To our knowledge, this is the first study to demonstrate that among patients with advanced cancer admitted to an inpatient oncology service, the standardized use of triggers for PC consultation is associated with substantial impact on 30-day readmission rates, chemotherapy following discharge, hospice referrals, and use of support services following discharge. Expansion of this model to other hospitals and health systems should improve the value of cancer care.
While pain is a common symptom among older adults, it often is underdiagnosed and undertreated. Aging-related physiological changes, misperceptions about the use of pain medications by both patients and providers, and the lack of evidence-based clinical research on pain management in older adults are some of the reasons why pain in older adults is mismanaged. Using extrapolated evidence from pain research in younger patients, consensus statements, and best practice guidelines, this article summarizes and highlights areas of geriatric pain assessment and management that need special consideration. Some highlighted areas include 1) pain assessment in cognitively impaired patients; 2) medication choice and initiation doses; 3) duration of adequate medication trials; and 4) common medication side effects and suggested management.
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