Research Priorities in Geriatric Palliative Care: Nonpain Symptoms

Abstract

Research addressing the burden, assessment, and management of nonpain symptoms associated with advanced illness in older adults is limited. While nonpain symptoms such as fatigue, sleep, dyspnea, anxiety, depression, cognitive impairment, nausea, and anorexia-cachexia are commonly noted by patients and clinicians, research quantifying their effects on quality of life, function, and other outcomes are lacking and there is scant evidence regarding management. Most available studies have focused on relatively narrow conditions (e.g., chemotherapyinduced nausea) and there are almost no data relevant to patients with multiple morbidities or multiple concurrent symptoms. Assessment and treatment of nonpain symptoms in older adults with serious illness and multiple comorbidities is compromised by the lack of data relevant to their care. Recommended research priorities address the documented high prevalence of distressing symptoms in older adults with serious illness, the unique needs of this population due to coexistence of multiple chronic conditions along with physiologic changes related to aging, the lack of evidence for effective pharmacologic and nonpharmacologic interventions, and the need for validated measures that are relevant across multiple care settings.

Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe‐FIT study

“…Meanwhile, this is a frequent and well‐known problem, but clinical practice guidelines on symptom management for this population are lacking for almost all other symptoms except for pain (Combs et al . ). With a growing number of older people living at home there is a need for clinical practice guidelines to support symptom management (Boeckxstaens & De Graaf ).…”

“…There is a lack of research addressing the prevalence and management of co-occurring symptoms and symptom burden in older people with multimorbidity and even less is known about possible interactions between these symptoms or the symptom clusters. Meanwhile, this is a frequent and well-known problem, but clinical practice guidelines on symptom management for this population are lacking for almost all other symptoms except for pain (Combs et al 2013). With a growing number of older people living at home there is a need for clinical practice guidelines to support symptom management (Boeckxstaens & De Graaf 2011).…”

Leveraging the Health and Retirement Study To Advance Palliative Care Research

“…Conducting symptom-focused research among older adults with serious illness and multimorbidity is a top priority. 29 HRS investigators have gathered data regarding symptoms since 1992 and these data have been used to describe the symptom burden of community dwelling older adults and examine the clinical and socioeconomic factors predictive of their symptomatology. [30][31][32][33][34][35][36] Pain and depression have been examined the most extensively.…”

Nursing research priorities based on CINAHL database: A scoping review

“…Regarding the first phenomenon, long‐term care (Brazil, Maitland, Ploeg, & Denton, ; Deschodt, Zunica, & Wellens, ; Keller, Beck, & Namasivayam, ; McGilton et al, ; Walsh & Yon, ), nursing home settings (Morley et al, ; Simmons et al, ; Walsh & Yon, ), palliative care (Combs, Kluger, & Kutner, ; Hanson & Winzelberg, ; Henoch et al, ; Lunney, ; O'Quinn & Giambra, ; Ritchie & Zulman, ; Schulz, ) and basic/fundamental care (Walsh & Yon, ) are important phenomena that should be studied more closely. With respect to fundamental care, the practical and emancipatory interests are important to direct nursing research and practice (Granero‐Molina et al, ).…”