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Keywords:

  • home-based primary care;
  • palliative care;
  • symptom management;
  • Edmonton Symptom Assessment Scale

Objectives

To document the degree of symptom burden in an urban homebound population.

Design

Cross-sectional survey.

Setting

The Mount Sinai Visiting Doctors (MSVD) program.

Participants

All individuals newly enrolled in the MSVD.

Measurements

Edmonton Symptom Assessment Scale (ESAS), which consists of 10 visual analogue scales scored from 0 to 10; symptoms include pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, shortness of breath, and other.

Results

ESAS scores were completed for 318 participants. Most participants were aged 80 and older (68%) and female (75%); 36% were white, 22% black, and 32% Hispanic. Forty-three percent had Medicaid, and 32% lived alone. Ninety-one percent required assistance with one or more activities of daily living, 45% had a Karnofsky Performance Scale score between 0 and 40 (unable to care for self), and 43% reported severe burden on one or more symptoms. The most commonly reported symptoms were loss of appetite, lack of well-being, tiredness, and pain; the symptoms with the highest scores were depression, pain, appetite, and shortness of breath. Participants were more likely to have severe symptom burden if they self-reported their ESAS, had chronic obstructive pulmonary disease or diabetes mellitus with end organ damage, or had a Charlson Comorbidity Index greater than 3 and less likely to have severe burden if they had dementia.

Conclusion

In chronically ill homebound adults, symptom burden is a serious problem that needs to be addressed alongside primary and specialty care needs.