Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;56(6):871-877.e7.
doi: 10.1016/j.jpainsymman.2018.09.005. Epub 2018 Sep 15.

Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia

Lauren J Hunt  1 , Christine S Ritchie  2 , Janine K Cataldo  3 , Kanan Patel  2 , Caroline E Stephens  4 , Alexander K Smith  5
Affiliations

Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia

Lauren J Hunt et al. J Pain Symptom Manage. 2018 Dec.

Abstract

Context: Pain may be a potentially modifiable risk factor for expensive and burdensome emergency department (ED) visits near the end of life for older adults with dementia.

Objectives: The objective of this study was to assess the effect of pain and unmet need for pain management on ED visits in the last month of life in older adults with dementia.

Methods: This is a mortality follow-back study of older adults with dementia in the National Health and Aging Trends Study who died between 2012 and 2014, linked to Medicare claims.

Results: Two hundred eighty-one National Health and Aging Trends Study decedents with dementia met criteria (mean age 86 years, 61% female, 81% white). Fifty-seven percent had at least one ED visit in the last month of life, and 46.5% had an ED visit that resulted in a hospital admission. Almost three out of four (73%) of decedents experienced pain in the last month of life, and 10% had an unmet need for pain management. After adjustment for age, gender, race, educational attainment, income, comorbidities, and impairment in activities of daily living, pain was not associated with increased ED use in the last month of life (adjusted incident rate ratio 0.87, 95% CI 0.64-1.17). However, decedents with unmet need for pain management had an almost 50% higher rate of ED visits in the last month of life than those without unmet needs (adjusted incident rate ratio 1.46, 95% CI 1.07-1.99).

Conclusion: Among older adults with dementia, unmet need for pain management was associated with more frequent ED visits in the last month of life.

Keywords: Dementia; emergency department; end-of-life; pain.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

None of the authors report any conflicts of interest.

Figures

Figure 1.
Figure 1.. Percentage of NHATS Decedents with Dementia (n=281) with 0, 1, or 2+ Emergency Department Visits in the Last Month by Pain Management Status
NHATS=National Health and Aging Trends Study
See this image and copyright information in PMC

References

    1. Hebert LE, Weuve J, Scherr PA, et al. Alzheimer disease in the United States (2010–2050) estimated using the 2010 census. Neurology. 2013;80(19): 1778–1783. - PMC - PubMed
    1. Alzheimer’s Association. 2015 Alzheimer’s disease facts and figures. Alzheimers Dement. 2015; 11(3):332–384. - PubMed
    1. U.S. Department of Health and Human Services. National Plan to Address Alzheimer’s Disease: 2017 Update. Available from: https://aspe.hhs.gov/report/national-plan-address-alzheimers-disease-201.... Accessed May 17, 2018.
    1. Smith AK, McCarthy E, Weber E, et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012;31(6): 1277–1285. - PMC - PubMed
    1. Feng Z, Coots LA, Kaganova Y, et al. Hospital and ED use among medicare beneficiaries with dementia varies by setting and proximity to death. Health Aff (Millwood). 2014;33(4):683–690. - PubMed

Publication types