Aches and Pain in the Geriatric Trauma Patient
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PAIN MANAGEMENT IN TRAUMA (MR HOFFMAN, SECTION EDITOR)
Aches and Pain in the Geriatric Trauma Patient Laura R. Brown 1
&
Alexandra C. Ferre 2 & Vanessa P. Ho 1,3
Accepted: 15 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review This review examines the pain control options for geriatric trauma patients, who represent an increasing proportion of the trauma population. Recent Findings Current pain management of geriatric trauma patients has evolved to a multimodal pain approach including nonopioid medications and regional anesthesia, due to safety concerns with respiratory depression and delirium when using primarily opioid-based pain regimens. Ideal regimens incorporate treatment of multiple pain pathways to decrease the required dosages of all pain medicine to safer thresholds, especially in the geriatric patient population. Intravenous, oral, and transdermal adjunctive medications provide effective pain control for these patients. Regional anesthesia also improves pain control and decreases narcotic use, especially in the setting of rib and femoral fractures. Summary The growing population of elderly trauma patients requires thoughtful multimodal pain therapy regimens tailored to injury type and personalized to the patient’s comorbidities to optimize outcomes and prevent complications. Keywords Analgesics . Opioid/adverse effects/therapeutic use . Geriatrics/*methods . Pain management/*methods . Pain . Postoperative/*drug therapy . Multimodal analgesia . Pain measurement in older adults
Introduction As healthcare and medical technology improves, adults are living longer and maintaining high activity levels as they age. The national trauma databank shows that the number of geriatric trauma patients is steadily increasing from 23% of the total trauma population in 2003 to 30% in 2016, which is the last annual report. Among a survey of practitioners of geriatric trauma care, > 80% of respondents indicated that geriatric trauma is an increasing problem, use of sedative medication This article is part of the Topical Collection on Pain Management in Trauma * Laura R. Brown [email protected] 1
Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Metro Health Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
2
Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
3
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
contributes to delirium, delirium is a major issue for these patients, and geriatric-specific protocols are needed [1•]. As this population continues to increase in size, trauma care needs to focus on safe and optimized care for this patient population. Older adults exhibit unique pain control issues when compared to their younger counterparts. Multiple studies demonstrate an association between delirium, postoperative complications, mortality, falls, and the use of opioid medications in elderly patients [2••, 3,
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