The last three days of life: a comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care

1. Simen Alexander Steindal PhD, RN Associate Professor^1,2,*,
2. Inger Schou Bredal PhD, RN Associate Professor³,
3. Anette Hylen Ranhoff PhD, MD Professor^4,5,
4. Liv Wergeland Sørbye PhD, RN Professor¹ and
5. Anners Lerdal PhD, RN Professor^6,7

International Journal of Older People Nursing

Background

Pain is a common symptom in older patients at the end of life. 
Little research has evaluated pain management among the oldest hospitalised dying patients.

Aims and objectives

To compare the pain characteristics documented by healthcare workers for the young old and the oldest old hospitalised patients and the types of analgesics administered in the last three days of life.

Design

A retrospective cross-sectional comparative study.

Methods

The study included 190 patients from a Norwegian general hospital: 
101 young old patients (aged 65–84 years) and 89 oldest old patients (aged 85–100 years). 
Data were extracted from electronic patient records (EPRs) using the Resident Assessment Instrument for Palliative Care.

Results

No significant differences were found between the young old and the oldest old patients with regard to pain characteristics. 
Pain intensity was poorly recorded in the EPRs. 
Most of the patients received adequate pain control.
 Morphine was the most frequently administered analgesic for dying patients. 
Compared to the oldest old patients, a greater proportion of the young old patients received paracetamol combined with codeine (OR = 3.25, 95% CI 1.02–10.40).

Conclusions

There appeared to be no differences in healthcare workers' documentation of pain characteristics in young old and oldest old patients, but young old patients were more likely to receive paracetamol in combination with codeine.

Implications for practice

A limitation of the study is the retrospective design and that data were collected from a single hospital. Therefore, caution should be taken for interpretation of the results. The use of systematic patient-reported assessments in combination with feasible validated tools could contribute to more comprehensive documentation of pain intensity and improved pain control.