A new study has found gaps still remain in our knowledge when it comes to clinicians looking after patients’ wellbeing, especially older people.
La Trobe University adjunct associate Professor, Benny Katz, of Australian Centre for Evidence Based Aged Care (ACEBAC), looked into the current trend of evidence-based medicine and it being adopted as a means of achieving optimal medical care to reduce variations in clinical practice.
“Randomised controlled trials are considered the highest level of scientific evidence. However, older individuals are either excluded or underrepresented in these studies, and those who are included are often atypical of patients seen in clinical practice.
“There are many clinical scenarios that do not lend themselves to being answered by randomised controlled trials,” Professor Katz said.
The aim of the study was to examine the approach to clinical decision-making in frail older persons when there was little, or no scientific evidence, to guide management.
The ageing population would likely result in larger numbers of patients with complex age-related conditions seeking treatment for pain.
Dr Katz used a case study to highlight many important issues surrounding the management of pain in older adults.
“There is a need in clinical practice to find a balance with evidence-based medicine and the preferences of the patient for optimal health outcomes,” he said.
The study also highlighted the importance of Comprehensive Geriatric Assessment (CGA)—a multidimensional process designed to detect factors that may have a significant impact on the wellbeing of an older adult.
“When treating older people, clinicians not only need to take into consideration the severity of pain, but also the impact of pain and its treatment on cognition, mood and functional status.
“Combining the practices of pain medicine and CGA may result in a better outcome,” he added.
According to Professor Katz, a focus on the medical aspects and adjustment of treatment based solely on age would often not be adequate as it failed to take into consideration the “heterogeneity” of older adults.
“Some will have aged ‘well’ and need little modification to the approach used for younger patients, while others who are frail or have multiple comorbidities will require a modified approach.”
The study—The Science and Art of Pain Management in Older Persons: Case Study and Discussion—is available on request. Call 03 9479 5353.