One-Third Of Nursing Home Residents End Last Months of Life In Agony: Study

New research suggests that more than one-third of all nursing home residents experience severe pain during the last six months before their death, and often that pain worsens directly before they pass away. 

Canadian researchers said that while studies have focused on nursing home resident pain, little focus has been given to how the pain levels change over time and how to manage severe pain levels before death. This is the first study to do that, with findings published last week in The Journal of the American Medical Directors Association.

Researchers analyzed data from the Resident Assessment Instrument-Minimum Data Set (MDS) 2.0, which is part of the longitudinal Translating Research in Elder Care. It comprised data for nursing home residents from Alberta, Manitoba, and Saskatchewan from 2007 to 2012.

The data included information from residents from 27 urban nursing homes in Western Canada, including 962 nursing home residents who died. Those patients resided in a nursing home for at least six months and had an MDS assessment completed within 30 days of death.

Pain assessments were conducted bot for patients who were not severely cognitively impaired, as well as those with severe cognitive impairments.

In the six months before their death, while about 60 percent of residents experienced consistently low pain, more than 34 percent of nursing home patients experienced moderate to severe pain. Many also experienced significant increases in pain during that time period.

Only about five percent of nursing home patients did not experience any degree of pain. This indicates a relatively low number of patients have no pain care needs. A greater number require focused pain management.

Among patients with no cognitive impairment, 65 percent experienced mild to no pain during the time before they died. Nearly 40 percent of patients experienced pain that worsened during their final six months, or they experienced pain that was consistently high right up to their death.

Researchers said the data indicates nursing homes are not doing a good job of managing residents pain during their final months and more focus needs to be on pain management and end-of-life care, which may be construed as nursing home neglect.

Overall, there was a greater proportion of residents with low or mild pain among the patients who were severely cognitively impaired, compared to those with no cognitive impairment. This may also signal nursing home patients with cognitive impairments have difficulty communicating their pain levels.

One focused pattern emerged. Once the pain began for a patient, whether moderate to severe, it remained present, either at that level or increased in severity, but did not diminish. The pain was managed, but did not reduce in consistency or severity.

This is the first study to focus on how pain changes over time for nursing home residents, especially directly before death. Researchers concluded that a more aggressive approach to treating pain in nursing home patients should be used to help offer end-of-life care.