188Pain Assessment – A Fundamental Part of Comprehensive Geriatric Assessment in the Frail Older Adult

Abstract

Background: The prevalence of pain ranges from 50-75% in those with advancing age, however it remains underdiagnosed and undertreated. Poorly controlled pain impacts on mood, cognition and function. Overall there is increased symptom burden and reduced quality of life. Pain should not be a barrier to rehabilitation for the frail population. Methods: We collected data through Comprehensive Geriatric Assessment (CGA) in a large university hospital. We assessed a random sample of 20 patients under the Frailty service during a 6 month period (Group 1). We looked at the prevalence of pain and the quality of our pain assessment. We correlated this with their Clinical Frailty Scale (CFS) and other comorbidities. We designed and implemented a new pain assessment pathway. We combined validated tools, including the verbal and numerical rating scales and the body map. We subsequently re-assessed to see if our pain assessment was more comprehensive (Group 2). Results: The mean baseline CFS for both groups was 5. The mean CFS at the time of the CGA was 6. Both groups had a similar prevalence of acute, chronic and mixed pain. The prevalence of pain was 60% in Group 1 versus 50% in Group 2. This increased to 80% in Group 2 with the application of the new questioning strategy. The location of pain was identified in only 25% of Group 1 compared to 100% of Group 2. There was a 50% increase in the use of pain descriptors in Group 2, which enabled more accurate diagnostics. This led to improved pain management and subsequent improved function. Conclusion: Pain is very prevalent in the frail older person. The new pain pathway has improved our clinical assessment and subsequent interdisciplinary approach to care. Our findings suggest that an appropriate pain assessment template should be a fundamental part of the CGA.