In a new study that could have implications for end-of-life care in Canada, researchers at the universities of Alberta, British Columbia and Manitoba found that at least a third of nursing home residents suffer persistent, significant pain during their last six months of life.
Researchers analyzed self-reported pain among 962 nursing home seniors in Alberta, Manitoba and Saskatchewan between 2007 and 2012. Their self-assessments-no pain, mild, moderate, or excruciating pain-for the six months immediately preceding death formed the focus of the study.
Overall, 60 per cent of residents reported consistent low or mild pain, while 34 per cent reported moderate or severe pain across different assessment periods.
"This tells us that once the pain was present it remained constant, and few residents saw any improvement as they approached death," said senior author Genevieve Thompson, a nursing professor at the University of Manitoba.
While pain among nursing home residents has been studied previously, Carole Estabrooks, a UAlberta nursing professor and director of TREC (Translating Research in Elder Care), said this study is the first to compare how pain levels change over time.
"For me, the real important thing is trying to pinpoint where some of the biggest challenges would be," she said. "We can only manage those things that we can measure. Identifying that there are groups that are potentially undermanaged is a really important first step in helping us target intervention."
For instance, Estabrooks said that, according to nursing home reports, people with severe dementia stop reporting that they have pain.
"People with dementia in the end stages are still in pain, they just have such a severe communication problem that it is hard to assess levels of pain."
Estabrooks said current work is not only building towards interventions, but determining prevalence and improving measurements
"You need to know that you can reasonably measure pain in some groups. If we targeted people who have moderate to severe pain, future research will give us a better idea about how robust our assessments of pain are."
The study was published in the Journal of the American Medical Directors Association. Future studies will analyze the effect of palliative or hospice services, nursing home size or environment, and other factors on residents' pain levels.
Other researchers who contributed to the study were Malcolm Doupe, a community health sciences professor at the University of Manitoba; Colin Reid, a professor in the School of Health and Exercise Sciences at UBC's Okanagan campus; and UBC nursing professor Jennifer Baumbusch.