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High Symptom Burden and Low Functional Status in the Setting of Multimorbidity
Author(s) -
Portz Jennifer D.,
Kutner Jean S.,
Blatchford Patrick J.,
Ritchie Christine S.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15045
Subject(s) - medicine , discontinuation , multivariate analysis , performance status , univariate analysis , comorbidity , palliative care , activities of daily living , physical therapy , logistic regression , cancer , nursing
Objectives To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life‐limiting illness. Design Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group. Group differences were tested using a t‐test; multivariate regression analysis was used to determine the effect of multiple variables on functional status and symptom burden. Setting Fifteen Palliative Care Research Cooperation sites. Participants Adults who participated in a parent statin‐discontinuation clinical trial were included in the analysis (N = 381). Inclusion criteria were diagnosis of a life‐limiting illness, statin use for 3 months or longer, life expectancy longer than 1 month, and declining functional status. Measurements Cancer diagnosis (solid organ and hematologic malignancies), multimorbidity (Charlson Comorbidity Index ( CCI ) score), symptom burden (Edmonton Symptom Assessment Scale ( ESAS ) score, number of symptoms with ESAS severity score >4), functional status (Australia‐modified Karnofsky Performance Scale ( AKPS )). Results Fifty‐one percent had a primary diagnosis of cancer; mean age 74.1 ± 11.6. Participants had multiple comorbid illnesses ( CCI score 4.9 ± 2.8), multiple symptoms ( ESAS score 27.2 ± 15.9), and poor functional status ( AKPS = 53 ± 13). In univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs 3.1 moderate or severe symptoms ( t = −3.2, P = .002), 12% vs 6% with severe symptoms ( t = −3.7, P < .001)), but cancer diagnosis was not. In univariate and multivariate analyses, higher symptom burden was associated with poorer functional status ( F = 11.6, P < .001), but multimorbidity was not. Conclusion Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in individuals with multimorbidity.