given pain medication -- compared to more than 65 percent of those under 75. The study involved information on more than 88,000 E.R. visits. The analysis did not include elderly people who were cognitively impaired or unable to report pain.
WHERE'S THE PAIN RELIEF?
There were no clear findings for the patient-age differences of the elderly receiving pain medication; however, researchers think one possible reason may be that emergency room personnel are concerned about adverse effects of pain medications for the elderly. Another explanation could be that E.R. personnel pay more attention to diagnosis in older patients and less attention to pain relief.
"To us, the gap we observe in pain management for older patients highlights the need to better understand how best to manage pain in older patients and understand the barriers to doing this," said Timothy F. Platts-Mills, MD, lead author of the study and assistant professor of emergency medicine at the University of North Carolina at Chapel Hill School of Medicine.
"All patients, regardless of age, deserve to have relief from pain, especially when it is severe."
AGEISM AND DISCRIMINATION
If you are 75 or older and in that 20 percent less likely to get pain relief, you might well be concerned about ageism and age-discrimination, even if it is unintentional.
Hospital emergency departments are an important source of acute care for the elderly, with more than 20 million visits by patients 65 and older each year. Almost half of these visits are for the evaluation and treatment of pain, reports Science Daily.
MEDICATION SIDE EFFECT CONCERNS
"There are side effects of pain medications," Dr. Platts-Mills told The New York Times. "But in almost all cases, you can provide some pain relief for older adults by selecting appropriate medications or reducing doses."
No one wants to admit it, but some of the reason why the elderly don't get needed pain medication in hospital emergency rooms absolutely is due to ageism and age discrimination.
I say this because of an abundance of previous research which found evidence of age discrimination in healthcare. The following is just a sampling of the studies:
- Older patients wait longer in accident and emergency departments;
- Under-investigation and under-treatment of older people is wide spread and strong -- particularly evident in cancer care, cardiology and stroke. Even when taking into account confounding factors such as frailty, co-morbidity and polypharmacy, research found that ageist attitudes have an effect on overall investigation and treatment levels;
- Ageist attitudes are held by health practitioners -- even more by doctors than other healthcare staff.
- The allocation of hospital critical care beds provides evidence that a lower proportion of eligible older patients in need are admitted to high dependency and intensive care units;
- There is under-provision of appropriate palliative care and end-of-life care for older patients, involving both direct and indirect age discrimination;
- There are increasing rates of emergency readmission within one month of hospital discharge, with higher rates for older people than younger patients;
- Although elderly patients often take longer to recover from hospital procedures, there are increasing rates of early discharge with inadequate planning;
- Age discrimination in healthcare is a cumulative effect of ageist attitudes among staff, who need to be much more aware of the physiology and needs of the older patient;
- Training and education of health care professionals need to change to reflect the fact that their day-to-day role will increasingly be focused on the care of senior patients with long-term conditions, instead of younger patients with curable single conditions.
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by Sharon McEachern