Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults

Amanda H. Salanitro, Martha Hovater, Kristine R. Hearld, David L. Roth, Patricia Sawyer, Julie L. Locher, Eric Bodner, Cynthia J. Brown, Richard M. Allman, Christine S. Ritchie

Research output: Contribution to journalArticle

Abstract

Objectives To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. Design Prospective, observational study with a baseline in-home assessment of symptom burden. Setting Central Alabama. Participants Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. Measurements Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. Results During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. Conclusion Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.

Original languageEnglish (US)
Pages (from-to)1632-1637
Number of pages6
JournalJournal of the American Geriatrics Society
Volume60
Issue number9
DOIs
StatePublished - Sep 1 2012

Keywords

  • comorbidity
  • healthcare utilization
  • older adults
  • symptom

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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    Salanitro, A. H., Hovater, M., Hearld, K. R., Roth, D. L., Sawyer, P., Locher, J. L., Bodner, E., Brown, C. J., Allman, R. M., & Ritchie, C. S. (2012). Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults. Journal of the American Geriatrics Society, 60(9), 1632-1637. https://doi.org/10.1111/j.1532-5415.2012.04121.x