Rich People Die Differently

Wealthy People Suffer Less Before Death Than Poor People

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July 7, 2005 -- Rich people not only live differently than the rest of us, but a new study suggests that they die differently, too.

Researchers found older men and women who had a net worth of $70,000 or more were a third less likely than poorer people to have been in pain frequently in the year before they died.

Not only did wealthier seniors feel less pain at the end of their lives, the wealthiest of the bunch also were less likely to suffer from common symptoms, such as depression or shortness of breath.

But regardless of wealth, researchers say the study shows that older Americans carry an unacceptable burden of pain and suffering in their last year of life.

"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," states researcher Maria Silveira, MD, MPH, assistant professor of general medicine at the University of Michigan Medical School, in a news release.

Differences at Death

In the study, researchers examined the prevalence of common symptoms, such as pain, fatigue, and depression, in the last year of life in a group of 2,604 men and women aged 70 or older who died between 1993 and 2000.

The participants were members of a health and retirement study and researchers interviewed surviving spouses or others to learn about their last months of life and the circumstances of their death.

The results showed that about half of the participants suffered from pain, fatigue, or depression as they approached death, and more than half suffered from at least three symptoms. Among those who reported pain in the last year of life, 59% reported it was severe.

Researchers found that reports of pain symptoms were significantly related to net worth. Older adults in the top quarter according to net worth were 33% less likely to suffer from pain at the end of life compared with those in the bottom quarter.

Those differences in pain during the last year of life persisted even after researchers took into account a person's age, sex, ethnicity, education, and existing medical conditions.


Researchers say older people with greater financial resources may express their symptoms more assertively and demand better care. Or they may have greater access to goods and services above and beyond what insurance pays for.

Other findings of the study include:

  • People with cancer were more than twice as likely to experience pain and had 30% higher rates of depression.
  • Older adults with dementia were 2.3 times more likely to be depressed in the last year of life and had 40% higher rates of fatigue.
  • Pain in the last year of life was most common among those with cancer, lung disease, or heart disease.
  • Depression was most common in people with some form of cognitive impairment, such as dementia or Alzheimer's disease.

Researchers say these results demonstrate a need for better symptom assessment for older adults at all levels of the health care system, including hospitals, clinics, and nursing homes.

"These are treatable symptoms and not an inevitable part of the dying process," says researcher Kenneth Langa, MD, PhD, assistant professor of general medicine at the University of Michigan Medical School, in the release.

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SOURCES: Silveira, M. Journal of Palliative Care, August 2005. News release, University of Michigan.

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