title: Correlates and Predictors of Changes in Dyspnea Symptoms Over Time Among Community-Dwelling Palliative Home Care Clients.
abstract: BACKGROUND
  Dyspnea is a frequently reported and highly distressing symptom for persons nearing end of life, affecting the quality of living and dying.
  
  
  OBJECTIVE
  This study described health and clinical characteristics of persons experiencing dyspnea who receive palliative home care services and identified factors affecting change in dyspnea over time.
  
  
  METHODS
  Anonymized assessments (N = 6655 baseline; 959 follow-up) from the interRAI palliative care assessment instrument (interRAI PC) were collected during pilot implementation (2006-2011). Triggering of the interRAI PC dyspnea clinical assessment protocol was used to indicate presence of dyspnea. Bivariate and logistic regression analyses described risk and protective factors for developing new dyspnea and for recovery from dyspnea at follow-up.
  
  
  RESULTS
  At baseline, 44.9% of persons exhibited dyspnea. Dyspnea was more prevalent among older adults, males, persons with shortened prognoses, and persons without cancer. Persons with dyspnea were more likely to experience functional impairment, moderate cognitive impairment, fatigue, weight loss, and urinary incontinence. Among persons with dyspnea at baseline, 31.5% recovered from dyspnea at follow-up. In contrast, 31% of persons without dyspnea at baseline reported new dyspnea at follow-up. Risk factors for developing new dyspnea included smoking, fatigue, and receiving oxygen therapy.
  
  
  CONCLUSIONS
  Results highlight that dyspnea is not inevitable as persons progress toward death. Accordingly, dyspnea should be identified and prioritized during the care planning process. Integrated approaches using the interRAI PC dyspnea clinical assessment protocol may assist clinicians to make informed decisions addressing dyspnea at the person-level and thereby improve quality of life at the end of life.
authors: School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada. Electronic address: shannon.freeman@unbc.ca.
authors: Shannon
authors: S
authors: Freeman
authors: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; interRAI Canada, Waterloo, Ontario, Canada.
authors: John P
authors: JP
authors: Hirdes
authors: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors: Paul
authors: P
authors: Stolee
authors: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors: John
authors: J
authors: Garcia
authors: interRAI Canada, Waterloo, Ontario, Canada; Department of Sociology, Nipissing University, North Bay, Ontario, Canada.
authors: Trevor Frise
authors: TF
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D010865:Pilot Projects; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: clinical assessment protocol; community-based care; end of life; interRAI palliative care assessment instrument; shortness of breath