"Assessment and Analgesia Prescription for Acute Pain in Older Adults Presenting to the Acute Frailty Unit"

"Assessment and Analgesia Prescription for Acute Pain in Older Adults Presenting to the Acute Frailty Unit"

M Aslam; A Ajmal; J Selwyn; Ageing and Health; Forth Valley Royal Hospital

Introduction:

Pain in older adults is a common yet frequently under-recognised and undertreated issue. Age-related physiological changes, cognitive decline, and communication barriers make accurate pain assessment challenging. Despite its subjectivity, patients self-report remains the most reliable measure of pain. A multidisciplinary, person-centred approach—guided by both qualitative and quantitative methods—is essential for effective pain management. A local audit at Forth Valley Royal Hospital highlighted inconsistent documentation and management of pain in older adults. Implementing structured tools, such as NHS Forth Valley’s four-level pain scale, alongside staff training and routine documentation, has the potential to improve recognition and ensure safe, effective pain relief.

Method:

Weekly data were collected over four weeks from patients aged ≥65 years presenting with acute or exacerbated chronic pain. Patients receiving palliative or end-of-life care were excluded. Baseline assessment included documentation of pain severity and adherence to NHS Forth Valley pain management guidelines. The aim is to increase the proportion of older adults, particularly those who are frail, who receive adequate analgesia within 24 hours of hospital admission.

Results:

Baseline data from 49 patients showed that pain severity was documented in only 18%, and just 49% received guideline-based analgesia. Interventions included brief teaching sessions for junior doctors on early pain documentation, reassessment, and guideline-based prescribing, supplemented by reminder emails and a poster in the MDT room. Following these interventions, pain severity documentation improved to 52%, and guideline-based analgesia prescribing increased to 72%.

Conclusion:

This two-cycle QI project demonstrated marked improvement in early pain assessment and management in older adults. Further cycles will focus on sustaining improvements and embedding practices into routine care.