Why 'dying has only gotten worse'

New study finds more elderly Americans feel pain near death

The number of U.S. residents who experienced pain in the last year of their life increased by nearly 12% between 1998 and 2010, according to a new study in the Annals of Internal Medicine.

A 1997 Institute of Medicine (IOM) report chronicled the suffering many U.S. residents faced at the end of their lives. The report issued "sweeping recommendations" for improvement, but the new study indicates that "dying has only gotten worse" since the IOM report, according to the Washington Post's "Wonkblog."

For the study, researchers assessed about 7,200 patients over age 50 who had enrolled in the nationally representative Health and Retirement Study. Researchers interviewed patients biennially until they died. Afterward, researchers interviewed family members about their relatives' experiences, particularly about whether the participants experienced pain, depression, or periods of confusion near the end of their lives.

Doctor: Why we need palliative care in the ICU

The researchers found that along with the reports of more people in pain, reports of depression and periodic confusion during that period also increased by about 26%.

Study author Joanne Lynn, who directs the Altarum Institute's Center for Elder Care and Advanced Illness, says the results could be because there are more high-tech treatments that lengthen a patient's life but do not cure his or her ailment. She says most research aims to eliminate diseases rather than improve support or symptom management.

From the experts: The case for palliative care

Tim Ihrig, a palliative care physician at UnityPoint Health, says physicians tend to under-treat symptoms, such as pain, during end-of-life care. He explains this could be because the symptoms go unrecognized or a fear of discussing dying candidly. He says conversations about end of life often do not occur until a patient's final days or hours (Gold, Kaiser Health News, 2/3; Millman, "Wonkblog," Washington Post, 2/3).

The takeaway: A new study finds that a growing number of older patients experience pain as they near death. Experts argue for more emphasis on palliative care, rather than just extending life. Does your hospital have a palliative care program? Our toolkit can help you get started.

Realizing the full benefit of palliative care

Effective palliative care can transform inpatient care delivery by reducing costs while improving quality for the sickest patients—in both fee-for-service and risk contracting environments. This study contains best practices for increasing the value of your palliative care service by engaging physicians, growing referrals, and expanding palliative care skills across the medical staff.


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