Development of an Algorithm for the Management of Acute Pain in Adults 65yrs and Older in an Acute Hospital setting

Background Current research indicates that patients aged over 65yrs have a 10% risk of frailty, with this number increasing up to 50% in patients over 85yrs age1. The management of acute pain within this group of patients is challenging owing to the increased risk of delirium if pain or medications to relieve the pain are poorly managed. Given the ageing Irish population and the prospective increased demands on the health care system, we aimed to evaluate if current practice is in keeping with national opioid prescribing recommendations and stewardship. Methods A snapshot audit approach using point prevalence was undertaken in 2024. All patients meeting the inclusion criteria, > 65yrs and able to self-report, were assessed by the Clinical Nurse Specialist in Pain Medicine, using The Pain Assessment Documentation Tool (PADT). Results Forty eight (54%) of inpatients met the inclusion criteria. There was a 35% incidence of severe pain. Furthermore, 23% felt their physical function had declined since admission due to pain and 12.5% reported pain interfered with their sleep. A total of 46% of the patients were prescribed opioids, in line with HSE guidance. However, of this cohort, 33% received no dose of prescribed short acting opioid, despite the high reported rate of severe pain. Thus, highlighting the need to provide further support for clinical staff to ensure the appropriate use of analgesia at ward level. Conclusion This audit identified crucial areas for immediate improvement. Notably, the need for a tailored algorithm for the management of acute pain in patients > 65yrs. This led to the formation of a working group, including Pain Medicine CNS, Pain Consultant and Clinical Pharmacist resulting in the development of two algorithms aimed at addressing both acute and neuropathic pain informed by best practice and an extensive literature review.