Exploring Pain and Frailty among Older Surgical Patients in Ethiopia: Association, Effects on Postoperative Pain and Clinicians’ Viewpoints

Background: There is growing concern about improving the care of older adults after surgery. Health status, frailty (age-related diminished physical, social and psychological capabilities), and chronic pain impact recovery after surgery, but there is scant knowledge about how frailty and chronic pain work together to impact postoperative pain in older adults, and the healthcare professionals' experience in managing pain is not well explored. Objectives: The objectives are to assess the prevalence and impact of preoperative chronic pain and frailty on postoperative pain severity, pain interference, analgesic consumption, and length of hospital stay among older surgical patients and to explore health care professionals' perspectives of opportunities, barriers, and experience in postoperative pain management for older adults with frailty.   Methodology: Convergent parallel mixed-methods research using Creswell and Clark's (2018) approach will be conducted. A cross-sectional and cohort study will assess the prevalence and impact of preoperative frailty and chronic pain on postoperative acute pain-related outcomes. Preoperative frailty will be collected using the Tilburg Frailty Indicator. The International Pain Outcome Questionnaire will measure preoperative and postoperative pain-related data. A generalised linear mixed model with different link functions, and Analysis of Variance (ANOVA) will be used for analysis. A descriptive qualitative study design will explore perioperative healthcare professionals' experience, perceived opportunities and barriers of pain management and will be thematically analysed.   Expected impact: This research is expected to provide a deeper understanding of pain and frailty in Sub-Saharan Africa and will lay the groundwork for large-scale projects to improve perioperative care for older adults and provide policy recommendations.