Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.
Knowledge is limited regarding pain assessment and management practices, as well as pain-related outcomes in hospice care.



To generate national estimates of pain assessment and management practices and outcomes of pain control among patients 65 years or older receiving hospice care in the U.S. and identify hospice discharge and agency characteristics predicting study outcomes.



The 2007 National Home Health and Hospice Care Survey was analyzed. Multivariate logistic regressions were estimated to identify discharge and agency characteristics predicting guideline-concordant pain assessment and management practices and pain control outcomes.



A high percentage of discharges had pain assessment at admission (97%) and before discharge (93%); use of valid pain rating scales was relatively low (69% and 54% for first and last assessments, respectively). Almost 95% of patients received pain medication, but only 42% received nonpharmacologic therapies. About 70% of patients assessed with a valid pain scale saw improvement in the level of pain or remained free of pain from admission to discharge. Non-Hispanic blacks were less likely to have pain assessments, and Hispanics were less likely to receive opioid analgesics or to have pain-free status at discharge, compared with non-Hispanic whites. Patients receiving care from for-profit (vs. nonprofit) agencies were more likely to receive pain assessment with a valid scale before discharge but less likely to experience pain control or improvement.



Greater use of valid pain assessment scales and nonpharmacologic therapies constitutes areas for improvement in hospice care. Targeted interventions are needed to address disparities in pain care by patient race and/or ethnicity and agency ownership status.
Department of Radiology, Weill Cornell Medical College, New York, New York, USA.
Meagan E
ME
Cea
Division of Geriatrics and Palliative Care, Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
M Cary
MC
Reid
Department of Pharmacology, Weill Cornell Medical College, New York, New York, USA.
Charles
C
Inturrisi
Weill Cornell Pain Medicine, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
Lisa R
LR
Witkin
Division of Geriatrics and Palliative Care, Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
Holly G
HG
Prigerson
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA; Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA. Electronic address: yub2003@med.cornell.edu.
Yuhua
Y
Bao
D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D059408:Pain Management; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D014481:United States
Hospice; pain assessment; pain control
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