Symptom Burden Predicts Nursing Home Admissions Among Older Adults
ABSTRACT CONTEXT: Symptom burden has been associated with functional decline in community-dwelling older adults and may be responsive to interventions. Known predictors of nursing home (NH) admission are often nonmodifiable. OBJECTIVES: To determine if symptom burden independently predicted NH admission among community-dwelling older adults over an eight and one half-year follow-up period. METHODS: A random sample of community-dwelling Medicare beneficiaries in Alabama, stratified by race, gender, and rural/urban residence had baseline in-home assessments of sociodemographic measurements, Charlson comorbidity count, and symptoms. Symptom burden was derived from a count of 10 patient-reported symptoms. Nursing home admissions were determined from telephone interviews conducted every six months over the eight and one half years of study. Cox proportional hazard modeling was used to examine the significance of symptom burden as a predictor for NH admission after adjusting for other variables. RESULTS: The mean ± SD age of the sample (N = 999) was 75.3 ± 6.7 years, and the sample was 51% rural, 50% African American, and 50% male. Thirty-eight percent (n = 380) had symptom burden scores ≥2. Seventy-five participants (7.5%) had confirmed dates for NH admission during the eight and one half years of follow-up. Using Cox proportional hazard modeling, symptom burden remained an independent predictor of time to NH placement (hazard ratio = 1.11; P = 0.02), even after adjustment for comorbidity count, race, sex, and age. CONCLUSION: Symptom burden is an independent risk factor for NH admission. Aggressive management of symptoms in older adults may reduce or delay NH admission.
SourceAvailable from: Kathryn Hyer[Show abstract] [Hide abstract]
ABSTRACT: Objectives To examine predictors of long-term nursing home placement (LTNHP) while controlling for mortality as a competing risk event.DesignLongitudinal.SettingHealth and Retirement Study, 1998–2010.ParticipantsNationally representative sample of community-living older adults (N = 10,385).MeasurementsLongitudinal data were used with a maximum follow-up of 12 years. First, a traditional Cox proportional hazards model was estimated treating death as an uninformative censoring event. A joint cause-specific hazards model that accounts for the competing risk of mortality in estimating the risk of LTNHP was then estimated.ResultsThe effect of adjusting for competing risk of mortality is evident for nearly all predictors of LTNHP. Predictors were over- or underestimated in the traditional Cox model, and several predictors changed in the direction of the association, whereas others changed in magnitude. For example, after controlling for mortality, women aged 85 and older had more than twice the risk (hazard ratio = 7.23, 95% confidence interval = 5.18–10.10) of LTNHP than evidenced in the traditional Cox model.Conclusion Whenever possible, the competing risk of mortality should be recognized and adjusted in developing screening tools and predictive risk models for LTNHP.Journal of the American Geriatrics Society 04/2014; 62(5). DOI:10.1111/jgs.12781 · 4.22 Impact Factor
BMC Geriatrics 01/2015; DOI:10.1186/1471-2318-15-1 · 2.00 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Context. Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives. The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity. Method. A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses. Results. The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was “To feel inadequate and limited”. Participants reported they no longer had the capacity or the ability to manage and they felt limited and isolated from friends or family. The second sub-theme was “To feel dependent”. This was a new and inconvenient experience, the burden they put on others caused a feeling of guilt. The final sub-theme was “To feel dejected”. The strength to manage and control their conditions was gone, the only thing left to do was to sit or lie down and wait for it all to pass. Conclusion. This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that it is possible to treat or improve.