The epidemiology of pain during the last 2 years of life.
BACKGROUND
The epidemiology of pain during the last years of life has not been well described.


OBJECTIVE
To describe the prevalence and correlates of pain during the last 2 years of life.


METHODS
Observational study. Data from participants who died while enrolled in the Health and Retirement Study were analyzed. The survey interview closest to death was used. Each participant or proxy was interviewed once in the last 24 months of life and was classified into 1 of 24 cohorts on the basis of the number of months between the interview and death. The relationship between time before death and pain was modeled and was adjusted for age, sex, race or ethnicity, education level, net worth, income, terminal diagnosis category, presence of arthritis, and proxy status.


METHODS
The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006).


METHODS
Older adult decedents.


METHODS
Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity.


RESULTS
The sample included 4703 decedents. Mean age (SD) of participants was 75.7 years (SD, 10.8); 83.1% were white, 10.7% were black, 4.7% were Hispanic; and 52.3% were men. The adjusted prevalence of pain 24 months before death was 26% (95% CI, 23% to 30%). The prevalence remained flat until 4 months before death (28% [CI, 25% to 32%]), then it increased, reaching 46% (CI, 38% to 55%) in the last month of life. The prevalence of pain in the last month of life was 60% among patients with arthritis versus 26% among patients without arthritis (P < 0.001) and did not differ by terminal diagnosis category (cancer [45%], heart disease [48%], frailty [50%], sudden death [42%], or other causes [47%]; P = 0.195).


CONCLUSIONS
Data are cross-sectional; 19% of responses were from proxies; and information about cause, location, and treatment of pain was not available.


CONCLUSIONS
Although the prevalence of pain increases in the last 4 months of life, pain is present in more than one quarter of elderly persons during the last 2 years of life. Arthritis is strongly associated with pain at the end of life.


BACKGROUND
National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.
University of California, San Francisco, Veterans Affairs Medical Center, 94121, USA. aksmith@ucsf.edu
Alexander K
AK
Smith
Irena Stijacic
IS
Cenzer
Sara J
SJ
Knight
Kathleen A
KA
Puntillo
Eric
E
Widera
Brie A
BA
Williams
W John
WJ
Boscardin
Kenneth E
KE
Covinsky
D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000150:complications; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000453:epidemiology* / Q000208:ethnology; D010166:Palliative Care; D015995:Prevalence; D011788:Quality of Life; D012959:Socioeconomic Factors; D019452:Terminally Ill; D013997:Time Factors