Range and Severity of Symptoms Over Time Among Older Adults With Chronic Obstructive Pulmonary Disease and Heart Failure

Walke, Lisa M.

doi:10.1001/archinte.167.22.2503

Cited by 138 publications

(141 citation statements)

References 27 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…Although the most prevalent signs and symptoms were consistent with findings reported in the literature, [13][14][15][16][17][18][19] patients in our study reported some rarely discussed signs and symptoms, such as change in urine output; cool, pale, or mottled skin; and irregular pulse. Our findings may be more comprehensive as a result of our use of the checklist format.…”

Section: Discussionsupporting

confidence: 92%

Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

Albert

Trochelman

et al. 2010

American Journal of Critical Care

View full text Add to dashboard Cite

Background Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. Objectives To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. Methods A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. Results Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P ≤ .001). Sudden weight gain increased from 5% in functional class I to 37.5% in functional class IV (P < .001). Dyspnea occurred in all functional classes (98%–100%) and both settings (92%–100%). Profound fatigue was associated with worsening functional class (P < .001) and hospital setting (P = .001); paroxysmal nocturnal dyspnea was associated with functional class IV (P = .02) and hospital setting (P < .001). Conclusion Profound fatigue is more reliable than dyspnea as an indicator of functional class. Nurses must recognize atypical signs and symptoms of worsening functional class to determine clinical status and facilitate patient care decisions.

show abstract

Section: Discussionsupporting

confidence: 92%

Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

Albert

Trochelman

et al. 2010

American Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…Research has shown that symptoms tend to increase over time if not assessed and targeted for the right interventions, and if recognized, most symptoms can be treated (Walke et al 2007). …”

Section: Discussion and Recommendationsmentioning

confidence: 99%

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Eckerblad

Theander

Ekdahl

et al. 2015

Applied Nursing Research

View full text Add to dashboard Cite

Context. Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.Objectives. The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.Method. A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.Results. The experience of living with a high symptom burden revealed the overall theme, "To adjust and endure" and three sub-themes. The first subtheme was "To feel inadequate and limited". Participants reported they no longer had the capacity or the ability to manage and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience, the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone, the only thing left to do was to sit or lie down and wait for it all to pass.Conclusion. This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that it is possible to treat or improve.

show abstract

“…Participants were selected from the Center for Medicare and Medicaid Services (CMS) Chronic Conditions Warehouse (CCW), a 5% random sample of Medicare beneficiaries providing beneficiary, assessment, and claims data across the continuum of care. The CCW includes 21 chronic condition variables indicating the presence of a condition as defined by evidence-based algorithms that specify (1) a minimum number of diagnoses/procedure codes, (2) occurring within a specific time frame (either 1, 2, or 3 years), and (3) within certain care settings. For example, the variable indicating the presence of congestive heart failure is derived from the occurrence of at least one of the following International Classification of Diseases, Ninth revision (ICD-9) codes: 398.…”

Section: Methodsmentioning

confidence: 99%

“…This is of particular relevance to older adults with heart failure, as comorbidity in this population increases symptomatology 2 , polypharmacy 3 , risk of hospital readmissions 4,5 , and mortality [6][7][8][9][10] . Moreover, the management of comorbidity, particularly those conditions that are not directly related to heart failure in either pathogenesis or management, can significantly complicate the overall care needed by these patients 3 .…”

Section: Introductionmentioning

confidence: 99%

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

et al. 2011

View full text Add to dashboard Cite

BACKGROUND: Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES: To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS: (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse fromMedicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS: The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the youngold, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION: Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.

show abstract

Range and Severity of Symptoms Over Time Among Older Adults With Chronic Obstructive Pulmonary Disease and Heart Failure

Cited by 138 publications

References 27 publications

Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

Contact Info

Product

Resources

About