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Non-pain Symptoms

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Geriatric Practice

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Abstract

The assessment and treatment of non-pain symptoms in the older adult patient is very important to maintaining quality at the end of life. Every assessment should begin with a discussion of care goals with a focus on what is most important to the patient, including acceptable treatment side effects and socioeconomic resources and/or concerns. Treatment plans should be interdisciplinary in scope and include medication dosage adjustments to account for aging physiology and related pathology. The treatments of more common symptoms such as fatigue, anorexia, constipation, and dyspnea are outlined in this chapter.

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References

  1. AGS Choosing Wisely Workgroup. American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc. 2013;61(4):622–31.

    Article  Google Scholar 

  2. AGS Choosing Wisely Workgroup. American Geriatrics Society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014;62(5):950–60.

    Article  Google Scholar 

  3. Agra Y, Sacristan A, Gonzalez M, Ferrari M, Portugues A, Calvo MJ. Efficacy of senna versus lactulose in terminal cancer patients treated with opioids. J Pain Symptom Manag. 1998;15:1–7.

    Article  CAS  Google Scholar 

  4. Albert R. End-of-life care: managing common symptoms. Am Fam Physician [serial on the Internet]. 2017 [cited February 7, 2018];95(6):356–361. Available from MEDLINE Complete.

    Google Scholar 

  5. American Geriatrics Society Expert Panel on the Care of Older Adults in Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012;60:E1–E25.

    Article  Google Scholar 

  6. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.

    Article  Google Scholar 

  7. Barnes H. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database of Systematic Reviews [serial on the Internet]. 2017 [cited February 7, 2018];(10). Available from: Cochrane Database of Systematic Reviews.

    Google Scholar 

  8. Bausewein C. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant disease. Cochrane Database of Systematic Reviews [serial on the Internet]. 2014 [cited February 7, 2018];(4). Available from: Cochrane Database of Systematic Reviews.

    Google Scholar 

  9. Buchwald D, Sullivan JL, Komaroff AL. Frequency of ‘chronic active Epstein-Barr virus infection’ in a general medical practice. JAMA. 1987;257:2303–7.

    Article  CAS  Google Scholar 

  10. Budhiraja R, Parthasarathy S, Budhiraja P, Habib MP, Wendel C, et al. Insomnia in patients with COPD. Sleep. 2012;35(3):369.

    Article  Google Scholar 

  11. Candy B. Laxatives for the management of constipation in people receiving palliative care. Cochrane Database of Systematic Reviews [serial on Internet]. 2015 [cited February 1, 2018];(5). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  12. Center to Advance Palliative Care (CAPC). www.capc.org. Accessed 8 Feb 2018.

  13. Chai E, Meier D, Morris J, Goldhirsh S. Fatigue. In: Geriatric palliative care. Oxford: Oxford University Press; 2014.

    Google Scholar 

  14. Clark K, Currow DC. Assessing constipation in palliative care in a gastroenterology framework. Palliat Med. 2012;26:834–84.

    Article  Google Scholar 

  15. Clark K. Metoclopramide for chronic nausea in adult palliative care patients with advanced cancer. Cochrane Database of Systematic Reviews [serial on Internet]. 2013 [cited January 26, 2018];(11). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  16. Connor SR, Pyenson B, Fitch K, Spense C, Iwaskai K. Comparing hospice and nonhospice survival among patients who die within a three-year window. J Pain Symptom Manag. 2007;33:238–46.

    Article  Google Scholar 

  17. Covinsky KE, Fuller JD, Yaffe K, et al. Communication and decision-making in seriously ill patients: findings of the SUPPORT project: the study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc. 2000;48.:Suppl:S187–93.

    Article  CAS  Google Scholar 

  18. Deschenes CL, McCurry SM. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep. 2009;11:20–6.

    Article  Google Scholar 

  19. Erichsén E, Milberg A, Jaarsma T, Friedrichsen MJ. Constipation in specialized palliative care: prevalence, definition, and patient-perceived symptom distress. J Palliat Med. 2015;18(7):585–92.

    Article  Google Scholar 

  20. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999;282:1365–70.

