Role of pain medications, consultants, and other services in improved pain control of elderly adults with cancer in geriatric evaluation and management units.
OBJECTIVES: To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control. DESIGN: Secondary data analysis from a randomized two-by-two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. SETTING: Eleven Veterans Affairs Medical Centers. PARTICIPANTS: Ninety-nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care. MEASUREMENTS: Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission. RESULTS: Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care. CONCLUSION: Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.
Nipp, R; Sloane, R; Rao, AV; Schmader, KE; Cohen, HJ
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