Did the Person Receive Any or Enough Help with Pain?
Guest Blog
By Judith A. Salerno, M.D., M.S.
Leonard D. Schaeffer Executive Officer
Institute of Medicine
As we become a nation with increasing numbers of older people, it’s common for talk to turn to such topics as how to fund post-retirement life and whether to sell the family home.
Rarely does talk around the dinner table turn to pain and end of life.
But a recent Institute of Medicine (IOM) report notes that managing pain is a fact of life for about 100 million Americans, roughly 43 percent of the adult U.S. population – many of them over age 65.
As someone who has dedicated my career to aging research and to improving geriatric care, I found two other statistics in the report sobering.
The report cites a survey of families who had a relative who recently died. They were asked a simple, but insightful question: Did the patient receive any or enough help with pain?
About one-third whose loved one died in a nursing home answered “No.”
When the question was posed to the relatives of patients who died in home hospice care, the percentage answering “no” dropped to 18 percent.
Pain management is challenging at any point in an illness or in any health care setting, but none more so than in the last stages of life. Hospice workers are more attuned to the palliative needs of patients with terminal illnesses, but even in this setting, families found there still was more that could be done.
I agree.
Easing pain during the course of a long-standing illness or its last stages can be fundamentally different than managing pain in other contexts. Unlike someone who is recovering from surgery for a sports-related illness (who indeed has pain relief needs), people with advanced chronic diseases often are coping with multiple, complex health conditions and endure much suffering. Spiritual and cultural issues also profoundly influence the way we choose to live out our lives with chronic illness.
From my perspective, in the best of worlds, patients near the end of life and those suffering with advanced illness would receive adequate and consistent pain management and the comfort care they desire regardless of their illnesses and no matter where they receive care.
We in the health professions are often deterred from providing adequate pain relief by the perceived risks of prescribing powerful yet effective pain medications such as opioids. Prescribed and monitored appropriately, such medicines can provide palliation and comfort. The last stages of life need not be defined by pain and suffering.
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Judith A. Salerno, M.D., M.S., is the Executive Officer of the Institute of Medicine of The National Academies. A geriatrician, Dr. Salerno is vitally interested in improving the health and well-being of older persons, and has designed public-private initiatives to address aging stereotypes, novel approaches to support training of new investigators in aging, and award-winning programs to communicate health and research advances to the public. Dr. Salerno also serves on numerous boards and national committees concerned with health care issues ranging from the quality of care in long-term care to the future of the geriatric workforce.
