There is a fundamental gap in understanding how best to address the issue of oligoanalgesia (inadequate treatment of pain) in elderly emergency department (ED) patients. The long-term goal is to better determine the optimal approach to treating older adults presenting to the ED in acute pain. The proposed training plan, which includes a combination of didactic training and mentored clinical investigation, will allow Dr. Andrew Chang to build on the Masters of Clinical Research training he has already received in order to obtain additional skills necessary to become an independent and extramurally-funded investigator in aging research. The didactic training will be accomplished by enrolling in courses at Columbia University's Mailman School of Public Health and Fordham University, as well as participation in national and/or international meetings in emergency medicine, geriatrics, and pain medicine. Mentored clinical investigation will occur under the close tutelage of three senior emergency medicine investigators, a senior aging research investigator, and a senior pain investigator.
The specific aims i nclude: (1) To determine patient and physician-related barriers to pain management of older adults presenting to the ED with acute pain;(2) To determine if disparities exist in the treatment of older adults with cognitive impairment;and (3) Assess a treatment approach that can safely provide adequate pain relief to older adults presenting to the ED with acute hip fracture. This mentored research will be conducted at the Montefiore Medical Center ED in the Bronx, New York. Upon completion of this program, Dr. Chang will have acquired a substantial breadth and depth of clinical research and be well positioned to begin an independent research career and pursue extramural funding.
Inadequately treated pain is a major public health problem in the United States and a particular problem in emergency departments. Older adults, who are the most rapidly growing segment of the population, are at even greater risk. The ability to safely and effectively treat older adults presenting to the ED with acute pain is critical as their use of the ED is only expected to increase.
|Chang, Andrew K; Bijur, Polly E; Lupow, Jason B et al. (2013) Randomized clinical trial of the 2 mg hydromorphone bolus protocol versus the ""1+1"" hydromorphone titration protocol in treatment of acute, severe pain in the first hour of emergency department presentation. Ann Emerg Med 62:304-10|
|Chang, Andrew K; Bijur, Polly E; Davitt, Michelle et al. (2013) Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients. Drugs Aging 30:747-54|