Interesting NAEMSP Abstracts

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Advancing Age is Associated with Less Analgesia even after Adjustment for

Acuity and Physiological Parameters C. Krauss, Sachita Shah,

H. , Massachusetts General Hospital, Boston, Massachusetts

Objectives: Given concerns about oligoanalgesia in elderly patients, this

study was conducted to assess whether advancing age was associated with less

analgesia provision, even after adjustment for physiological parameters such

as vital signs. Methods: This was a retrospective review of 100 consecutive

scene and interfacility helicopter EMS transports (7/06), where fentanyl

analgesia was administered by a nurse/paramedic crew operating under

standing orders, including fentanyl at 1-5 b.mug/kg. A multivariate linear

regression model with dependent variable initial fentanyl dose (b.mug/kg)

assessed the independent variables of age (the primary end point, group as

pediatric age < 18, adult age 18-65, geriatric age > 65), sex, blood

pressure, heart rate, respiratory rate, and intubation status. The overall

(entire transport period) fentanyl dose was also assessed to ascertain

whether any age-related differences were from conservative initial dosing.

Statistical methods also included descriptive techniques (medians, 95%

confidence intervals CI), b.chi2 testing for categorical variables, and

Kruskal-Wallis testing for nonparametric continuous variables. Statistical

significance was defined at the p = 0.05 level. Results: Increasing age was

associated with decreasing initial fentanyl dose, with age accounting for

20% of the total variation in fentanyl dosing (p < 0.001). Compared to adult

patients, geriatric patients received 0.3 b.mug/kg less fentanyl (95% CI:

0.15-0.47). Age was the only factor identified as associated with fentanyl

dose: there was no association between analgesia and sex (p = 0.15), Glascow

Coma Scale (p = 0.37), respiratory rate (p = 0.30), heart rate (p = 0.49),

or intubation status (p = 0.75). Incorporation of various physiological

variables in the model failed to change the point estimate of age-fentanyl

association and no effect modification or confounding was identified. The

results did not change when total fentanyl dose was assessed. Conclusions:

(1) Advancing age is associated with less analgesia provision, even when

physiological and acuity parameters are accounted for. (2) The tendency of

prehospital and other health care providers to administer lower analgesia

doses to older patients should be subjected to scientific scrutiny, to

determine whether age alone is a valid reason for decreasing analgesia

dosing.