Abstracts 2008 - 01

Dr Elizabeth Aitken, FRCP MBBS
Consultant in Elderly Care Medicine
University Hospital Lewisham, London

Elizabeth trained at King’s College Hospital, London University.  After post graduate training at King’s and Bromley Hospital, she was appointed Consultant Physician in General and Geriatric medicine at University Hospital Lewisham in 1997.  She has a clinical interest in orthogeriatrics, osteoporosis, syncope and falls.  She leads the audit and clinical governance for the Medicine Division at Lewisham Hospital and since 2000 has led the falls service.  More recently she has taken over as Clinical Director for Older Adults and Long Term Conditions.  In 2007 she led a service redesign for the care of older people with fractured neck of femur presenting to Lewisham.  Her main interests are in service development for older people and care of older people with hip fractures.

Elizabeth has recently been appointed as Clinical Pathway Improvement Facilitator for Fractured neck of femur care with the NHS Institute for Innovation and Improvement.

ABSTRACT - Pain in the Elderly with particular reference to Fractured Neck of Femur

The lifetime risk of a woman having a hip fracture is 15%.  Of these women up to 50% will lose their ability to live independently and a number will need continuing care.  There are many factors known to help patients with hip fracture have a better outcome, including early operation, early mobilisation and optimal pain control.

Pain in older adults, particularly in patients with dementia is under-recognised and under- treated.    We wanted to ensure that pain was recognised and adequately assessed.

In 2007 University Hospital Lewisham redesigned the fractured neck of femur care pathway.  This involved a complete redesign of the service with patients being admitted directly under the care of a physician onto an acute elderly medicine ward.    As part of the service redesign, a pain pathway was developed by a sub group of the team in order to ensure that these elderly, frail patients with multiple co-morbidities had their pain adequately controlled. 

At the same time in September 2007 the British Geriatric Society and the British Pain Society jointly published a document “The assessment of pain in older people”. 

A summary of these pain guidelines and the future plans for management of patients with hip fracture will be presented.  The presentation concentrates on the assessment of pain in older patients, in particular older patients with cognitive impairment and the clinical signs with particular reference to these guidelines.  The role of the scales that can be used in older people will be discussed.

Useful websites and references:

National Hip Fracture Database:  www.nhfd.co.uk

Royal College of Physicians Falls and Bone Health Audit:  www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/Pages/Falls-and-Bone-Health-in-Older-People.aspx

Scottish Intercollegiate Guidelines Network Prevention and Management of Hip Fracture in Older People:  www.sign.ac.uk/guidelines/fulltext/56/index.html

Guidance on the assessment of pain in older people published September 2007 by the British Pain Society and the BGS.
http://www.bgs.org.uk/Publications/Publication%20Downloads/Sep2007PainAssessment.pdf