TY - JOUR
T1 - Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults
AU - Salanitro, Amanda H.
AU - Hovater, Martha
AU - Hearld, Kristine R.
AU - Roth, David L.
AU - Sawyer, Patricia
AU - Locher, Julie L.
AU - Bodner, Eric
AU - Brown, Cynthia J.
AU - Allman, Richard M.
AU - Ritchie, Christine S.
PY - 2012/9
Y1 - 2012/9
N2 - Objectives To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. Design Prospective, observational study with a baseline in-home assessment of symptom burden. Setting Central Alabama. Participants Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. Measurements Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. Results During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. Conclusion Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
AB - Objectives To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. Design Prospective, observational study with a baseline in-home assessment of symptom burden. Setting Central Alabama. Participants Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. Measurements Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. Results During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. Conclusion Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
KW - comorbidity
KW - healthcare utilization
KW - older adults
KW - symptom
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U2 - 10.1111/j.1532-5415.2012.04121.x
DO - 10.1111/j.1532-5415.2012.04121.x
M3 - Article
C2 - 22985139
AN - SCOPUS:84866357399
SN - 0002-8614
VL - 60
SP - 1632
EP - 1637
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -