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Study Urges Doctors to Consider “Symptom Burden” in Older Patients

Larry went to the doctor because his knee pain was worsening. The doctor ordered x-rays and increased Larry’s dose of anti-inflammatory medication. Larry never mentioned to the doctor that he had been feeling depressed lately, and that he’d been having trouble sleeping … yet both of those things can increase sensations of pain. And in turn, pain can increase depression and sleep problems!

Bottom line, when it comes to symptoms … well, it’s complicated!

A research team from the University of Washington recently completed a study on “symptom burden”—the effect that various symptoms have, alone and together, on older patients. The study, published in the Journal of the American Geriatrics Society, urged doctors to pay more attention to the combined impact of symptoms on seniors and their quality of life.

Study author Prof. Kushang Patel and his team looked at the findings of the National Health and Aging Trends Study, which includes data from 7,500 seniors. They found that more than 50% of people older than 65 have two or more troublesome symptoms, and 25% have three or more. The number of symptoms increased with age. For the purpose of the study, the researchers defined “symptoms” as “negative health-related experiences reported by patients but not observed by clinicians.”

These six symptoms were the most common:

  • pain
  • fatigue
  • depression
  • anxiety
  • breathing difficulty
  • sleep problems

Sometimes symptoms are directly caused by an illness—for example, chest pain from heart problems, knee pain from arthritis, or breathing difficulty due to COPD. The causes of sleep problems and depression may be more complicated and there may be interplay between symptoms and various health problems. The American Geriatrics Society explains, “Older adults often experience more than one symptom at a time, which can make each symptom feel worse.”

Symptom burden was associated with increased falls, a higher rate of hospitalization, a loss of strength and function, and shorter life. Clearly, treating symptoms is a big quality of life issue! Yet it often falls through the cracks as doctors focus on treating a particular disease or health condition.

The American Geriatrics Society notes that while palliative care specialists focus on symptom relief when patients are at the end of life, there is much more that can be done for all patients, as part of improved patient-centric, integrated care.

“Our results indicate that the overall burden of symptoms is something the clinician should consider, as it may have an impact that is not apparent when just dealing with diseases and symptoms individually, one at a time,” reported Prof. Patel. “For many older adults, symptoms often interfere with accomplishing daily activities. Addressing symptoms gives clinicians an opportunity to identify the patient’s goals and priorities, which can then help guide treatment decisions.”

Professional Geriatric Care Managers, like Elder Advisory Group, are training in advocating for clients through their holistic planning approach to care.

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