Pain Assessment, Treatment, and Functional Outcomes in Hospitalized, Older Adults

This is a clinically grounded, patient-focused proposal aimed to improve the understanding of how pain is assessed, treated, and experienced by older adults during and after hospitalization. Despite the high prevalence of pain in this population, clinicians face challenges in balancing effective treatment with concerns about adverse effects, communication complexity, and functional outcomes. This award will support the scientific program and career development plan of Dr. Aksharananda Rambachan, to enable him to become an independently funded physician-investigator. In Aim 1, we will describe how pain is assessed and treated for older hospitalized adults. We will retrospectively analyze data from ~30,000 older adults hospitalized on a general medicine service using linear mixed models. In Aim 2, we will conduct a qualitative study using interviews and focus groups to understand the experiences and perspectives of patients, caregivers, and clinicians regarding pain during hospitalization. In Aim 3, we will prospectively examine the relationship between patient reported pain, inpatient pain treatment, and post-discharge functional measures and outcomes, in older hospitalized patients by integrating patient-reported data with clinical data. Dr. Rambachan’s career development plan consists of capacity building in three distinct training areas: (1) Core Principles of Geriatrics and Outcomes Assessments, (2) Specialized Advanced Quantitative Research Methods, and (3) Qualitative Research Methods. Dr. Rambachan will undertake coursework, seminars, structured tutorials, and experiential learning. His mentorship team includes Dr. Margaret Fang (primary mentor), Professor of Medicine and a nationally recognized NIA researcher, who will oversee Dr. Rambachan’s overall progress. Co-mentors include Dr. Andrew Auerbach, Professor of Medicine, who leads the multiinstitutional “Hospital Medicine ReEnginnering Network”; Dr. Kenneth Covinsky, Professor in Geriatrics, who is a nationally recognized geriatrics researcher; and Dr. Elizabeth Dzeng, Associate Professor of Medicine, and qualitative research expert. Dr. Rambachan will also collaborate with a team of advisors in pain management, communication, and statistics. The successful completion of this program will enable Dr. Rambachan to develop as an independent physician-investigator to improve treatment and outcomes for older, hospitalized adults.