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Range and Severity of Symptoms Over Time Among Older Adults With Chronic Obstructive Pulmonary Disease and Heart Failure
Lisa M. Walke, MD;
Amy L. Byers, PhD, MPH;
Mary E. Tinetti, MD;
Joel A. Dubin, PhD;
Ruth McCorkle, PhD;
Terri R. Fried, MD
Arch Intern Med. 2007;167(22):2503-2508.
Background Symptoms are a central component of health status; however, little is known about the full range and trajectory of symptoms experienced by persons with chronic diseases other than cancer.
Methods Observational cohort study with interviews performed at least every 4 months for up to 2 years among community-dwelling persons 60 years or older with chronic obstructive pulmonary disease (COPD) or heart failure (HF). Seven symptoms rated as absent, mild, moderate, or severe were assessed at each interview.
Results Among the 79 participants with COPD, at least 50% reported shortness of breath, physical discomfort, fatigue, and problems with appetite and anxiety. Among the 59 participants with HF, at least 50% reported physical discomfort, fatigue, and problems with appetite at both their initial and final interviews. Both disease-specific and non–disease-specific symptoms increased in severity over time. The prevalence of individual symptoms did not differ according to whether the participants lived or died.
Conclusions As a potentially modifiable contributor to poor health status, the high symptom burden among older persons with COPD and HF represents a large unmet need for improved symptom assessment and treatment. This need may not be met by current disease management guidelines, which focus on a small number of symptoms except for patients at the end of life.
Author Affiliations: School of Medicine, Departments of Internal Medicine (Drs Walke, Tinetti, and Fried) and Epidemiology and Public Health (Drs Tinetti and Dubin), Program on Aging (Dr Byers), and Center for Excellence in Chronic Illness Care, School of Nursing (Dr McCorkle), Yale University, New Haven, Connecticut; and Geriatrics and Extended Care (Dr Walke) and Clinical Epidemiology Research Center (Dr Fried), VA Connecticut Healthcare System, West Haven. Dr Byers is now with the Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York. Dr Dubin is now with the Departments of Statistics and Actuarial Science and Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada.
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