title: Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life.
abstract: BACKGROUND
  Pain, dyspnea, and depression are highly troubling near the end of life.
  
  
  OBJECTIVE
  To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Health and Retirement Study, a national sample of community-dwelling US residents aged 51 and older.
  
  
  METHODS
  Family respondents of 8254 decedents who died between 1998 and 2012.
  
  
  METHODS
  Clinically significant pain often during the last year of life; dyspnea and depression for at least one month during the last year of life.
  
  
  RESULTS
  Life support was associated with dyspnea (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.42-2.06) and depression (OR 1.20, CI 1.04-1.39), treatment for cancer with pain (OR 1.65, CI 1.41-1.92), and oxygen for a lung condition with dyspnea (OR 14.78, CI 11.28-19.38). More diagnoses were associated with dyspnea (OR 1.24, CI 1.17-1.30) and depression (OR 1.14, CI 1.08-1.21). More activities of daily living (ADL) dependencies were associated with clinically significant pain (OR 1.06, CI 1.03-1.09), dyspnea (OR 1.06, CI 1.02-1.10), and depression (OR 1.10, CI 1.07-1.12), and more instrumental activities of daily living (IADL) dependencies with depression (OR 1.12, CI 1.08-1.18). Worse self-rated health was associated with pain (OR 0.83, CI 0.77-0.88), dyspnea (OR 0.89, CI 0.84-0.95), and depression (OR 0.83, CI 0.78-0.89). Arthritis was associated with clinically significant pain (OR 2.24, CI 1.91-2.63).
  
  
  CONCLUSIONS
  Factors associated with common, burdensome symptoms in a national sample suggest clinical and population strategies for targeting symptom assessment and management.
authors.affiliation: 1 David Geffen School of Medicine, University of California at Los Angeles , Los Angeles, California.|2 RAND Corporation , Santa Monica, California.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Singer
authors.affiliation: 3 Department of Preventive Medicine, University of Southern California , Los Angeles, California.
authors.forename: Daniella
authors.initials: D
authors.lastname: Meeker
authors.affiliation: 4 Division of Gerontology and Geriatrics, Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.affiliation: 5 Center for Elder Care and Advanced Illness, Altarum Institute , Washington, DC.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lynn
authors.affiliation: 6 Hospice and Palliative Nurses Association , Pittsburgh, Pennsylvania.
authors.forename: June R
authors.initials: JR
authors.lastname: Lunney
authors.affiliation: 2 RAND Corporation , Santa Monica, California.|7 Stanford University School of Medicine , Stanford, California.|8 VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz