title: Palliative care needs and symptom patterns of hospitalized elders referred for consultation.
abstract: BACKGROUND
  To provide effective palliative care (PC) to the geriatric population, an understanding of the reasons for consultation, main diagnoses related to referral, and symptom severity in chronic disease states is essential.
  
  
  OBJECTIVE
  We compared the baseline characteristics, referral patterns, and symptom severity among older and younger patients referred for inpatient PC consultation.
  
  
  METHODS
  We conducted a retrospective review of 2382 inpatient PC consultations. We excluded "reconsultations" and patients under the age of 18. Patient characteristics (reason for consultation and diagnosis) and symptom severity were compared across three age groups: Younger, <65 years of age; Older, 65-84 years of age; and Oldest, 85 years of age and older. Multivariable logistic regression adjusted for the effects of gender, ethnicity, and diagnostic subset was performed.
  
  
  RESULTS
  Most patients referred for inpatient PC consultation were older than the age of 65. Oldest patients were consulted on earlier and more often for "end-of-life care." Oldest adults were less likely to report pain, anxiety, and nausea (adjusted odds ratios [AOR] of 0.25, 0.39, and 0.19, respectively) and more likely to report anorexia than Younger adults (AOR=1.66). There was no clear difference between age groups in reporting of dyspnea and depression.
  
  
  CONCLUSIONS
  Older adults in need of PC appear to have symptom burdens and consultation referral patterns that are different from those of younger patients. Further research is needed to determine whether these symptom patterns are caused by psychosocial factors, whether these reflect true differences among age groups, and whether symptom measurement instruments should be tailored to patient age.
authors: Department of Medicine, Unity Health System, Rochester, New York 14626, USA. aolden@unityhealth.org
authors: Aaron M
authors: AM
authors: Olden
authors: Robert
authors: R
authors: Holloway
authors: Susan
authors: S
authors: Ladwig
authors: Timothy E
authors: TE
authors: Quill
authors: Edwin
authors: E
authors: van Wijngaarden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index