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Symptom Burden Is Associated with Psychological Wellbeing and Mortality in Older Adults

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The journal of nutrition, health & aging

Abstract

Importance

Over half of outpatient visits are due to physical symptoms; yet, the significance of symptoms in relation to older people’s wellbeing and prognosis has gained very little research attention.

Objectives

This study aims to analyze the prognostic value of symptom burden, derived from symptom count and frequency, in an older cohort aged 75 to 95. We also explore the association between symptom burden and psychological wellbeing.

Design

Randomly assigned cohorts of community-dwelling people aged 75–95 filled in the postal questionnaire of the Helsinki Aging Study in 2009.

Setting

Community-based, postal questionnaires (survey response rate 74%).

Participants

1583 community-dwelling people aged 75–95 in the urban Helsinki area.

Main outcomes and measures

The inquired symptoms were dizziness, back pain, joint pain, chest pain or discomfort, shortness of breath, leg pain when walking, loss of appetite, and urinary incontinence. Symptom burden was calculated according to the number of symptoms and their frequency (score range: 0–8). The participants were subdivided into four groups according to their symptom burden. Mortality data was extracted from the Finnish Population Register in 2014. Psychological wellbeing (PWB) was measured using the validated PWB score.

Results

Of 1583 participants, 18% reported no symptoms over the past 2 weeks (Group 0), 31% scored 0.5–1 in the symptom burden score (Group 1), 23% scored 1.5–2 (Group 2), and 28% scored 2.5–8 (Group 3). There was a linear relationship between symptom burden and comorbidities, functional status, falls, and PWB. The groups showed a significant difference in 5-year mortality, even adjusted for age, sex, and comorbidities: Group 1 1.18, 95% CI 0.84–1.66; Group 2 1.63, 95% CI 1.15–2.31, and Group 3 2.08, 95% CI 1.49–2.91 compared to Group 0 (p for linearity <0.001).

Conclusion and relevance

Symptom burden is associated with higher mortality and lower PWB independent of comorbidities in community-dwelling people aged 75–95. We conclude that somatic symptoms need to be assessed when examining the general health status of an aging patient. Self-reported symptoms seem to convey information about health that cannot be derived from medical diagnoses only.

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Acknowledgements

This research has been funded by the Päivikki and Sakari Sohlberg foundation and Helsinki University Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of General Practice and Primary Health Care, University of Helsinki, Ilkantie 10 B 22 00400, Helsinki, Finland

    Tuuli Elina Lehti, H. Öhman, M. Knuutila, H. Kautiainen, H. Karppinen & K. H. Pitkala

  2. Social Services and Health Care, City of Helsinki, Helsinki, Finland

    Tuuli Elina Lehti & M. Knuutila

  3. Clinics of Internal Medicine and Geriatrics, Helsinki University Hospital, Helsinki, Finland

    H. Öhman & T. E. Strandberg

  4. Department of Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland

    R. Tilvis & T. E. Strandberg

  5. Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland

    K. H. Pitkala

Authors
  1. Tuuli Elina Lehti
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  2. H. Öhman
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  3. M. Knuutila
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  4. H. Kautiainen
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  5. H. Karppinen
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  6. R. Tilvis
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  7. T. E. Strandberg
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  8. K. H. Pitkala
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Corresponding author

Correspondence to Tuuli Elina Lehti.

Ethics declarations

Conflict of interests: Dr. Strandberg reports educational cooperation with Servier, Orion, and Novartis, and he is a member of the European Geriatric Medicine Society (EuGMS) special interest group on cardiovascular medicine in older people and diabetes in older people. Dr. Pitkala, Dr. Öhman, Dr. Karppinen, Dr. Tilvis, Lehti, Knuutila, and Kautiainen declare no conflicts of interest.

Ethical standards: All authors declare: 1. That this manuscript is not published elsewhere; 2. Any conflicts of interest; 3. They meet criteria for authorship and ensure appropriate acknowledgments made in the manuscript; 4. Appropriate funding statements in the manuscript; 5. They will inform the journal if any subsequent errors are found in the manuscript. The study design was approved by the Helsinki University Hospital Ethics Committee, and all procedures comply with the current laws of Finland.

Additional information

Author information: Dr Pitkälä had full access to all the data in the study and takes responsibility for the integrity of the data, and the accuracy of the analyses. Dr Pitkälä is the guarantor. Study concept and design: Lehti, Öhman, Knuutila, Kautiainen, Karppinen, Tilvis, Strandberg, Pitkälä. Acquisition of data: Lehti, Kautiainen, Pitkälä. Analysis and interpretation of data: Lehti, Kautiainen, Pitkälä. Drafting of the manuscript: Lehti. Critical revision of the manuscript for important intellectual content: Lehti, Öhman, Knuutila, Kautiainen, Karppinen, Tilvis, Strandberg, Pitkälä. Statistical analysis: Lehti, Kautiainen, Pitkälä. Obtained funding: Pitkälä.

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Lehti, T.E., Öhman, H., Knuutila, M. et al. Symptom Burden Is Associated with Psychological Wellbeing and Mortality in Older Adults. J Nutr Health Aging 25, 330–334 (2021). https://doi.org/10.1007/s12603-020-1490-5

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  • DOI: https://doi.org/10.1007/s12603-020-1490-5

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