Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the <scp>RCT AG</scp>e‐<scp>FIT</scp> study

Eckerblad, Jeanette; Theander, Kersti; Ekdahl, Anne; Jaarsma, Tiny

doi:10.1111/jan.13032

Cited by 25 publications

(24 citation statements)

References 37 publications

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“…Although multimorbidity was associated with higher symptom burden, cancer was not. Severe and persistent symptoms have previously been linked to multimorbidity in community-dwelling older adults, 19,20 and greater symptom burden has been associated with multimorbidity in individuals with cancer. 21,22 These findings, in concert with those of previous studies, suggest that, in many instances, noncancer diagnoses drive symptom burden whether the individual has cancer or not.…”

Section: Discussionmentioning

confidence: 99%

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Portz

Kutner

Blatchford

et al. 2017

J American Geriatrics Society

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Objective To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status among patients with life-limiting illness. Design Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group (PCRC). Group differences were tested with a t-test; multivariate regression analysis was used to determine effect of multiple variables on functional status and symptom burden. Participants Adults (N=381) recruited from 15 Palliative Care Research Cooperation sites who participated in the parent statin-discontinuation clinical trial were included in the analysis. Inclusion criteria for the trial was: diagnosis of a life-limiting illness, statin use for ≥ 3 months, life expectancy >1 month, and declining functional status. Measurements Cancer diagnosis: solid organ and hematologic malignancies; Multimorbidity: >2 on Charlson Comorbidity Index (CCI); High symptom burden: a) number of symptoms with a severity score >4, and b) any score > 7 on Edmonton Symptom Assessment Scale (ESAS); Functional status: Australia-modified Karnofsky Performance Scale (AKPS). Results Fifty-one percent had a primary diagnosis of cancer, mean age 74.1 years (SD 11.6). Participants had multiple comorbid illnesses (CCI=4.9, SD=2.8), multiple symptoms (ESAS=27.2, SD=15.9) and reduced functional status (AKPS=53, SD=13). In both univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs. 3.1 moderate or severe symptoms (t=−3.2, p=.002); 12% vs. 6% with severe symptoms (t=−3.7, p<0.001), while cancer diagnosis was not. In both univariate and multivariate analyses, higher symptom burden was associated with lower functional status (F = 11.6, p<0.001) while multimorbidity was not. Conclusion Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in patients with multimorbidity.

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Section: Discussionmentioning

confidence: 99%

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Portz

Kutner

Blatchford

et al. 2017

J American Geriatrics Society

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“…We cannot account for multimorbidity in this cause-of-death-based estimate, but it is safe to assume that, as well as the condition recorded as the ‘main’ cause of death, many people in our estimate will have had other comorbid conditions. This means that the complexity of palliative care need is likely to grow due to the high symptom burden [51], complex healthcare needs [52], and high hospitalisation rates [53] of patients with multimorbidity. Our projections may therefore underestimate overall palliative care need.…”

Section: Discussionmentioning

confidence: 99%

How many people will need palliative care in 2040? Past trends, future projections and implications for services

Etkind

Bone

Gomes

et al. 2017

BMC Med

520

384

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BackgroundCurrent estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries.MethodsWe used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure.ResultsBy 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need.ConclusionsIf recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0860-2) contains supplementary material, which is available to authorized users.

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“…6 Although there have not been many studies on thirst distress among patients with other diseases or illnesses, some patients who have diabetes, cancer, older patients with multimorbidity or patients in an intensive care unit, may also suffer from thirst distress. [23][24][25][26] Our study population was mostly representative of stable patients with HF visiting a HF clinic. However, the thirst intensity score in some patients was rather low (i.e.…”

Section: Itemmentioning

confidence: 99%

“…In future studies it would be interesting to examine thirst distress in other populations that experience troublesome thirst. [23][24][25][26]…”

Section: Itemmentioning

confidence: 99%

Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure

Waldréus

Jaarsma

Wal

et al. 2017

European Journal of Cardiovascular Nursing

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

Abstract: Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

Cited by 25 publications

References 37 publications

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

How many people will need palliative care in 2040? Past trends, future projections and implications for services

Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure

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