title: The last three days of life: a comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care.
abstract: BACKGROUND
  Pain is a common symptom in older patients at the end of life. Little research has evaluated pain management among the oldest hospitalised dying patients.
  
  
  OBJECTIVE
  To compare the pain characteristics documented by healthcare workers for the young old and the oldest old hospitalised patients and the types of analgesics administered in the last three days of life.
  
  
  METHODS
  A retrospective cross-sectional comparative study.
  
  
  METHODS
  The study included 190 patients from a Norwegian general hospital: 101 young old patients (aged 65-84 years) and 89 oldest old patients (aged 85-100 years). Data were extracted from electronic patient records (EPRs) using the Resident Assessment Instrument for Palliative Care.
  
  
  RESULTS
  No significant differences were found between the young old and the oldest old patients with regard to pain characteristics. Pain intensity was poorly recorded in the EPRs. Most of the patients received adequate pain control. Morphine was the most frequently administered analgesic for dying patients. Compared to the oldest old patients, a greater proportion of the young old patients received paracetamol combined with codeine (OR = 3.25, 95% CI 1.02-10.40).
  
  
  CONCLUSIONS
  There appeared to be no differences in healthcare workers' documentation of pain characteristics in young old and oldest old patients, but young old patients were more likely to receive paracetamol in combination with codeine.
  
  
  CONCLUSIONS
  A limitation of the study is the retrospective design and that data were collected from a single hospital. Therefore, caution should be taken for interpretation of the results. The use of systematic patient-reported assessments in combination with feasible validated tools could contribute to more comprehensive documentation of pain intensity and improved pain control.
authors.affiliation: Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway.|Palliative Care Unit, Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Simen Alexander
authors.initials: SA
authors.lastname: Steindal
authors.affiliation: Surgery and Transplantation Department, Faculty of Medicine, University of Oslo and Cancer, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Inger Schou
authors.initials: IS
authors.lastname: Bredal
authors.affiliation: Medical Department, Diakonhjemmet Hospital, Oslo, Norway.|Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Anette Hylen
authors.initials: AH
authors.lastname: Ranhoff
authors.affiliation: Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway.
authors.forename: Liv Wergeland
authors.initials: LW
authors.lastname: Sørbye
authors.affiliation: Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway.|Deptartment of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Anners
authors.initials: A
authors.lastname: Lerdal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004282:Documentation; D005260:Female; D015577:Geriatric Assessment; D005851:Geriatric Nursing; D006801:Humans; D008297:Male; D009664:Norway; D009730:Nursing Assessment; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*
chemical_list: D000700:Analgesics
keywords: Resident Assessment Instrument for Palliative Care; electronic patient records; end of life; hospital; oldest old; pain