Pain is common in the last two years of life, study finds
In the first study to look at the prevalence of pain experienced among older people during the last two years of life, researchers at the San Francisco VA Medical Center found that 46 percent of study participants suffered moderate to severe pain during their final four months of life.
The researchers also found that more than one quarter of the participants had moderate to severe pain during the last two years of life, and that arthritis was the biggest single predictor of pain, outweighing all eventual causes of death, including cancer.
The impact of arthritis on the experience of pain among older adults has not been recognized to the extent it should be, says lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine physician at SFVAMC. He notes that the prevalence of pain in the last month of life was 60 percent among patients with arthritis and 26 percent among patients without arthritis.
This research tells us that physicians should anticipate that pain will increase among their elderly and dying patients, assess their patients for pain frequently, and prescribe appropriate pain medications at appropriate levels, says Smith, who is also an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco.
Smith recommends that physicians regularly assess and treat pain in their older patients with chronic diseases who are not obviously nearing death. In other words, he says, pain management is not just for hospice patients. The study appears in the November 2, 2010 issue of the Annals of Internal Medicine.
The authors analyzed data from interviews conducted with 4,703 men and women age 50 and older who died while enrolled in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement, and aging sponsored by the National Institute on Aging. The interviews were conducted during each participants last 24 months of life.
As physicians, we need to recognize the high burden of pain among our older patients, says Smith.