Singer Adam E, Meeker Daniella, Teno Joan M, Lynn Joanne, Lunney June R, Lorenz Karl A
Ann Intern Med. 2015 Feb 3;162(3):175-83. doi: 10.7326/M13-1609.
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.
To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010.
Observational study.
The HRS (Health and Retirement Study), a nationally representative longitudinal survey of community-dwelling U.S. residents aged 51 years or older.
7204 HRS participants who died while enrolled in the study and their family respondents.
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.
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.
Use of proxy reports and limited information about some patient and surrogate variables.
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.
National Institute of Nursing Research.
改善临终关怀的呼声已将注意力集中在临终时疼痛及其他困扰症状的管理上。
描述1998年至2010年生命最后一年中疼痛强度和症状患病率的变化。
观察性研究。
健康与退休研究（HRS），一项对美国51岁及以上社区居住居民具有全国代表性的纵向调查。
7204名在研究期间死亡的HRS参与者及其家属受访者。
生命最后一年由他人代报的疼痛情况以及生命最后一年中至少持续1个月的其他症状。分析了所有死者以及猝死、癌症、充血性心力衰竭或慢性肺病和虚弱类别中的疼痛强度和症状患病率趋势。
1998年至2010年期间，所有死者中任何疼痛患病率的他人代报从54.3%（95%CI，51.6%至57.1%）增至60.8%（CI，58.2%至63.4%），增幅为11.9%（CI，3.1%至21.4%）。所有死者中抑郁症和周期性意识模糊的报告患病率也分别增加了26.6%（CI，14.5%至40.1%）和31.3%（CI，18.6%至45.1%）。特定死者类别中个别症状的患病率有所增加，但癌症除外，癌症患病率无显著变化。所有死者或任何特定死者类别中中度或重度疼痛的患病率均未改变。
使用他人代报以及关于一些患者和替代变量的信息有限。
尽管国家努力改善临终关怀，但1998年至2010年生命最后一年中疼痛及其他令人担忧症状的他人代报有所增加。
国家护理研究所在。
