The epidemiology of pain during the last years of life has not been well described.
To describe the prevalence and correlates of pain over the last two years of life.
Observational study. We analyzed data from subjects who died while enrolled in the Health and Retirement Study. The survey interview closest to death was used. Each subject or proxy was interviewed once in the last 24 months of life and were classified into one of 24 cohorts based on the number of months between the interview and death. We modeled the relationship between time before death and pain adjusted for age, gender, race/ethnicity, education, net worth, income, terminal diagnosis category, arthritis, and proxy status.
The Health and Retirement Study, a nationally representative survey of community-living older adults (1994–2006).
Older adult decedents.
Significant pain as indicated by a report that the subject was “often troubled” by pain of at least moderate severity.
The sample included 4,703 decedents (mean age [SD] 75.7 [10.8], 83.1% white, 10.7% black, 4.7% Hispanic, 52.3% men). The adjusted prevalence of pain 24 months prior to death was 26% (95% CI, 23–30%). The prevalence remained flat until 4 months prior to death (28%, 25–32%), then increased, reaching 46% (38–55%) in the last month of life. The prevalence of pain in the last month of life was 60% among patients with arthritis vs. 26% among patients without arthritis (p<.001), and did not differ by terminal diagnosis category (cancer 45%, heart disease 48%, frailty 50%, sudden death 42%, other 47%, p=0.195).
cross sectional data; 19% proxy responses; information about cause, location, and treatment of pain not available.
While the prevalence of pain increases in the last 4 months of life, pain is present in over a quarter of elders over 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; National Palliative Care Research Center.