Date of Award

May 2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Kim Litwack

Committee Members

Christine R. Kovach, Mary Jo Baisch, Goldie Kadushin, Rebecca S. Finley, Bodan M. Minczak

Keywords

Emergency Care, Older Adults, Pain Management, Quality

Abstract

ASSESSING QUALITY OF PAIN MANAGEMENT OF OLDER ADULTS IN

EMERGENCY CARE

by

Sharon R. Rainer

The University of Wisconsin Milwaukee, 2015

Under the Supervision of Dr. Kim Litwack

Pain care of older adults in a complex system such as the emergency department (ED) is challenging and deserves further investigation. Both acute and chronic pain is common among older adults. Typically, retrospective univariate design studies evaluate independent factors related to the quality of pain treatment across all age groups. While physicians have conducted most ED pain management studies research concerning older adult pain management is under-studied especially in the nursing literature. This is important because pain is prevalent among ED patients especially those over age 65. The purpose of this study was to examine the effects of selected predictors (i.e., age, gender, and crowding) on quality of pain management for older adults (i.e., age > 65 years of age) in an urban, academic Emergency Department in the mid-east United States. In a sample of 143 patients, 40% did not receive analgesia in the ED. Of those not receiving analgesia, 53.6% were 65 years or older. Of those who did receive analgesia, the average wait from time seen by a provider to medication administration was 1.2 hours (69.9 minutes). The average length of the ED visit was 5.3 hours (317 minutes) and the average number of pain reassessments during a visit was one (1). ED crowding was not a statistically significant factor contributing to delayed initiation of pain care. Gender and age were not

statistically significant factors in the number of pain reassessments or delays in administering analgesia. Potentially inappropriate medication (PIM) prescribing was evaluated and fewer older adults received NSAIDs. More research is needed to evaluate structure, process and outcomes variables that influence pain care of older adults in the ED.

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