Symptom Burden in Chronically Ill Homebound Individuals
Article first published online: 3 DEC 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 61, Issue 1, pages 126–131, January 2013
How to Cite
J Am Geriatr Soc 61:126–131, 2013.
- Issue published online: 11 JAN 2013
- Article first published online: 3 DEC 2012
- home-based primary care;
- palliative care;
- symptom management;
- Edmonton Symptom Assessment Scale
To document the degree of symptom burden in an urban homebound population.
The Mount Sinai Visiting Doctors (MSVD) program.
All individuals newly enrolled in the MSVD.
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.
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.
In chronically ill homebound adults, symptom burden is a serious problem that needs to be addressed alongside primary and specialty care needs.