Here - American Geriatrics Society

P OSTER
A BSTRACTS
the use of instruments validated for this particular environment is not
yet widespread. The ideal timing of or interval during which a delirium
screening process should take place has yet to be determined. Future
research in the ED will be needed to both validate delirium
screening instruments that are currently used for investigation and
clinical care as well as to define the ideal timing and form of the delirium
assessment process for older adults.
B30
Pain Care in the Emergency Department: Is it Satisfactory?
M. Barlow, U. Hwang. Department of Emergency Medicine;
Department of Geriatrics and Palliative Medicine, Mount Sinai
School of Medicine, New York, NY.
Supported By: Michelle Barlow was funded by an AFAR grant
through the 2011 MSTAR program.
Ula Hwang is supported by a K23 award from the NIA.
BACKGROUND: Pain is a common reason for emergency department
(ED) visits by older adults. There is evidence that older
adults receive poorer ED pain care than younger patients, but many
of these studies used retrospective data and were unable to assess patient
satisfaction. The objective of this study is to compare the quality
of ED pain care received with patient satisfaction.
METHODS: This is a prospective observational study at an academic,
tertiary care medical center that has been ongoing since July
2011. Adult patients (≥ 20 years), who present to the ED with severe
abdominal pain (pain score 10 out of 10) are surveyed at the end of
their ED visit regarding their pain, care received, and satisfaction levels.
Quality metrics of pain care received as well as covariates (age,
gender, ethnicity, Charlson comorbidity score, etc.) are abstracted
from the medical record.
RESULTS: Between July 7 and November 14, 2011, 90 subjects
meeting inclusion criteria were surveyed. There were no significant
differences between older adults (65+ years, 16%) and younger
adults (20-64 years, 84%) in their surveyed pain scores, time to first
analgesic administration, nor overall receipt of analgesics. There was
also no difference in pain care satisfaction. When comparing the 69%
of patients satisfied with pain care versus the 31% who were unsatisfied,
those who were satisfied had lower surveyed pain scores (5.64 vs.
8.88, p < 0.0001) and were less likely to want more analgesics (37% vs.
86%, p < 0.0001). Unsatisfied patients waited longer for administration
of first analgesic (trend, p = 0.09). There was, however, no significant
difference in analgesic administration (86% of unsatisfied received
analgesics vs. 85% of satisfied).
CONCLUSIONS: Pain care satisfaction is associated with lower
pain scores and decreased desire for additional analgesics. Contrary
to growing evidence of poorer ED pain care for older adults, subjects
in this cohort appear to receive equivalent care to their younger
counterparts. Older and younger adults received and had analgesics
administered in similar time frames; they also had similar pain scores
and levels of satisfaction. This is the opposite of recent studies and
may indicate that both the type (abdominal versus other pain) and
severity of pain described as well as the quality indicators used to define
appropriate care may impact the level of discrepancy observed.
B31
Functional Impairment and Disability during the Last Two Years
of Life.
A. K. Smith,Y. Miao,W. Boscardin, K. Covinsky. Medicine, Division of
Geriatrics, University of California, San Francisco, San Francisco, CA.
Supported By: NIA, NCRR.
Background: We know little about the national prevalence of
disability at varying points across the last years of life.
Methods: Data are from participants ages 50+ who died in the
Health and Retirement Study (HRS) between the years 1995 and
2008. Each participant was interviewed once in the last 24 months of
life. We used the HRS interview closest to death to reconstruct national
estimates of the monthly prevalence of functional impairment
and disability in the two years prior to death. Measures of functional
impairment and disability included: IADL difficulty (Difficulty with
cooking, shopping, using telephone, taking medications, managing
money); ADL dependence (requires assistance with dressing,
bathing, eating, transferring, walking across the room, and toileting).
We estimated the predicted probability of functional impairment or
disability by age at death and gender, adjusting for race or ethnicity,
educational level, net worth, and proxy status.
Results: There were 7624 decedents (mean age at death 80,
52%% women, 84% White, 10% African-American, 4% Latino, 27%
proxy interview). The unadjusted prevalence of all forms of functional
impairment rose linearly over the last two years of life (Table).
The predicted prevalence of disability prior to death rose with advancing
age. After adjustment for gender, race/ethnicity, educational
level, net worth, and proxy status, the predicted prevalence of any
ADL dependency for elders ages 50-69 12 months prior to death was
24% (95% CI 18-29), compared to 29% (24-34) for ages 70 to 79, 37%
(31-44) for ages 80 to 89, and 47% (41-54) for ages 90 and older (p for
trend