CANCER PAIN IN THE ELDERLY HOSPICE PATIENT

To assess the relationship between subjective pain assessment and other clinical variables in geriatric hospice patients with cancer, we performed a retrospective record review and observation of home visits for patients treated by a community-based hospice with three satellite offices covering the state of Rhode Island. From a sample of 537 patients with terminal cancer admitted during 1990, 239 patients 65 years of age and older were identified. Of the 239 patients, 89 % survived 90 days or less, and 21 % lived 7 days or less. Upon admission, 55 % of the sample reported pain, with 44 % reporting pain in the range from discomfort to excruciating. Of those patients not reporting pain upon admission, 55 % went on to experience pain that subsequently required medication management. There were no relationships between the patients' reporting of pain on admission and subsequent survival time, between the length of time from initial diagnosis to hospice admission and the patients' reporting of pain intensity, and between the complaints reported by the study sample and those reported by a comparison group of younger, terminally ill cancer patients. There were also no statistically significant differences between under and over age 65 groups in terms of survival after admission. There was a difference between the admission nurse's placement of pain on the problem list and the patients' reporting of pain; although the numbers were small, it was found that a nurse caring for the elderly, but not one caring for a younger patient, was almost twice as likely to incorrectly leave pain off a problem list than to incorrectly ascribe pain to a patient not reporting it at the time of the interview. These data suggest that elderly patients entering hospice with pain require early concentration of pain management services. For patients entering hospice without pain, attention to initial onset of pain requires both appropriate assessment and specific treatment plans to minimize suffering.