One third of nursing home residents suffer significant pain in the last six months of life, a new study has found.

Canadian researchers monitored pain levels for 962 nursing home residents between 2007 and 2012. Residents classified their levels between having no pain up to excruciating pain.

Researchers found 34.6% of participants were in moderate or excruciating pain across different assessment periods, and only 5.3% of that group experienced any improvement in pain levels.

“This tells us that once the pain was present it remained constant, and few residents saw any improvement as they approached death,” said Genevieve Thompson, Ph.D., senior author and nursing professor at the University of Manitoba.

This study was conducted by researchers from the University of Manitoba, University of British Columbia and the University of Alberta. It was published in the Journal of the American Medical Directors Association this spring.

Researchers expect future studies to focus on how pain levels during the end of life are affected by palliative or hospice services, nursing home size and nursing home environment.