It's been more than 15 years since the Institute of Medicine released its seminal 1997 report detailing the suffering that many Americans experience at the end of life and offering sweeping recommendations on how to improve care.
But the number of people experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study published Monday. And the number of people with depression in the last year of life increased by more than 26 percent.
All that happened as guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.
"We've put a lot of work into this and it's not yielding what we thought it should be yielding. So what do we do now?" asked Dr. Joanne Lynn, a study author who directs the Center for Elder Care and Advanced Illness at the Altarum Institute.