title: Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults.
abstract: OBJECTIVE
  To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults.
  
  
  METHODS
  Prospective, observational study with a baseline in-home assessment of symptom burden.
  
  
  METHODS
  Central Alabama.
  
  
  METHODS
  Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence.
  
  
  METHODS
  Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined.
  
  
  RESULTS
  During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity.
  
  
  CONCLUSIONS
  Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
authors.affiliation: Geriatric Research, Education and Clinical Center Veterans Affairs Tennessee Valley Healthcare, Nashville, Tennessee 37212, USA. Salanitro@Vanderbilt.Edu
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Salanitro
authors.forename: Martha
authors.initials: M
authors.lastname: Hovater
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Hearld
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
authors.forename: Eric
authors.initials: E
authors.lastname: Bodner
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Brown
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018434:Sickness Impact Profile; D014481:United States