Pain Management Considerations in the Geriatric ED Patient: Start Low, Go Slow, But Get Somewhere

Hoel RW, Giddings Connolly RM, Takahashi PY. Polypharmacy Management in Older Patients. Mayo Clin Proc. 2021;96(1):242–56. https://doi.org/10.1016/j.mayocp.2020.06.012.

Article  PubMed  Google Scholar 

Gazelka HM, Leal JC, Lapid MI, Rummans TA. Opioids in Older Adults: Indications, Prescribing, Complications, and Alternative Therapies for Primary Care. Mayo Clin Proc. 2020;95(4):793–800. https://doi.org/10.1016/j.mayocp.2020.02.002.

Article  CAS  PubMed  Google Scholar 

Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry. 2019;93:284–90. https://doi.org/10.1016/j.pnpbp.2019.04.006.

Article  PubMed  PubMed Central  Google Scholar 

• Elder NM, Heavey SF, Tyler KR. Emergency Department Pain Management in the Older Adult. Clin Geriatr Med. 2023;39(4):619–34. https://doi.org/10.1016/j.cger.2023.05.012. Inclusive, wide ranging articles with sections on physiology, pain syndromes, and multiple tables outlining medication choices.

Article  PubMed  Google Scholar 

Tyler KR, Hullick C, Newton BA, Adams CB, Arendts G. Emergency department pain management in older patients. Emerg Med Australas. 2020;32:840–6. https://doi.org/10.1111/1742-6723.13562.

Article  PubMed  Google Scholar 

Escourrou E, Laurent S, Leroux J, Oustric S, Gardette V. The shift from old age to very old age: an analysis of the perception of aging among older people. BMC Prim Care. 2022;23(1):3. https://doi.org/10.1186/s12875-021-01616-4. Published 1 Jan 2022.

Article  PubMed  PubMed Central  Google Scholar 

Khan KT, Hemati K, Donovan AL. Geriatric Physiology and the Frailty Syndrome. Anesthesiol Clin. 2019;37(3):453–74. https://doi.org/10.1016/j.anclin.2019.04.006.

Article  PubMed  Google Scholar 

Zucchelli A, Vetrano DL, Grande G, et al. Comparing the prognostic value of geriatric health indicators: a population-based study. BMC Med. 2019;17(1):185. https://doi.org/10.1186/s12916-019-1418-2. Published 2 Oct 2019.

Article  PubMed  PubMed Central  Google Scholar 

Vrettos I, Voukelatou P, Panayiotou S, et al. Factors Associated With Mortality in Elderly Hospitalized Patients at Admission. Cureus. 2022;14(2):e22709. https://doi.org/10.7759/cureus.22709. Published 28 Feb 2022.

Article  PubMed  PubMed Central  Google Scholar 

Pietiläinen L, Bäcklund M, Hästbacka J, Reinikainen M. Premorbid functional status as an outcome predictor in intensive care patients aged over 85 years. BMC Geriatr. 2022;22(1):38. https://doi.org/10.1186/s12877-021-02746-1. Published 10 Jan 2022.

Article  PubMed  PubMed Central  Google Scholar 

Magidson PD, Thoburn AK, Hogan TM. Emergency orthogeriatrics: concepts and therapeutic considerations for the geriatric patient. Emerg Med Clin North Am. 2020;38(1):15–29. https://doi.org/10.1016/j.emc.2019.09.002.

Article  PubMed  Google Scholar 

•• American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. J Am Geriatr Soc. 2023;71(7):2052–81. https://doi.org/10.1111/jgs.18372. Periodically updated benchmark article. Provides clinicians with a framework for understanding how to safely prescribe medications to older adults. Organizes the approach based on the medications themselves, in context of other medications, and in context of disease states.

Article  Google Scholar 

Joseph A, Vemula B, Smith TJ. Symptom Management in the Older Adult: 2023 Update. Clin Geriatr Med. 2023;39(3):449–63. https://doi.org/10.1016/j.cger.2023.04.006.

Article  PubMed  Google Scholar 

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. Pain Med. 2009;10(6):1062–83. https://doi.org/10.1111/j.1526-4637.2009.00699.x

• Rajput K, Ng J, Zwolinski N, Chow RM. Pain Management in the Elderly: A Narrative Review. Anesthesiol Clin. 2023;41(3):671–91. https://doi.org/10.1016/j.anclin.2023.03.003. Inclusive, wide ranging articles with sections on physiology, pain syndromes, and multiple tables outlining medication choices.

