Clinical care of community-dwelling older adults with advanced chronic diseases would be enhanced by identifying and alleviating the range of symptoms they experience

In a study to determine the prevalence of a range of symptoms among older persons living independently with advanced chronic diseases, researchers at Yale have found that the majority experienced multiple moderate or severe symptoms.

"The clinical care of community-dwelling older adults with advanced chronic diseases would be enhanced by identifying and alleviating the range of symptoms they experience," said principal investigator Lisa M. Walke, M.D., assistant professor of internal medicine/geriatrics at Yale School of Medicine.

Published in the November 22 issue of Archives of Internal Medicine, the study was based on in-home interviews with 226 people age 60 and older with a primary diagnosis of advanced cancer, congestive heart failure or chronic obstructive pulmonary disease (COPD). Participants were asked to rate the intensity of 10 symptoms as not present, mild, moderate or severe in the prior 24 hours.

Virtually all participants, 86 percent, experienced at least one symptom rated moderate or severe, and 69 percent experienced two or more symptoms. The most prevalent symptoms reported were limited activity, fatigue and physical discomfort. Participants with COPD reported more moderate or severe symptoms, than those with cancer.

Symptoms are the language used by patients to describe their subjective experience of illness and have been shown to be associated with important health outcomes in hospitalized cancer patients. Little is known regarding the symptoms experienced by adults with a variety of advanced diseases who are not hospitalized or enrolled in hospice.

"Our study suggests that greater attention to the assessment and alleviation of symptoms in this group is greatly needed," said Walke.