@article {8569, title = {Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life.}, journal = {J Palliat Med}, volume = {19}, year = {2016}, month = {2016 Oct}, pages = {1066-1073}, abstract = {

BACKGROUND: Pain, dyspnea, and depression are highly troubling near the end of life.

OBJECTIVE: To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study, a national sample of community-dwelling US residents aged 51 and older.

PARTICIPANTS: Family respondents of 8254 decedents who died between 1998 and 2012.

MEASUREMENTS: Clinically significant pain often during the last year of life; dyspnea and depression for at least one month during the last year of life.

RESULTS: Life support was associated with dyspnea (odds ratio [OR] 1.71, 95\% confidence interval [CI] 1.42-2.06) and depression (OR 1.20, CI 1.04-1.39), treatment for cancer with pain (OR 1.65, CI 1.41-1.92), and oxygen for a lung condition with dyspnea (OR 14.78, CI 11.28-19.38). More diagnoses were associated with dyspnea (OR 1.24, CI 1.17-1.30) and depression (OR 1.14, CI 1.08-1.21). More activities of daily living (ADL) dependencies were associated with clinically significant pain (OR 1.06, CI 1.03-1.09), dyspnea (OR 1.06, CI 1.02-1.10), and depression (OR 1.10, CI 1.07-1.12), and more instrumental activities of daily living (IADL) dependencies with depression (OR 1.12, CI 1.08-1.18). Worse self-rated health was associated with pain (OR 0.83, CI 0.77-0.88), dyspnea (OR 0.89, CI 0.84-0.95), and depression (OR 0.83, CI 0.78-0.89). Arthritis was associated with clinically significant pain (OR 2.24, CI 1.91-2.63).

CONCLUSIONS: Factors associated with common, burdensome symptoms in a national sample suggest clinical and population strategies for targeting symptom assessment and management.

}, issn = {1557-7740}, doi = {10.1089/jpm.2015.0391}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27454900}, author = {Adam E Singer and Meeker, Daniella and Joan M Teno and Lynn, Joanne and June R Lunney and Karl A Lorenz} } @article {8300, title = {Symptom Trends in the Last Year of Life From 1998 to 2010 A Cohort Study}, journal = {Annals of Internal Medicine}, volume = {162}, year = {2015}, note = {Times Cited: 1 0 1}, pages = {175-U58}, publisher = {162}, abstract = {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.}, keywords = {Health Conditions and Status, Methodology, Retirement Planning and Satisfaction}, doi = {10.7326/m13-1609}, author = {Adam E Singer and Meeker, Daniella and Joan M Teno and Lynn, Joanne and June R Lunney and Karl A Lorenz} }