Article  PubMed  Google Scholar 

Mattison MLP. Delirium. Ann Intern Med. 2020;173(7):ITC49–64. https://doi.org/10.7326/AITC202010060.

Article  PubMed  Google Scholar 

Liu YP, Chien WC, Chung CH, Chang HA, Kao YC, Tzeng NS. Are Anticholinergic Medications Associated With Increased Risk of Dementia and Behavioral and Psychological Symptoms of Dementia? A Nationwide 15-Year Follow-Up Cohort Study in Taiwan. Front Pharmacol. 2020;11:30. https://doi.org/10.3389/fphar.2020.00030. Published 14 Feb 2020.

Article  PubMed  PubMed Central  Google Scholar 

Growdon ME, Gan S, Yaffe K, Steinman MA. Polypharmacy among older adults with dementia compared with those without dementia in the United States. J Am Geriatr Soc. 2021;69(9):2464–75. https://doi.org/10.1111/jgs.17291. Epub 2021 Jun 8. PMID: 34101822; PMCID: PMC8440349.

Article  PubMed  PubMed Central  Google Scholar 

Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nat Rev Neurol. 2022;18(10):579–96. https://doi.org/10.1038/s41582-022-00698-7.

Article  PubMed  PubMed Central  Google Scholar 

Sillner AY, Holle CL, Rudolph JL. The Overlap Between Falls and Delirium in Hospitalized Older Adults: A Systematic Review. Clin Geriatr Med. 2019;35(2):221–36. https://doi.org/10.1016/j.cger.2019.01.004.

Article  PubMed  Google Scholar 

Daoust R, Paquet J, Moore L, et al. Recent opioid use and fall-related injury among older patients with trauma. CMAJ. 2018;190(16):E500–6. https://doi.org/10.1503/cmaj.171286.

Article  PubMed  PubMed Central  Google Scholar 

Bolding DJ, Corman E. Falls in the Geriatric Patient. Clin Geriatr Med. 2019;35(1):115–26. https://doi.org/10.1016/j.cger.2018.08.010.

Article  PubMed  Google Scholar 

Baker M, Perazella MA. NSAIDs in CKD: Are They Safe? Am J Kidney Dis. 2020;76(4):546–57. https://doi.org/10.1053/j.ajkd.2020.03.023.

Article  CAS  PubMed  Google Scholar 

Martinelli AN. Rapid Fire: Polypharmacy in the Geriatric Patient. Emerg Med Clin North Am. 2021;39(2):395–404. https://doi.org/10.1016/j.emc.2021.01.001.

Article  PubMed  Google Scholar 

Koyyada A. Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations. Therapie. 2021;76(1):13–21. https://doi.org/10.1016/j.therap.2020.06.019.

Article  PubMed  Google Scholar 

Garlich JM, Pujari A, Debbi EM, et al. Time to block: early regional anesthesia improves pain control in geriatric hip fractures. J Bone Joint Surg Am. 2020;102(10):866–72. https://doi.org/10.2106/JBJS.19.01148.

Article  PubMed  Google Scholar 

Wolmarans M, Albrecht E. Regional anesthesia in the emergency department outside the operating theatre. Curr Opin Anaesthesiol. 2023;36(4):447–51. https://doi.org/10.1097/ACO.0000000000001281.

Article  PubMed  PubMed Central  Google Scholar 

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA: UpToDate, Inc.; July 30, 2021. https://online.lexi.com. Accessed 7 Dec 2023.

Varrassi G, Pergolizzi JV, Dowling P, Paladini A. Ibuprofen Safety at the Golden Anniversary: Are All Nsaids the Same? A Narrative Review. Adv The 2020;37(1):61–82.

Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2017;70(2):177–84.

Article  PubMed  Google Scholar 

Platt E, Neidhardt JM, End B, et al. Safety and efficacy of low-dose versus high-dose parenteral ketorolac for acute pain relief in patients 65 years and older in the emergency department. Cureus. Published online 12 Jun 2023.

Motov S, Mann S, Drapkin J, et al. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial. Am J Emerg Med. 2019;37(2):220–7.

Article  PubMed  Google Scholar 

Fields TR. The challenges of approaching and managing gout. Rheum Dis Clin North Am. 2019;45(1):145–57.

Article  PubMed  Google Scholar 

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