Distressing Symptoms and Disability Before and After Sentinel Health Events among Community-living Older Persons
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Relief from distressing symptoms and maintaining independent function are two of the top health outcome pri- orities among community-living older persons. The long-term goal of this line of research is to reduce distress- ing symptoms and improve functional outcomes after serious health events, defined as hospitalizations for criti- cal illness, major elective and non-elective surgeries, and other acute conditions. The overall objective of this competing renewal of R01AG017560 is to rigorously evaluate distressing symptoms and disability in the con- text of serious health events and, in turn, provide the evidence needed to inform future palliative care interven- tions. The central hypothesis is that the development or persistence of distressing symptoms contributes to poor functional outcomes after a serious health event. The rationale for the proposed research is that many distressing symptoms that develop or persist after a serious health event should be amenable to palliative care, and that effective management of these symptoms has the potential to improve functional outcomes after serious health events that we have shown to be highly disabling. The central hypothesis will be tested by pur- suing two specific aims: (1) to evaluate changes in distressing symptoms before and after serious health events; and (2) to evaluate the association between distressing symptoms and the course of disability after se- rious health events. We hypothesize that: (a) distressing symptoms will increase after each type of serious health event (critical illness, major elective and non-elective surgery, and other acute hospitalizations); (b) these increases in distressing symptoms will be greater among persons with multimorbidity, those living in disadvantaged neighborhoods, those with critical illness vs. hospitalization for other acute conditions, and those with non-elective vs. elective surgery; (c) after each type of serious health event, the course of disability will be worse among persons with multiple distressing symptoms; and (d) these associations between multiple distressing symptoms and the course of disability will be more pronounced among persons with multimorbidity and those living in disadvantaged neighborhoods. The proposed research is innovative because it leverages high-quality data from a unique longitudinal study of community-living older persons who have been meticu- lously followed for 23+ years with home-based assessments at 18-month intervals and monthly telephone in- terviews to ascertain a comprehensive set of 15 distressing symptoms and to assess disability in 13 basic, in- strumental and mobility activities. The proposed research is significant because it is expected to inform the de- velopment of palliative care interventions that can be implemented during or immediately after serious health events to reduce distressing symptoms and, in turn, improve functional outcomes, especially in multimorbid older persons and those who live in disadvantaged neighborhoods, two highly vulnerable groups that have of- ten been underrepresented or neglected in prior research. Ultimately, our findings will lead to a paradigm shift by expanding the indication for palliative care beyond traditional settings such hospitals and cancer centers.
