who examined the prevalence and impact of six common symptoms (pain, fatigue,
depression, anxiety, breathing difficulty, sleep problems) found that nearly
half of adults ages 65 and older have two or more of these symptoms and
one-fourth have three or more.

But often
clinicians miss these symptoms, and the more serious health issues they portend
because patients only talk about one of these symptoms during a visit.

from the national study of 7,609 U.S. Medicare beneficiaries were recently
published by the Journal of the American Geriatrics Society.

study shows that the report of multiple symptoms is common among older adults
and increases the risk for a range of negative health outcomes over time, such
as falls and hospitalization,” said lead author Kushang Patel, research
associate professor in anaesthesiology and pain medicine at the University of
Washington School of Medicine.

researchers assessed the patients’ physical performance annually over a
six-year period and monitored the occurrence of falls, disability,
hospitalization, nursing home admission, and mortality.

The study
defined symptoms as negative health-related experiences reported by patients
but not observed by clinicians. Symptoms account for most outpatient visits and
are among the leading causes of disability, the researchers said.

Patel and
colleagues said that although many symptoms can be attributed to a specific
disease or condition — such as chest pain with heart disease — often symptoms
have multiple causes and can reinforce each other.

instance, Patel said, when older patients request to see a care provider about
pain, they may also be experiencing fatigue and sleep difficulty. In fact,
those three symptoms are the most common triad, the investigators reported.

results indicate that the overall burden of symptoms is something the clinician
should consider, as it may have an impact that is not apparent when just
dealing with diseases and symptoms individually, one at a time,” Patel
said. “For many older adults, symptoms often interfere with accomplishing
daily activities. Addressing symptoms gives clinicians an opportunity to
identify the patient’s goals and priorities, which can then help guide
treatment decisions.”

findings provide a clarion call for confronting head-on the problem of symptom
burden in older adults,” said Lauren Hunt and Alexander Smith, researchers
in geriatrics at the University of California, San Francisco.

Hunt and
Smith called for more investments in pharmacologic and non-pharmacological
interventions and better training among the healthcare workforce to address the
symptom burden in older adults.

hopes the research will help drive efforts to improve patient-centered,
integrated care for vulnerable older adults.


Patel et al: Symptom Burden Among Community
Dwelling Older Adults in the United
States. Journal of the American Geriatrics Society,