Pain assessment and management for older patients with hip fractures

Older patients with hip fractures require a multidisciplinary management approach. Central to these considerations and treatment targets is adequate analgesia, which should be provided as early as possible. An overview of pain assessment and management considerations for patients with hip fractures is provided. There are several tools available to assess severity of pain, such as the Numeric Rating Scale (NRS), Visual Analogue Scale, Pictorial Pain Scale and Verbal Descriptor Scale (VDS). For older people, the NRS and VDS may be preferred. For patients with cognitive impairment, the Pain Assessment in Advanced Dementia (PAINAD) scale or the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) may be used. Ideally, paracetamol should be provided every 6 hours, with opioids for additional breakthrough pain. If this is inadequate or if there is a requirement to reduce administration of opioids, nerve blocks may be considered. Compared to femoral nerve blocks, fascia-iliaca blocks are potentially easier to learn, safer and well-tolerated. Overall, older patients with hip fractures require adequate analgesia, which involves standardised pain assessment using appropriate tools and multimodal pain management approaches.