title: Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors.
abstract: OBJECTIVE
  To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life.
  
  
  METHODS
  Secondary data analysis.
  
  
  METHODS
  General community.
  
  
  METHODS
  Nondisabled persons aged 70 and older (N=754).
  
  
  METHODS
  Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life.
  
  
  RESULTS
  Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71-106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI)=0.16-0.34, P<.001), depression (0.14, 95% CI=0.05-0.24, P=.003), and mobility problems (0.07, 0.03-0.1, P<.001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most-recent comprehensive assessment (6.62 percentage points, 95% CI=4.31-8.94, P<.001), heart failure (3.34 percentage points, 95% CI=0.71-5.97, P=.01), and ex-smoker status (3.01 percentage points, 95% CI=0.94-5.07, P=.004) but decreased with older age (-0.19 percentage points, 95% CI=-0.37 to -0.02, P=.03).
  
  
  CONCLUSIONS
  Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.
authors.affiliation: Hull York Medical School, University of Hull, Hull, UK.
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Johnson
authors.affiliation: University of York, York, UK.
authors.forename: J Martin
authors.initials: JM
authors.lastname: Bland
authors.affiliation: Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, Australia.
authors.forename: Evelyne A
authors.initials: EA
authors.lastname: Gahbauer
authors.affiliation: Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Magnus
authors.initials: M
authors.lastname: Ekström
authors.affiliation: Palliative & End of Life Care, Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: Aynharan
authors.initials: A
authors.lastname: Sinnarajah
authors.affiliation: Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, Australia.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: breathlessness; dyspnea; elderly; end of life; prevalence