Physical symptoms as a predictor of health care use and mortality among older adults

Am J Med. 2005 Mar;118(3):301-6. doi: 10.1016/j.amjmed.2004.12.015.


Purpose: To describe the patterns of physical symptoms in older adults and to examine the validity of symptoms in predicting hospitalization and mortality.

Subjects and methods: Adults aged 60 years and older (N=3498) who completed screening for self-reported symptoms at routine primary care visits. Self-reported symptoms were collected using an abbreviated PRIME-MD screening instrument. Clinical characteristics, hospitalization, and mortality in the year following screening were measured using data taken from a comprehensive electronic medical record.

Results: The mean patient age was 69 years, 69% were women, and 56% were African-American. A majority (51%) of respondents characterized their health as fair or poor. The most commonly reported symptoms were musculoskeletal pain (65%), fatigue (55%), back pain (45%), shortness of breath (41%), and difficulty sleeping (38%). A summary score of physical symptoms (range 0-12) was a significant independent predictor of future hospitalization and death even when controlling for clinical characteristics, chronic medical conditions, self-rated health, and affective symptoms. Disease-specific symptoms were more common among patients diagnosed with the specific condition but there was also a substantial background prevalence of these symptoms.

Conclusion: Physical symptoms are highly prevalent in older primary care patients and predict hospitalization and mortality at one year. Future work is needed to determine how to target symptoms as a potential mechanism to reduce health care use and mortality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Chronic Disease
  • Female
  • Geriatric Assessment*
  • Health Services / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality*
  • Reproducibility of Results
  • Surveys and Questionnaires