Symptom Burden in Chronically Ill Homebound Individuals

Abstract

Objectives To document the degree of symptom burden in an urban homebound population. Design Cross-sectional survey. Setting The Mount Sinai Visiting Doctors Program (MSVD). Participants All individuals newly enrolled in the MSVD. Measurements 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. Results 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. Conclusion In chronically ill homebound adults, symptom burden is a serious problem that needs to be addressed alongside primary and specialty care needs.

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

“…Older people with advanced chronic diseases are known to suffer from symptoms such as pain, lack of energy/fatigue, shortness of breath and loss of appetite (Walke et al 2006, Wajnberg et al 2013). However, the way a symptom is perceived is a unique experience and a lack of symptom control may result in significant deterioration of health-related quality of life (Newcomb 2010).…”

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

“…8 Similarly, hospice patients in various settings, including the home, experienced severe symptom burden such as lack of energy (83%), pain (76%), and loss of appetite (63%). 9 Although studies have examined interventions that have decreased pain over time in patients with conditions such as arthritis and cancer, 10 few studies have evaluated symptom control over time for patients in diverse long-term settings.…”

“…We focused on three symptoms that our previous research found were most prevalent (approximately 50%) for homebound patients at enrollment in HBPC-pain, tiredness, and loss of appetite. 8 We also included depression and anxiety as they substantially impact patient quality of life, 17,18 disability, 19 and health care costs, [20][21][22] and they may be particularly amenable to in-home intervention through primary care or specialist referral.…”

Geriatric Syndromes and Geriatric Assessment for the Generalist

“…60,61 The most relevant aspects of palliative care medicine for complex geriatric patients are quality-of-life assessment, symptom management, advance care planning, and attention to family experiences in care. 62 Providing support for caregivers in the form of respite care also is an important feature of high-performing geriatric models of care.…”