0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

The Epidemiology of Pain During the Last 2 Years of Life

Alexander K. Smith, MD, MS, MPH; Irena Stijacic Cenzer, MA; Sara J. Knight, PhD; Kathleen A. Puntillo, RN, DNSc; Eric Widera, MD; Brie A. Williams, MD; W. John Boscardin, PhD; and Kenneth E. Covinsky, MD, MPH
[+] Article and Author Information

From University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California.


Abstract versions of this work were presented at the Annual Meeting of the American Geriatrics Society, Chicago, Illinois, 29 April–3 May 2009, and the 32nd Annual Meeting of the Society of General Internal Medicine, Miami, Florida, 13–16 May 2009.

Acknowledgment: The authors thank Jessamyn Conell-Price, BA, for her assistance in preparing this manuscript for publication.

Grant Support: Dr. Smith is supported by a Research Supplement to Promote Diversity in Health Related Research from the National Institute on Aging (R01AG028481), the National Center for Research Resources UCSF-CTSI (UL1 RR024131), and the National Palliative Care Research Center. Dr. Covinsky is supported by a K-24 grant from the National Institute on Aging (K24AG029812) and a grant from the National Institute on Musculoskeletal and Skin Diseases (P60 AR053308).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1398.

Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.

Requests for Single Reprints: Alexander K. Smith, MD, MS, MPH, Division of Geriatrics, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, 4150 Clement Street (181G), San Francisco, CA 94121; e-mail, aksmith@ucsf.edu.

Current Author Addresses: Drs. Smith, Widera, Williams, and Covinsky and Ms. Cenzer: Division of Geriatrics, Department of Medicine, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121.

Dr. Knight: Departments of Psychiatry and Urology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121.

Dr. Puntillo: Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610.

Dr. Boscardin: Division of Biostatistics, Department of Epidemiology and Biostatistics, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121.

Author Contributions: Conception and design: A.K. Smith, I.S. Cenzer, S.J. Knight, B.A. Williams, K.E. Covinsky.

Analysis and interpretation of the data: A.K. Smith, I.S. Cenzer, S.J. Knight, W.J. Boscardin, K.E. Covinsky.

Drafting of the article: A.K. Smith, I.S. Cenzer, E. Widera.

Critical revision of the article for important intellectual content: A.K. Smith, S.J. Knight, K.A. Puntillo, E. Widera, B.A. Williams, W.J. Boscardin, K.E. Covinsky.

Final approval of the article: A.K. Smith, I.S. Cenzer, S.J. Knight, K.A. Puntillo, E. Widera, B.A. Williams, K.E. Covinsky.

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

Statistical expertise: A.K. Smith, I.S. Cenzer, W.J. Boscardin, K.E. Covinsky.

Obtaining of funding: A.K. Smith, K.E. Covinsky.

Administrative, technical, or logistic support: A.K. Smith, K.E. Covinsky.

Collection and assembly of data: A.K. Smith, I.S. Cenzer.


Ann Intern Med. 2010;153(9):563-569. doi:10.7326/0003-4819-153-9-201011020-00005
Text Size: A A A

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.

Design: 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.

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

Participants: Older adult decedents.

Measurements: 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).

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

Conclusion: 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.

Primary Funding Source: National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.

Topics

pain

Figures

Grahic Jump Location
Figure.
Frequency of clinically significant pain during the last 2 years of life.

Diamonds represent the mean prevalence of clinically significant pain (defined as often having moderate or severe pain) at each month before death. Bars represent 95% CIs.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Who Reports Having More Pain at the End of Life?

The summary below is from the full report titled “The Epidemiology of Pain During the Last 2 Years of Life.” It is in the 2 November 2010 issue of Annals of Internal Medicine (volume 153, pages 563-569). The authors are A.K. Smith, I.S. Cenzer, S.J. Knight, K.A. Puntillo, E. Widera, B.A. Williams, W.J. Boscardin, and K.E. Covinsky.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)