Symptom Burden Predicts Hospitalization Independent of Comorbidity in Community-Dwelling Older Adults
Version of Record online: 17 SEP 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 60, Issue 9, pages 1632–1637, September 2012
How to Cite
J Am Geriatr Soc 60:1632–1637, 2012.
- Issue online: 17 SEP 2012
- Version of Record online: 17 SEP 2012
- National Institutes of Health
- healthcare utilization;
- older adults;
To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults.
Prospective, observational study with a baseline in-home assessment of symptom burden.
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.
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.
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.
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.