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Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
Karlstad University, Sweden.
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Karolinska Institute KI, Sweden.
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

Place, publisher, year, edition, pages
BioMed Central, 2015. Vol. 15, no 1
Keyword [en]
Chronic disease; Older people; Symptom assessment
National Category
Sociology Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-114010DOI: 10.1186/1471-2318-15-1ISI: 000347569800001PubMedID: 25559550OAI: oai:DiVA.org:liu-114010DiVA: diva2:786807
Note

Funding Agencies|Faculty of Health sciences, Linkoping University; county council of Ostergotland; Signe and Olof Wallenius trust fund; Solstickan; Swedish Association of Geriatric Medicine; Mundipharma

Available from: 2015-02-06 Created: 2015-02-05 Last updated: 2017-12-04
In thesis
1. Symptom burden among people with chronic disease
Open this publication in new window or tab >>Symptom burden among people with chronic disease
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief.

Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease.

Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT.

Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III).

Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 97 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1484
Keyword
Symptom experience, Symptom burden, Chronic disease, Community-dwelling
National Category
Gerontology, specializing in Medical and Health Sciences Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-122742 (URN)10.3384/diss.diva-122742 (DOI)978-91-7685-939-1 (ISBN)
Public defence
2015-12-18, K3, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (Swedish)
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Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2015-11-20Bibliographically approved

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Eckerblad, JeanetteEkdahl, AnneUnosson, MitraWiréhn, Ann-BrittMilberg, AnnaKrevers, BarbroJaarsma, Tiny

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Division of Health, Activity and CareFaculty of Health SciencesDepartment of Geriatric Medicine in LinköpingLocal Health Care Services in Central ÖstergötlandDivision of Health Care AnalysisFaculty of Medicine and Health SciencesDepartment of Advanced Home Care in NorrköpingCenter of Palliative Care
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