Silence of the Brittle: The Role of Frailty in Pain Perception and Management in Geriatric Trauma Patients

Introduction: Pain management in geriatric trauma patients is linked to improved quality of life and better outcomes. However, the role of patient-related factors in pain perception and management is unknown. The aim of our study is to assess whether frailty is associated with differences in daily pain scores and analgesic use among geriatric trauma patients. Methods: We performed a 2-y (2021-2022) analysis of geriatric database at our level I trauma center. We included all geriatric (≥65 y) patients admitted to our trauma service with normal neurological exam and length of stay >48 h. Patients were stratified using the trauma-specific frailty index into frail (F) and nonfrail (NF) groups. Daily pain scores (10-point numeric scale), the highest reported pain score during the admission, regional and systemic analgesia received in the first 7 d, and overall analgesic requirements were recorded and compared. Analgesics were converted to morphine milligram equivalents. Descriptive statistics and multivariable linear regression analyses, adjusting for potential confounding factors were performed. Results: We identified a total of 275 geriatric trauma patients (NF 167, F 108). The mean age was 78 (8) y and 52% were male. The median injury severity score was 9 [4-10], with 93% sustaining blunt injuries. There were no significant differences in terms of patients’ demographic and injury characteristics between F and NF groups. On univariate analysis, the F group were less likely to report pain and had significantly lower opioid morphine milligram equivalent requirements in the first week of admission and overall. On linear regression analysis, frailty was independently associated with lower average pain scores in the first week (β = −1.81, 95% confidence interval [CI] [−3.51 to −0.11], P = 0.038), lower overall highest pain scores (β = −0.97, 95% CI [−1.64 to −0.302], P = 0.05), and received less opioids per day in the first week (β = −10.63, 95% CI [−16.55 to −4.71], P < 0.001) and overall (β = −15.02, 95% CI [−22.81 to −7.24], P < 0.001). Subanalysis of patients substratified by injury severity score showed similar trends. Conclusions: Frailty was associated with lower reported pain scores and reduced opioid use, regardless of injury severity. Whether these discrepancies are owing to differences in pain perception by patients or under-reporting it to health-care providers is yet to be understood. These findings lay the foundation for further research to explore the role of frailty on the pathophysiology of pain in geriatric trauma patients.