liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, 1-11 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim

The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment.

Background

Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity.

Design

Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT).

Methods

Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011–2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care.

Results

Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68–81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38–59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms.

Conclusions

Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2016. 1-11 p.
Keyword [en]
Registration clinicaltrials.gov identifier: NCT01446757 Keywords Symptom management, Community Care, Older people, Quality of care
National Category
Nursing Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-122741DOI: 10.1111/jan.13032PubMedID: 27222059OAI: oai:DiVA.org:liu-122741DiVA: diva2:872488
Note

At the time for thesis presentation publication was in status: Manuscript

At the time for thesis presentation publication was named: Symptom trajectory and symptom burden in older people with multimorbidity, data from the RCT AGe-FIT study

Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2016-09-23Bibliographically approved
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 (print) (ISBN)
Public defence
2015-12-18, K3, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2015-11-20Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Eckerblad, JeanetteEkdahl, AnneJaarsma, Tiny
By organisation
Division of Health, Activity and CareFaculty of Medicine and Health SciencesDepartment of Social and Welfare StudiesDepartment of Geriatric Medicine in Linköping
In the same journal
Journal of Advanced Nursing
NursingGerontology, specializing in Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 115 hits
ReferencesLink to record
Permanent link

Direct link