350 Evaluation of analgesia prescribing in hospitalised adults ≥ 65

Abstract

Abstract Background Pain is common in hospitalised patients aged ≥65. It is recommended to follow the World Health Organisation pain ladder but special consideration should be given to the adverse effects of opiates and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Methods A retrospective review of geriatric medicine inpatients aged ≥65 years was conducted. Data was collected from August 2023 over a 24-hour period using electronic patient records. Results One hundred and nineteen patient records were reviewed. The average age was 84 years (SD = 3.53 years); 56% female. One hundred and eleven patients (93%) were prescribed analgesia. Seventy patients (56%) had pain documented as a clinical issue with musculoskeletal (MSK) pain, the most common type at 64%(n = 45)), 10% (n = 7) undocumented pain source, 8.5%(n = 6) visceral pain, 8.5% (n = 6) vascular pain, 3% (n = 2) neuropathic pain, 3% (n = 2) cancer related pain, and 3% (n = 2) dental pain. Fifty-five patients (49.5%) were prescribed regular paracetamol, and fifty-one (46%) as required (PRN) paracetamol. Twenty-two (20%) were on a regular opiate and forty-two (38%) on a PRN opiate. Oramorph was the most common opiate prescribed (n = 26). Nineteen patients (17%) were on a regular NSAID; with twenty-one (19%) on a PRN NSAID. Topical diclofenac was the most common agent (28 patients). Sixteen (14%) patients were on a neuropathic agent, of which pregabalin was the most common (9 patients). 53% (N = 63) of patients were newly prescribed paracetamol, 26% (N = 31) opiates, 18% (N = 21) NSAIDs and 8% (N = 9) neuropathic agents. Twelve patients without an active pain issue were charted regular paracetamol. Thirty-four patients prescribed opiates had renal impairment. Conclusion There was a high rate of analgesia prescribing among older hospitalised patients (93%). Paracetamol was followed by opiates, NSAIDS and neuropathic agents in frequency. Issues identified include paracetamol over prescribing, NSAID underuse and use of opiates in renal impairment. These findings suggest that clinicians would benefit from a local guideline for the management of pain in the older population.