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The rich die
differently from you and me
Newswise — The inequalities that mark American life maintain their
hold through age and even death, a new study shows.
Wealthier elders are significantly less likely than poorer ones to
suffer pain at the end of their lives, according to a University of
Michigan study forthcoming in the August issue of the Journal of
Palliative Care.
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Specifically, men and women age 70 or older whose net worth was
$70,000 or higher were 30 percent less likely than poorer people to
have felt pain often during the year before they died. This
difference persisted after the researchers controlled for age,
gender, ethnicity, education and diagnosis.
Wealthier elders also experienced a lower number of symptoms
overall, the study found. Those in the wealthiest half of the
elderly population not only had less pain, but were less likely to
suffer from shortness of breath and depression.
Still, both rich and poor older Americans suffered more than
expected in their last year of life, the researchers concluded.
"Regardless of wealth, older Americans carry an unacceptable burden
of suffering in their last year of life," said Maria Silveira, a
physician at the Veterans Affairs Ann Arbor Healthcare System, a
research scientist at the U-M and the lead author of the study. "The
older adults we studied who lived in the community suffered as much
in their last year of life as do younger people who are severely ill
and hospitalized."
Fatigue was the most common symptom, experienced by 57 percent of
those who died. More than 50 percent experienced pain, and 59
percent of those who experienced pain were reported to have suffered
pain at severe levels.
The
study was based on an analysis of data on 2,604 men and women age 70
or older who died between 1993 and 2000. They were part of the
Health and Retirement Study conducted by the U-M Institute for
Social Research (ISR) and funded by the National Institute on Aging.
The study interviews a nationally representative sample of 22,000
Americans age 50 and over every two years.
When a participant in the study dies, researchers interview
surviving spouses or others to learn about their last months of life
and the circumstances of their death. For the current study,
Silveira and U-M colleagues Mohammed Kabeto and Kenneth Langa were
especially interested in symptoms of pain, depression, and shortness
of breath at the end of life. "These are treatable symptoms," Langa
said, "and not an inevitable part of the dying process."
"Our current health system provides palliative care mostly through
hospice and hospitals," Silveira said. "As a result, health care
providers' radar may be set to miss older adults unless they have a
reason to become hospitalized."
The
authors offered several possible explanations for their "most unique
and sobering finding"---that wealthier elders suffer less than
poorer ones at the end of life.
When personal resources are limited, elders without coverage for
prescription medications, including those on Medicare, may choose to
sacrifice comfort in order to prolong their life or maintain their
ability to function, the authors speculate, Silveira said.
"Elders with greater financial resources may express their symptoms
more assertively and demand better care, the researchers suggest.
They may have greater access to goods and services above and beyond
what insurance provides, and to social support from family and
friends. They may also reside in settings with better quality of
care."
To
break the connection between wealth and suffering at the end of
life, the government might consider expanding Medicare to include
medications, or expanding the criteria for hospice to include older
adults with significant symptoms, regardless of their prognosis.
Currently, hospice treatment is covered only for those whose
physicians certify to have less than six months to live.
"This would enable older adults to access medications regardless of
ability to pay," Silveira said. "It would also improve access to
services for underserved and vulnerable populations."
Silveira is an M.D., M.P.H. and is an assistant professor of general
medicine at the U-M Medical School and a member of the VA Center of
Excellence at the VA Ann Arbor Healthcare System.
Langa is M.D., Ph.D. and is an assistant professor of general
medicine at the U-M Medical School, a research investigator at the
VA Ann Arbor Healthcare System, and a faculty associate at ISR.
Mohammed Kabeto is M.S., and is a research associate in general
medicine at the Medical School.
Established in 1948, the Institute for Social Research (ISR) is
among the world's oldest survey research organizations, and a world
leader in the development and application of social science
methodology. ISR conducts some of the most widely-cited studies in
the nation, including the Survey of Consumer Attitudes, the National
Election Studies, the Monitoring the Future Study, the Panel Study
of Income Dynamics, the Health and Retirement Study, the Columbia
County Longitudinal Study and the National Survey of Black
Americans. ISR researchers also collaborate with social scientists
in more than 60 nations on the World Values Surveys and other
projects, and the Institute has established formal ties with
universities in Poland, China, and South Africa. ISR is also home to
the Inter-University Consortium for Political and Social Research (ICPSR),
the world's largest computerized social science data archive. Visit
the ISR Web site at www.isr.umich.edu for more information.
Related web sites:
Institute for Social Research:
http://www.isr.umich.edu
ISR Health and Retirement Study:
http://hrsonline.isr.umich.edu/
U-M Medical School:
http://www.med.umich.edu/medschool
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