Baseline quality of life before intensive care: A comparison of patient versus proxy responses

Gifford, Jeneen M.; Husain, Nadia; Dinglas, Victor D.; Colantuoni, Elizabeth; Needham, Dale M.

doi:10.1097/ccm.0b013e3181cd10c7

Cited by 55 publications

(50 citation statements)

References 40 publications

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“…This approach offers the distinct advantages of national scope and prospective assessment of depressive symptoms with a consistent instrument, and avoids the challenges of using proxy or retrospective assessment of baseline symptoms. 19 We hypothesized that hospitalization for severe sepsis in-and-of-itself would not be significantly associated with an increased risk of subsequent substantial depressive symptoms after controlling for pre-sepsis depressive symptoms. In addition, we tested for an increased risk of substantial depressive symptoms among patients with select baseline characteristics, severe sepsis-related exposures, and post-severe sepsis functional impairments, hypothesizing that patients with pre-sepsis substantial depressive symptoms would be at increased risk for post-sepsis substantial depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Davydow¹,

Hough²,

Langa³

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. Design Prospective longitudinal cohort study. Setting Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998–2006). Participants 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. Results The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis [Relative Risk (RR) 1.00, 95%Confidence Interval (95%CI) (0.73, 1.34)] nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, pre-sepsis substantial depressive symptoms [RR 2.20, 95%CI (1.66, 2.90)] and worse post-sepsis functional impairment [RR 1.08 per new limitation, 95%CI (1.03, 1.13)] were independently associated with substantial depressive symptoms following sepsis. Conclusions The prevalence of substantial depressive symptoms in severe sepsis survivors is high, but is not increased relative to their pre-sepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions prior to hospital discharge, may improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Davydow¹,

Hough²,

Langa³

et al. 2013

The American Journal of Geriatric Psychiatry

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“…Such information would need to be reliable despite the challenges of retrospective collection. In practice it has proven challenging to obtain sufficiently reliable measurements of immediate prehospitalization function for critically ill patients (26,27). Advances in survey techniques, including facilitated recall prompted by medical record review, may mitigate this potential source of bias in cohort studies unable to prospectively collect prehospitalization data.…”

Section: Proportion Of Geriatric Conditions After Sepsis Compared To mentioning

confidence: 99%

“…Respondents with severe sepsis were compared with their own pre-sepsis measurement of the outcome variables. These pre-sepsis assessments were collected prospectively, thus limiting the potential bias of retrospective assessment of the geriatric conditions before the sepsis episode (26,27). We present both unadjusted and adjusted models.…”

Section: Analysesmentioning

confidence: 99%

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Spurious Inferences about Long-Term Outcomes

Iwashyna

Netzer

Langa

et al. 2012

Am J Respir Crit Care Med

114

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Rationale: Survivors of critical illness suffer significant limitations and disabilities. Objectives: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs. Methods: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory. Measurements and Main Results: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls. Conclusions: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.Keywords: severe sepsis; long-term outcomes; geriatric conditions; cohort studies; trajectory bias A substantial body of research has demonstrated that survivors of critical illness face extensive physical, psychological, cognitive, and social deficits in the aftermath of their critical illness (1). For example, survivors of acute respiratory distress syndrome (ARDS) have prolonged 6-minute walk times, executive dysfunction, other neuropsychiatric deficits, and diminished ability to return to work (2-13). Numerous studies have found quality of life among survivors of critical illness (14, 15), severe sepsis (16,17), and ARDS (4-8, 13, 18) to be abnormally low.Patients surviving critical illness have limitations and disabilities somewhat characteristic of an older adult population. Rubenfeld recently postulated a "progeric hypothesis" that the sequelae of critical illness mirror accelerated aging (19). This hypothesis suggests that severe sepsis may be associated with the development of so-called geriatric conditions (15,20,21). These are conditions common among older adults, multifactorial in etiology, and associated with disability, often contributing to decreased quality of life (20-23). The followin...

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“…In a study to ascertain the accuracy of proxy reports, capable patients and their relatives simultaneously filled the Sickness Impact Profile questionnaire. There was an incomplete correlation between the results of patients and proxy's, 52 greatly depending upon the specific HRQOL domain being measured. 48 It was concluded that physical functioning is rated similarly between patient and proxy but not any of the psychological aspects.…”

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confidence: 99%

Quality of Life among Chronic Disease Patients

Shofany¹

2017

NCOAJ

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Abbreviations: HIV, human immunodeficiency virus;HRQOL, health related quality of life; IWB, the index of well-being; QQL, quality of life; QWB, quality of wellbeing; WHOICF, the world health organization international classification IntroductionQuality Of Life (QOL) has become an increasingly attractive subject in recent decades, drawing attention from both enthusiasts and researchers. [1][2][3] But what is quality of life in fact? Is it defined by our looks? Financial state? Nature or nurture? In truth, people define it by all of the above and many more.4 This study, however, intentionally wishes to define the quality of life through the narrow focus lens of the chronic medicine field. There is a good reason why the quality of life of chronic patients has been a popular field of research in the last 20 years. Non-communicable chronic diseases such as cancer, stroke, diabetes, HIV and more have been found to take a staggering annual death toll of 38 million.5 It comes with little surprise then, that the HRQOL (Health Related Quality Of Life) of people suffering from such maladies was vastly studied and documented. The research into chronic patients' HRQOL is believed to significantly benefit their bodies and minds. After all, such writings are meant to expose the means to maximize the patient's' quality of life. These means may alleviate the conditions which commonly restrict patients' careerrelated tasks and their daily activities as well as affording them an extended period of independence. 6The research into HRQOL can aid patients by means of exposing the QOL factors that may be affected by chronic disease. With such information, the treatment may be adjusted to specifically handle these factors. Research may also to help to tell apart the ways different diseases can influence QOL. If the quality of life is affected by chronic disease, further study can provide therapists with tools to measure and even predict the effectiveness of their treatments.One glaring paradox about the wealth of research into chronic patients HRQOL is the fact that HRQOL is a rather poorly defined term. Each research tends to regard QOL differently, using measurements, theories and means of validation that suite only one specific interpretation. In worse cases, the study may even base itself on multiple, contradictory definitions of QOL by the very same researcher. Thus, much is still left to properly define and explore in the field. For these reasons, it is imperative to be skeptical when exploring existing HRQOL literature and heed the words of its critics.The problematic definition of QOL in chronic medicine literature stands in the heart of this study as it attempts to explore, compare and confront the meanings of the term on different sources. This work will first present examples of the many definitions of QOL and specifically health-related QOL. Secondly, it will move into more detailed explorations of HRQOL in chronic medicine, demonstrating measuring methods, significant factors, research areas and findings as provided by di...

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Baseline quality of life before intensive care: A comparison of patient versus proxy responses

Cited by 55 publications

References 40 publications

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Spurious Inferences about Long-Term Outcomes

Quality of Life among Chronic Disease Patients

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