    Article  CAS  Google Scholar 

  21. Garfinkle D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648–54.

    Google Scholar 

  22. Glynn J, Gale S, Tank S. Causes of sleep disturbance in a specialist palliative care unit. BMJ Support Palliat Care. 2014;4(Suppl 1):A56.

    Article  Google Scholar 

  23. Hayes D Jr, Anstead MI, Ho J, Phillips BA. Insomnia and chronic heart failure. Heart Fail Rev. 2009;14(3):171–82.

    Article  Google Scholar 

  24. Hugel H, Ellershaw JE, Cook L, Skinner J, Irvine C. The prevalence, key causes and management of insomnia in palliative care patients. J Pain Symptom Manag. 2004;27(4):316.

    Article  Google Scholar 

  25. Kleinpell R, Vasilevskis EE, Fogg L, Ely W. Exploring the association of hospice care on patient experience and outcomes of care. BMJ Support Palliat Care. Published Online First: 16 Aug 2016. https://doi.org/10.1136/bmjspcare-2015-001001.

  26. Kroenke K, Arrington ME, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Intern Med. 1990;150:1685–9.

    Article  CAS  Google Scholar 

  27. Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care. Prevalence, patient characteristics, and outcomes. JAMA. 1988;260:926–34.

    Article  Google Scholar 

  28. Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175:691–700.

    Article  Google Scholar 

  29. Lacasse Y, Golstein R, Lasseron TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2006;(4):Art No: CD003793.

    Google Scholar 

  30. Lee-Robichaud H. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database of Systematic Reviews [serial on Internet]. 2010 [cited February 1, 2018];(1). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  31. Markowitz AJ, Rabow MW. Palliative management of fatigue at the close of life: “it feels like my body is just worn out”. JAMA. 2007;298:217.

    Article  CAS  Google Scholar 

  32. Marshall LL. Megestrol acetate therapy in geriatric patients: case reviews and associated deep vein thrombosis. Consult Pharm. 2003;18(9):764–73.

    PubMed  Google Scholar 

  33. Martin B, Hauer T, Arena R, Leslie D, Galbraith D, et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation. 2012;126:677–87.

    Article  Google Scholar 

  34. Matthews A. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews [serial on Internet]. 2015 [cited February 12, 2018];(9). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  35. Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, et al. Sleep disturbances in patients with advanced cancer in different palliative care settings. J Pain Symptom Manag. 2015;50(6):786–92.

    Article  Google Scholar 

  36. Milne A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews [serial on Internet]. 2009 [cited February 5, 2018];(2). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  37. Nagar V, Birthi P. Chronic opioid pain management for chronic kidney disease. J Pain Palliat Care Pharmacother [serial on the Internet]. 2015 [cited February 7, 2018];29(1):48–50. Available from: MEDLINE Complete.

    Google Scholar 

  38. Narayanan V, Koshy C. Fatigue in cancer: a review of the literature. Indian J Palliat Care. 2009;15:19–25.

    Article  Google Scholar 

  39. Polanski J, Jankowska-Polanska B, Chabowski M, Szumanska-Chabowska A. Quality of life of patients with lung cancer. Onco Targets Ther. 2016;9:1023–8.

    PubMed  PubMed Central  Google Scholar 

  40. Politis M, Wu K, Molloy S, Bain P G, Chaudhuri KR, Piccini P. Parkinson’s disease symptoms: the patient’s perspective. Mov Disord. 2010;25(11):1646.

    Article  Google Scholar 

  41. Radbruch L, Strasser F, Elsner F, Goncalves JF, Loge J, et al. Fatigue in palliative care patients – an EAPC approach. Palliat Med. 2008;22:13–22.

    Google Scholar 

  42. Reuben DB, Herr KA, Pacala JT, Pollock BG, Potter JF, Semla TP. Geriatrics at your fingertips. 19th ed. New York: The American Geriatrics Society; 2017.

    Google Scholar 

  43. Ross DD, Alexander CS. Management of common symptoms in terminally ill patients: Part 1. Fatigue, anorexia, cachexia, nausea and vomiting. Am Fam Physician. 2001;64(5):807–14.

