Pain is highly prevalent in healthcare settings, however disparities continue to exist in pain care treatment. Few studies have investigated if differences exist based on patient related characteristics associated with aging. The objective of this study was to determine if there are differences in acute pain care for older versus younger patients. This was a multicenter, retrospective, cross-sectional observation study of 5 emergency departments across the US evaluating the 2 most commonly presenting pain conditions for older adults - abdominal and fracture pain. Multivariable adjusted hierarchical modeling was completed. A total of 6,948 visits were reviewed. Older (≥65 years) and oldest (≥85 years) were less likely to receive analgesics when compared to younger patients (<65 years), yet older patients had greater reductions in final pain scores. When evaluating pain treatment and final pain scores, differences appeared to be based on type of pain. Older abdominal pain patients were less likely to receive pain medications, while older fracture patients were more likely to receive analgesics and opioids when compared to younger patients. Differences in pain care for older patients appear to be driven by type of presenting pain.

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Background Previous studies examining gender-based disparities in Emergency Department (ED) pain-care have been limited to a single pain-condition, a single study-site, and lack rigorous control for confounders. Objective A multicenter evaluation of the effect of gender on abdominal pain (AP) and fracture (FP) pain-care outcomes. Research Design Retrospective cohort-review of ED visits at 5 US hospitals in January, April, July and October 2009. Subjects 6,931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249). Measures The primary-predictor was gender. The primary outcome was time to analgesic-administration. Secondary outcomes included time to medication-order, and the likelihood the receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain-score, ED crowding and triage acuity. Results On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP Women: 112 (65–187) min, Men: 96 (52–167) min, p<0.001] and ordering Women: [84 (41–160) min, Men: 71 (32–137) min, p<0.001], whereas women with FP did not (Administration: p=0.360; Order: p=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR: 0.766, 95% CI: 0.670 – 0.875, p<0.001), whereas women with FP were not (p=0.357). Discussion In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease gender-disparities in pain-care should take type of pain into account.

Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.Design. Secondary analysis of retrospective cohort study. Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type.Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR 5 2.03; 95 CI 5 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate 5 0.268; 95 CI 5 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P 5 0.057), but no other differences in process outcomes were found.Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.

Objective To determine whether need for surgical consult contributes to delayed or reduced analgesic administration in older adults presenting to the ED with abdominal pain. Methods Secondary data analyses from a prospective cohort study consisting of adults ≥ 65 years in age presenting to the ED with a chief complaint of abdominal pain from 11/1/2012 through 10/31/2014. Measurements included administration of analgesics, time to administration, type given, and pain score reduction. Covariates for adjusted analyses included age, sex, race/ethnicity, and Emergency Severity Index. Results 3,522 patients were included, of which 281 (8.7%) received any consult. Consult patients were less likely to receive any analgesic medication (53.0%) compared to non-consult patients (62.5%), relative risk (RR) of 0.80 (95% CI 0.70 to 0.91). However, among those patients receiving analgesic medications, there were no differences in likelihood of receiving an opioid, time to administration, or pain score reduction. When analyzing patients who received a surgical consult (n=154, 4.4%), these associations were notably stronger. Surgical consult patients had a lower rate of analgesic administration (46.8%) compared to non-consult patients (62.4%), RR = 0.75 (95% CI 0.63 to 0.89). Again, no differences were found in likelihood of receiving any opioid, time to administration, or pain score reduction. Conclusion Need for abdominal surgical consult is associated with decreased administration of analgesics in older patients, possibly indicating a continued need to improve management in this setting. This difference, however, did not impact pain score reductions.

5.3 (2.1-13.7)], infection in the last 3 months [OR 3.1(1.5-6.7)], % neutrophils > 80% [OR 4.1(1.9-9.0)], and platelet count < 150,000 [OR 3.4 (91.5-7.4)] are identified as predictors of bacteremia. There is no difference in the in-hospital mortality rate between the positive and negative blood culture groups. Conclusion: Factors that predict bacteremia are similar to factors that predict poor outcome in sepsis. However, female sex may be an important factor in bacterimic elderly patients.