Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life

Published in: Journal of Palliative Medicine, 2016

Posted on RAND.org on August 23, 2016

by Adam E. Singer, Daniella Meeker, Joan M. Teno, Joanne Lynn, June R. Lunney, Karl Lorenz

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Pain, dyspnea, and depression are highly troubling near the end of life.


To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample.


Retrospective cohort study.


Health and Retirement Study, a national sample of community-dwelling US residents aged 51 and older.


Family respondents of 8254 decedents who died between 1998 and 2012.


Clinically significant pain often during the last year of life; dyspnea and depression for at least one month during the last year of life.


Life support was associated with dyspnea (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.42–2.06) and depression (OR 1.20, CI 1.04–1.39), treatment for cancer with pain (OR 1.65, CI 1.41–1.92), and oxygen for a lung condition with dyspnea (OR 14.78, CI 11.28–19.38). More diagnoses were associated with dyspnea (OR 1.24, CI 1.17–1.30) and depression (OR 1.14, CI 1.08–1.21). More activities of daily living (ADL) dependencies were associated with clinically significant pain (OR 1.06, CI 1.03–1.09), dyspnea (OR 1.06, CI 1.02–1.10), and depression (OR 1.10, CI 1.07–1.12), and more instrumental activities of daily living (IADL) dependencies with depression (OR 1.12, CI 1.08–1.18). Worse self-rated health was associated with pain (OR 0.83, CI 0.77–0.88), dyspnea (OR 0.89, CI 0.84–0.95), and depression (OR 0.83, CI 0.78–0.89). Arthritis was associated with clinically significant pain (OR 2.24, CI 1.91–2.63).


Factors associated with common, burdensome symptoms in a national sample suggest clinical and population strategies for targeting symptom assessment and management.

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