    CAS  PubMed  Google Scholar 

  44. Ruiz Garcia V. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews [serial on Internet]. 2017 [cited February 1, 2018];(7). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  45. Sampson E. Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews [serial on Internet]. 2009 [cited February 5, 2018];(2). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  46. Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000;95:1472–5.

    Article  CAS  Google Scholar 

  47. Sera L, McPherson M, Holmes H. Commonly prescribed medications in a population of hospice patients. Am J Hosp Palliat Care [serial on the Internet]. 2014 [cited February 5, 2018];31(2):126–131. Available from MEDLINE Complete.

    Google Scholar 

  48. Simon S. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database of Systematic Reviews [serial on the Internet]. 2016 [cited February 7, 2018];(10). Available from: Cochrane Database of Systematic Reviews.

    Google Scholar 

  49. Sykes N. A clinical comparison of laxatives in a hospice. Palliat Med. 1991;5:307–14.

    Article  Google Scholar 

  50. Sykes N. The relationship between opioid use and laxative use in terminally ill cancer patients. Palliat Med. 1998;12:375–82.

    Article  CAS  Google Scholar 

  51. Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manag. 2013;45:2–13.

    Article  Google Scholar 

  52. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, et al. Early palliative care for patients with metastatic non-small cell lung cancer. N Engl J Med. 2010;363:733–42.

    Article  CAS  Google Scholar 

  53. Timothy HM, To LB, Currow DC. Can we detect transfusion benefits in palliative care patients? J Palliat Med. 2016;19:110–1113.

    Article  Google Scholar 

  54. Watanabe N. Mirtazapine versus other antidepressant agents for depression. Cochrane Database of Systematic Reviews [serial on Internet]. 2011 [cited February 2, 2018];(12). Available from: Cochrane Database of Systemic Reviews.

    Google Scholar 

  55. Wee B. Interventions for noisy breathing in patients near to death. Cochrane Database of Systematic Reviews [serial on Internet]. 2017 [cited February 12, 2018];(4). Available from: Cochrane Databases of Systematic Reviews.

    Google Scholar 

  56. Weissman D. Fast Facts and Concepts #3. Syndrome of imminent death. 2005; 3rd ed. May 2015. Available from: https://www.mypcnow.org.

  57. Wildiers H, Dhaenekint C, Demeulenaere P, Clement P, Desmet M, Menten J, et al. Atropine, hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care. J Pain Symptom Manage [serial on the Internet]. 2009 [cited February 5, 2018];38(1):124–133. Available from: MEDLINE Complete.

    Google Scholar 

  58. Yennurajalingam S, Bruera E. Palliative management of fatigue at the close of life: “it feels like my body is just worn out”. JAMA. 2007;297:295–304.

    Article  CAS  Google Scholar 

  59. Kroenke K, Spitzer RL, Williams JBW. The PHQ 9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  Google Scholar 

  60. Veauthier C, Gaede G, Radbruch H, Wernecke K-D, Paul F. Sleep disorders reduce health-related quality of life in multiple sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis). Int J Mol Sci. 2015;16(7):16514–28.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Inpatient Geriatrics, Robley Rex VAMC, Louisville, KY, USA

    Belinda Setters

  2. Departments of Internal Medicine and Family & Geriatric Medicine, University of Louisville, Louisville, KY, USA

    Belinda Setters

  3. Geriatrics Division, CHA House Calls Program, Cambridge Health Alliance, Cambridge, MA, USA

    Serena Hsiou-Ling Chao

  4. Department of Medicine, Harvard School of Medicine, Boston, MA, USA

    Serena Hsiou-Ling Chao

Authors
  1. Belinda Setters
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  2. Serena Hsiou-Ling Chao
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Correspondence to Belinda Setters .

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Editors and Affiliations

  1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Audrey Chun

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Setters, B., Chao, S.HL. (2020). Non-pain Symptoms. In: Chun, A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_43

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  • DOI: https://doi.org/10.1007/978-3-030-19625-7_43

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19624-0

  • Online ISBN: 978-3-030-19625-7

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