Serious pain afflicts a third of nursing home residents in last six months of life

Many nursing home residents have a fairly pain-free experience until the end of life, but at least a third suffer persistent, significant pain during their last six months, according to a new study from the University of Manitoba, University of British Columbia and University of Alberta that could have implications for end-of-life care in Canada.

Researchers analyzed pain evaluations for 962 nursing home seniors in Alberta, Manitoba and Saskatchewan between 2007 and 2012. These assessments—no pain, mild, moderate, or excruciating pain—for the six months immediately preceding death formed the focus of the study.

"Sixty per cent of residents reported consistent low or mild pain, while around 34 per cent reported moderate or severe pain across different assessment periods. This tells us that once the pain was present it remained constant, and few residents saw any improvement as they approached death," said senior author Genevieve Thompson, a nursing professor at the University of Manitoba.

Pain among nursing home residents has been studied before, but the current study is the first to compare how pain levels change over time, added study co-author and UBC nursing professor Jennifer Baumbusch.

"Easing pain is such a critical part of end-of-life care and yet we know little about how pain persists over a period of time. This new knowledge suggests that we need a more aggressive approach to treating pain based on the information provided by the residents themselves," said Baumbusch.

The study was published in the Journal of the American Medical Directors Association. Future studies will analyze the effect of palliative or hospice services, nursing home size or environment, and other factors on residents' pain levels.