University of California, San Francisco, Veterans Affairs Medical Center, 94121, USA.
Ann Intern Med. 2010 Nov 2;153(9):563-9. doi: 10.7326/0003-4819-153-9-201011020-00005.
The epidemiology of pain during the last years of life has not been well described.
To describe the prevalence and correlates of pain during the last 2 years of life.
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.
The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006).
Older adult decedents.
Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity.
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).
Data are cross-sectional; 19% of responses were from proxies; and information about cause, location, and treatment of pain was not available.
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.
National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.
近年来，临终前疼痛的流行病学尚未得到充分描述。
描述生命最后 2 年期间疼痛的发生率和相关因素。
观察性研究。对参加健康与退休研究并在研究期间死亡的参与者的数据进行了分析。使用了最接近死亡的调查访谈。根据从访谈到死亡之间的月数，将每位参与者或代理人分为 1 到 24 个队列中的 1 个。通过模型研究了死亡前时间与疼痛之间的关系，并根据年龄、性别、种族或民族、教育水平、净资产、收入、终末诊断类别、关节炎的存在和代理人状况进行了调整。
健康与退休研究是一项针对社区居住的老年人（1994 年至 2006 年）的全国代表性调查。
老年死亡者。
临床显著疼痛，表现为参与者报告疼痛“经常困扰”，疼痛至少为中度严重程度。
样本包括 4703 名死者。参与者的平均年龄（SD）为 75.7 岁（SD，10.8）；83.1%为白人，10.7%为黑人，4.7%为西班牙裔；52.3%为男性。死亡前 24 个月疼痛的调整发生率为 26%（95%CI，23%至 30%）。发病率在死亡前 4 个月前保持平稳（28%[CI，25%至 32%]），然后在生命的最后一个月增加，达到 46%（CI，38%至 55%）。关节炎患者生命最后一个月的疼痛发生率为 60%，而无关节炎患者为 26%（P<0.001），且与终末诊断类别无关（癌症[45%]、心脏病[48%]、虚弱[50%]、猝死[42%]或其他原因[47%]；P=0.195）。
数据为横断面；19%的回复来自代理人；并且没有关于疼痛的原因、位置和治疗的信息。
尽管生命的最后 4 个月疼痛的发生率增加，但在生命的最后 2 年中，超过四分之一的老年人仍有疼痛。关节炎与生命末期的疼痛密切相关。
美国国立卫生研究院老龄化研究所、国家研究资源中心、国家肌肉骨骼和皮肤病研究所以及国家姑息治疗研究中心。
