The impact of medication use on symptom burden in older patients with multiple medical morbidities

BackgroundOn average, older adults have more medical morbidities and consume a greater number of prescribed medications than their younger counterparts. However, the independent impact of greater medication use on symptom burden is not clear.ObjectiveTo determine to what extent there is: (1) an association between medical morbidity and symptom burden; and/or (2) an association between medication use and symptom burden.Materials and methodsWe performed a cross-sectional study, including one-on-one surveys of patients and medical record reviews, at a Veterans' Affairs primary care clinic in Connecticut, involving 159 community-dwelling males age >65 years, who were seen at routine appointments during the 5-month study period. The most commonly reported symptoms associated with adverse drug events were considered, and severity of symptoms was reported according to a Likert scale. Symptom burden was calculated as the sum of “severe and very severe” symptoms across all symptom categories. Linear regression and Chi-square analyses were performed to assess the bivariate associations between symptom burden and medications and between symptom burden and medical morbidities.ResultsOn average, participants had 2.6 ± 1.4 medical morbidities, were prescribed 7.9 ± 2.8 medications, and reported 0.70 ± 1.2 severe or very severe symptoms. Linear regression analysis demonstrated a direct association between medical morbidities and symptom burden (slope = 0.38, r² = 0.17, p < 0.0001) and a weaker association between medication use and symptom burden (slope = 0.11, r² = 0.06, p = 0.002). When considered in a multiple regression model, medical morbidity continued to be a significant predictor of symptom burden (p < 0.0001), but the number of medications was no longer predictive (p = 0.52).ConclusionMedical morbidity contributes significantly to symptom burden, and use of additional medications does not allay or contribute to this effect.     

Health related quality of life measures by demographics and common health risks, Jordan 2004

Objective:  

To measure health-related quality of life (HRQOL) in Jordan     

Range and severity of symptoms over time among older adults with chronic obstructive pulmonary disease and heart failure

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.     

Symptom assessment in community-dwelling older adults with advanced chronic disease

Brief symptom instruments are designed to assess symptoms while maintaining low respondent burden, but they may omit important information. Our objective was to determine whether a representative brief symptom instrument effectively captures the full symptom experience of older adults with advanced diseases. In this cross-sectional study, we interviewed 90 community-dwelling adults with cancer, congestive heart failure, or chronic obstructive pulmonary disease regarding the presence of symptoms in the prior 24 hours. Participants rated the intensity and bothersome nature of 15 symptoms--10 symptoms were included in the Edmonton Symptom Assessment Scale (ESAS) plus 5 supplemental symptoms. Participants reported similar proportions of ESAS and supplemental symptoms. Intensity and "bothersomeness" ratings frequently differed. Brief symptom instruments only provide a limited assessment of the respondent's symptom experience. The benefit obtained from incorporating both the intensity and bothersome nature of a longer list of symptoms may outweigh the potential increase in respondent burden.     

Comparative dosimetric evaluation of three-dimensional conformal and stereotactic radiotherapy for treatment of intracranial tumors

AimsTo evaluate the dosimetric profile among three-dimensional conformal radiotherapy (3D-CRT) and stereotactic radiotherapy (SRT) for the treatment of intracranial tumors.Materials and methodsSeventeen patients with intra cranial tumors of benign nature or low malignant potential were enrolled and planned for SRT as well as 3D-CRT.Dosimetric comparison between these two plans was done considering the following parameters: Target coverage, conformity index, and heterogeneity index.ResultsThe dosimetric parameters of the 3D-CRT plans were a little inferior compared with those for the SRT plans. The difference between mean target coverage, mean conformity index and mean heterogeneity index for 3D-CRT and SRT plans was highly significant at P < 0.001 (t = 7.74), P < 0.001 (t = 5.52), and P < 0.01 (t = 3.15) respectively.ConclusionSRT is a very efficient treatment option for intracranial tumors, in view of better target coverage and conformality compared with 3D-CRT.