Prehospital pain management in older adults with proximal Femur fractures: current practices and implications for delirium prevention.

ABSTRACT:

Background

Delirium is still a common complication among older adults. Established multifactorial interventional programs focus on intrahospital management. Except general recommendations as maintaining vital parameters, prehospital management stays unacknowledged. There is a contrast between insufficient prehospital pain management and analgesics possibly contributing to delirium.

Objectives

Our aim was to evaluate current practice of prehospital management in terms of pain management and transport. Secondary aim was to evaluate if medication administered by Emergency Medical Services influences the incidence of perioperative delirium in patients ⩾ 70 years.

Methods

A retrospective analysis of 137 patients was performed in 2020 to 2021. The analysis is based on screened patients within a prospective observational cohort study investigating postoperative delirium incidence in a study cohort of patients ⩾ 70 years who received surgical treatment due to proximal femur fracture at a geriatric level I trauma center. The data were blinded for further analysis of prehospital protocols. We evaluated basic demographic data, parameters included in the current documentation protocol and recorded measures including administration of medication.

Results

Mean age of the study collective was 86.9 (SD ± 6.8) years with 66% being female. Documentation frequency decreased following initial assessment. No correlation between pain level, administration of medication and the occurrence of perioperative delirium was found. More than half presented with pain ⩾4/10 NRS. Overall analgesia was initiated in only 10% in the entire cohort, mostly by emergency physicians. We saw a correlation between preexisting dementia and preoperative delirium and a slightly higher rate of delirium in patients with suspected dehydration.

Conclusions

Prehospital pain management and documentation is still insufficient in older patients. If any correlation between different types of prehospital analgesia and perioperative delirium is to be found we first need to implement a sufficient standard of care regarding pain management. Fluid substitution can be useful if the individual state of dehydration is evaluated.

SUBMITTER: Brauckmann V 

PROVIDER: S-EPMC12901908 | biostudies-literature | 2026

REPOSITORIES: biostudies-literature