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Symptom Trends in the Last Year of Life From 1998 to 2010: A Cohort StudySymptom Trends in the Last Year of Life

Adam E. Singer, MPhil; Daniella Meeker, PhD, MS; Joan M. Teno, MD, MS; Joanne Lynn, MD, MA, MS; June R. Lunney, PhD, RN; and Karl A. Lorenz, MD, MSHS
[+] Article, Author, and Disclosure Information

From Pardee RAND Graduate School, RAND Corporation, Santa Monica, California; University of Southern California, Los Angeles, California; David Geffen School of Medicine, University of California at Los Angeles, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Brown University, Providence, Rhode Island; Altarum Institute, Washington, DC; and Hospice and Palliative Nurses Association, Pittsburgh, Pennsylvania.

This work was presented at the American Academy of Hospice and Palliative Medicine (AAHPM) 2014 Annual Assembly, San Diego, California, 12–15, March 2014, where it received the AAHPM Investigator Paper Award in the student category.

Disclaimer: The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.

Grant Support: By the National Institute of Nursing Research (grant R01 NR013372; Dr. Lorenz); Mr. Singer received support from grant T32 GM008042 as a member of the Medical Scientist Training Program at the University of California, Los Angeles.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1609.

Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Mr. Singer (e-mail, asinger@rand.org). Data set: Available through the HRS (http://hrsonline.isr.umich.edu).

Requests for Single Reprints: Adam E. Singer, MPhil, Pardee RAND Graduate School, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138; e-mail, asinger@rand.org.

Current Author Addresses: Mr. Singer: Pardee RAND Graduate School, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138.

Dr. Meeker: University of Southern California, Department of Preventive Medicine, 2001 North Soto Street, Los Angeles, CA 90089.

Dr. Teno: Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI 02903.

Dr. Lynn: Center for Elder Care and Advanced Illness, Altarum Institute, 2000 Main Street Northwest #400, Washington, DC 20036.

Dr. Lunney: Hospice and Palliative Nurses Association, 1 Penn Center West #229, Pittsburgh, PA 15276.

Dr. Lorenz: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Author Contributions: Conception and design: A.E. Singer, D. Meeker, J.M. Teno, J. Lynn, J.R. Lunney, K.A. Lorenz.

Analysis and interpretation of the data: A.E. Singer, D. Meeker, J.M. Teno, J. Lynn, J.R. Lunney, K.A. Lorenz.

Drafting of the article: A.E. Singer, D. Meeker, K.A. Lorenz.

Critical revision of the article for important intellectual content: A.E. Singer, D. Meeker, J.M. Teno, J. Lynn, K.A. Lorenz.

Final approval of the article: A.E. Singer, J.M. Teno, J. Lynn, K.A. Lorenz.

Provision of study materials or patients: K.A. Lorenz.

Statistical expertise: A.E. Singer, D. Meeker.

Obtaining of funding: D. Meeker, K.A. Lorenz.

Administrative, technical, or logistic support: K.A. Lorenz.

Collection and assembly of data: A.E. Singer, K.A. Lorenz.

Ann Intern Med. 2015;162(3):175-183. doi:10.7326/M13-1609
Text Size: A A A

Background: Calls for improvement in end-of-life care have focused attention on the management of pain and other troubling symptoms at the end of life.

Objective: To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010.

Design: Observational study.

Setting: The HRS (Health and Retirement Study), a nationally representative longitudinal survey of community-dwelling U.S. residents aged 51 years or older.

Participants: 7204 HRS participants who died while enrolled in the study and their family respondents.

Measurements: Proxy-reported pain during the last year of life and other symptoms for at least 1 month during the last year of life. Trends in pain intensity and symptom prevalence were analyzed for all decedents and within the categories of sudden death, cancer, congestive heart failure or chronic lung disease, and frailty.

Results: Between 1998 and 2010, proxy reports of the prevalence of any pain increased for all decedents from 54.3% (95% CI, 51.6% to 57.1%) to 60.8% (CI, 58.2% to 63.4%), an increase of 11.9% (CI, 3.1% to 21.4%). Reported prevalences of depression and periodic confusion also increased for all decedents by 26.6% (CI, 14.5% to 40.1%) and 31.3% (CI, 18.6% to 45.1%), respectively. Individual symptoms increased in prevalence among specific decedent categories, except in cancer, which showed no significant changes. The prevalence of moderate or severe pain did not change among all decedents or in any specific decedent category.

Limitation: Use of proxy reports and limited information about some patient and surrogate variables.

Conclusion: Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010.

Primary Funding Source: National Institute of Nursing Research.





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Preexisting addiction?
Posted on February 4, 2015
Chris Bailey, RN, BA, BSN
None presently
Conflict of Interest: None Declared
Was preexisting drug addiction considered as a symptom trend? Would that be relevant?

No funding received in support of this work. (?)
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Summary for Patients

Symptoms During the Last Year of Life

The full report is titled “Symptom Trends in the Last Year of Life From 1998 to 2010. A Cohort Study.” It is in the 3 February 2015 issue of Annals of Internal Medicine (volume 162, pages 175-183). The authors are A.E. Singer, D. Meeker, J.M. Teno, J. Lynn, J.R. Lunney, and K.A. Lorenz.


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