Objectives: To explore the predictors of symptom burden at the end of life.
Design: Observational, secondary analysis of Health and Retirement Study (HRS) data.
Setting: USA.
Participants: Two thousand six hundred four deceased, older adults.
Methods: Multivariate Poisson and logistic regression to explore the relationship between
sociodemographic and clinical factors with symptoms.
Results: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58% of
participants experienced more than 3 of these during their last year of life. Sociodemographic
and clinical factors were associated with the number of symptoms as well as the presence of
pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer
symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85–0.96) and less pain (odds
ratio [OR] 0.66, CI 0.51–0.85) than comparisons did. Patients with cancer experienced more
pain (OR 2.02, CI 1.62–2.53) and depression (OR 1.31, CI 1.07–1.61). Patients experienced more
depression (OR 2.37, CI 1.85–3.03) and dyspnea (OR 1.40, CI 1.09–1.78).
Limitation: Use of proxy reports for primary data.
Conclusion: Older Americans experience a large symptom burden in the last year of life,
largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of
symptom control relates to clinical factors as well as net worth. This association between
symptoms and wealth suggests that access to health care and other social services beyond
those covered by Medicare may be important in decreasing symptom burden at the end of
life.
