Patterns of Discharge Analgesic Prescription in Hip Fracture Patients by Label of Cognitive Status: A Retrospective...

Pain relief is known to be under-prescribed in cognitively impaired patients. Though cognitive impairment (CI) may lead to lower reported pain at times, differences disappear at higher pain levels, where nociception is similar between groups. CI research also exhibits reduced placebo responsiveness in patients. Ensuring equitable pharmacological treatment for pain after hip-fracture surgery is thus ethically necessary. This pilot study compares discharge analgesic prescribing patterns between patients with and without documentation labels of CI in a metropolitan inpatient orthogeriatrics service.

A retrospective pilot audit conducted on discharge e-prescriptions from patients aged ≥ 65 years who underwent hip-fracture repair in the calendar year of 2020. Fifty records with documented CI and fifty with normal cognition (NC) were studied. CI was defined by documentation labels-including dementia, mild CI, or delirium. Because this study examined prescribing behavior, the focus was on a prescriber's perception of CI evidenced by labels. This reflects real-world clinical practice but risks misclassification bias. Multiple medication-related outcomes were examined for potential differences between groups for this pilot study. Medication data from electronic discharge prescriptions were converted to standardized equivalents for comparison.

Paracetamol was prescribed more frequently on discharge to patients with documented CI than to those with normal cognition (p = 0.02). No other clinically meaningful and/or statistically robust differences in prescribing patterns were observed across analgesic or non-analgesic medication classes. Given the small sample size and exploratory nature of the study, confidence intervals were wide and overlapping.

Paracetamol was prescribed more frequently on discharge to patients with documented CI than to those with normal cognition documented. As an exploratory pilot audit, these findings should be interpreted cautiously but may justify larger studies across broader clinical settings and timeframes.