Health Impacts of Prehospital Pain Management for Injured Older Adults

点击翻译按钮获取中文摘要

PROJECT SUMMARY Traumatic injury is a leading cause of death and disability for older adults in the United States. Due to the physiological and psychosocial processes of aging, older adults have unique trauma care needs. Unfortunately, current guidelines for trauma care and emergency medical services (EMS) to not adequately address these needs. The impact of prehospital care on health outcomes represents a substantial gap in the literature for the treatment of injured older adults. Approximately 10% of injured older adults receive opioid analgesia for pain management during the prehospital interval, or the time from the onset of injury until hospital arrival. Little is known about the consequences of these interventions. Prehospital opioid analgesia could decrease risk of delirium by managing severity of acute pain, and thereby reducing the accumulation of factors disrupting normal brain activity and improving health outcomes. Conversely, opioid pain medications are neuroactive drugs that can disrupt brain activity, increasing risk of delirium and worsening health outcomes. By either pathway, prehospital administration of opioid analgesia has profound implications for short- and long-term health and functional status of injured older adults. This application for a National Institute on Aging Mentored Research Scientist Development Award (K01) seeks support for Dr. Molly Jarman, a new Instructor of Surgery at the Brigham and Women’s Hospital Center for Surgery and Public Health who aspires to a career focused on improving the quality, effectiveness, and accessibility of prehospital EMS and trauma care systems for the older adult population in the United States. Dr. Jarman’s prior research has focused on geographic determinants of injury mortality and access to trauma center care. To extend the impact and practical application of this research, Dr. Jarman proposes to move her research toward geriatric trauma outcomes, addressing the emerging need for trauma care optimized for the aging United States population. Accordingly, the K01 training is focused on gaining knowledge in geriatric trauma care and prehospital trauma care services, as well as statistical methods for causal inference and economic analysis. The proposed research will employ advanced analytic methods to closely examine the impact of prehospital pain management interventions. Research aims will include (1) an assessment of factors influencing EMS use of prehospital opioid analgesia for injured older adults, (2) short- and long-term health outcomes associated with prehospital opioid analgesia, and (3) estimation of Medicare expenditures during the first year following injury for patients with and without prehospital pain management. The practical application of this work will be to inform efforts by national, state, and local EMS leaders seeking to provide appropriate care for injured older adults during the prehospital interval, including changes to practice guidelines and investment in EMS infrastructure and/or personnel training. By providing salary support, training, freedom from administrative responsibilities, and formal mentorship structure, this award will facilitate Dr. Jarman’s transition to an independent research career focused on improve health outcomes and functional status of injured older adults.