Pain Management in Frail Hip Fracture Patients Receiving Palliative Care: A Descriptive Study.

Abstract

Adequate pain management in frail hip fracture patients receiving nonoperative treatment has been identified as an important issue. Palliative care could be an option to consider to ensure a comfortable end of life for these patients. This study aimed to describe pain relief in frail patients admitted to palliative care following a hip fracture, and the pain management strategies used among them. This descriptive monocentric observational study included a retrospective phase, based on a review of medical records, and a prospective phase, by direct observation of patients. Data collection took place within the first five days following admission to palliative care. Pain was assessed with the ALGOPLUS scale. Data on pharmacological and nonpharmacological pain management strategies were collected from medical records. A total of 61 patients with a mean age of 87 years (±7) and severe frailty were included. The proportion of patients with pain at rest ranged from 30% on day 1 to 10% on day 5, and from 71% to 32% during mobilization. The mean oral morphine equivalent daily dose administered ranged from 13.1 mg (±10.7) to 21.9 mg (±16.2). On average, 75% of patients received co-analgesics, and nonpharmacological strategies were applied in 33% of them over the five-day of data collection period. Pain remains an issue in frail patients with a nonoperated hip fracture, despite the provision of palliative care. Optimizing pain management, particularly ahead of mobilization, remains a crucial and underexplored area to address for this population.