Symptom Burden Predicts Hospitalization Independent of Comorbidity in Community-Dwelling Older Adults

Authors

  • Amanda H. Salanitro MD, MS, MSPH,

    Corresponding author
    1. Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee
    • Geriatric Research, Education and Clinical Center Veterans Affairs Tennessee Valley Healthcare, Nashville, Tennessee
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  • Martha Hovater MS,

    1. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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  • Kristine R. Hearld PhD,

    1. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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  • David L. Roth PhD,

    1. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
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  • Patricia Sawyer PhD,

    1. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
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  • Julie L. Locher PhD, MSPH,

    1. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
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  • Eric Bodner BS,

    1. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
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  • Cynthia J. Brown MD,

    1. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
    2. Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
    3. Geriatric Research, Education and Clinical Center, Atlanta Department of Veterans Affairs, Birmingham, Alabama
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  • Richard M. Allman MD,

    1. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
    2. Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
    3. Geriatric Research, Education and Clinical Center, Atlanta Department of Veterans Affairs, Birmingham, Alabama
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  • Christine S. Ritchie MD, MSPH

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Center for Research on Aging, Jewish Home of San Francisco, San Francisco, California
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Address correspondence to Dr. Amanda Salanitro, Room A-414, 1310 24th Avenue South, Nashville, TN 37212. E-mail: Amanda.Salanitro@Vanderbilt.Edu

Abstract

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.

Ancillary