Learning about the impact of multiple symptoms in older adults

“Symptoms” is the medical term for any sign of a health problem, even if that sign doesn’t help your healthcare provider diagnose a specific illness. Symptoms, such as feeling tired or rundown (also called fatigue), are among the leading causes of disability for older adults.

Sometimes symptoms are directly caused by illness–for example, an aching chest can be a symptom associated with a heart attack. But often, symptoms have multiple causes. For example, fatigue can be a common symptom when you have conditions such as knee osteoarthritis, depression, and heart failure.

What’s more, older adults often experience more than one symptom at a time, which can make each symptom feel worse.

Up until now, we haven’t had much information about how symptoms that occur at the same time affect an older adult’s ability to function. To learn more, a team of researchers recently examined information from a large study of older adults, the National Health and Aging Trends Study (NHATS), which included more than 7,500 participants aged 65 and older. The study was published in the Journal of the American Geriatrics Society.

The researchers focused on answers given to several questions in the NHATS that showed whether a participant had symptoms such as:

• Shortness of breath or difficulty breathing
• Trouble falling or staying asleep at night
• Depression or anxiety

The researchers also recorded measurements of the participants’ grip strength, whether they walked slowly, their balance, and their ability to rise from a chair. They were also asked whether they had fallen one or more times in the last year.

The researchers also measured whether participants had any chronic diseases, whether they had an overnight hospital stay during the last year, and whether they had trouble performing their daily activities (such as getting in or out of bed, eating, toileting, bathing, and getting dressed).

The researchers learned that 75 percent of older adults had at least one symptom and nearly half had two or more symptoms. They noted that nearly 14 percent–almost 5 million older adults in the U.S.–had four or more symptoms.

The researchers learned that:

• Symptoms increased with older age.
• Women were more likely to have more symptoms than men.
• Compared to white individuals, black and Hispanic participants had more symptoms. Older adults with lower levels of education had a higher number of symptoms than those with higher education levels.
• Current smoking, obesity, and an inactive lifestyle were also associated with a higher number of symptoms.
• Participants who had a chronic medical condition, or multiple chronic conditions, also experienced more symptoms.

Importantly, older adults who reported more symptoms had weaker grip strength and walked more slowly. Over time, older adults with more symptoms had an increased risk of falls, hospitalizations, disability, and mortality.

The researchers believe that as we age and experience more multiple chronic conditions, the number of us living with multiple symptoms as older adults is likely to grow. While healthcare providers understand that treating symptoms is important to improving quality of life at the end-of-life (palliative care), there is less understanding about the best way to treat multiple symptoms that older adults experience.

The researchers said that their findings highlight the need for more research on symptoms in older adults to develop effective management strategies.

###

This summary is from “Symptom Burden among Community-Dwelling Older Adults in the United States.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Kushang V. Patel, PhD, MPH; Jack M. Guralnik, MD, PhD; Elizabeth A. Phelan, MD, MS; Nancy M. Gell, PT, PhD, MPH; Robert B. Wallace, MD, MSc; Mark D. Sullivan, MD, PhD; and Dennis C. Turk, PhD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation’s work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has–for 75 years–worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.