Symptom Burden Among Community-Dwelling Older Adults in the United States

J Am Geriatr Soc. 2019 Feb;67(2):223-231. doi: 10.1111/jgs.15673. Epub 2018 Dec 12.


Objectives: To determine the prevalence and impact of common co-occurring symptoms among community-dwelling older adults in the United States.

Design: The National Health and Aging Trends Study is a nationally representative, prospective study with annual data collection between 2011 and 2017.

Setting: Community-based, in-person interviews (survey response rates, 71%-96%).

Participants: A total of 7,609 community-dwelling Medicare beneficiaries, 65 years or older.

Measurements: Symptoms assessed at baseline include pain, fatigue, breathing difficulty, sleeping difficulty, depressed mood, and anxiety. Total symptom count ranged from zero to six. Several outcomes were examined, including grip strength, gait speed, and overall lower-extremity function as well as incidence of recurrent falls (two or more per year), hospitalization, disability, nursing home admission, and mortality.

Results: Prevalence of zero, one, two, three, and four or more symptoms was 25.0%, 26.6%, 20.7%, 14.0%, and 13.6%, respectively. Symptom count increased with advancing age and was higher in women than in men. Pain and fatigue were the most common co-occurring symptoms. Higher symptom count was associated with decreased physical capacity. For example, participants with one, two, three, and four or more symptoms had gait speeds that were 0.04, 0.06, 0.09, and 0.13 m/s slower, respectively, than those with no symptoms, adjusting for specific diseases, total number of diseases, and other potential confounders (P < .001). The risk of several adverse outcomes also increased with greater symptom count. For example, compared with those with no symptoms, the adjusted risk ratios for recurrent falls were 1.48 (95% confidence interval [CI] = 1.30-1.70), 1.54 (95% CI = 1.32-1.80), 1.90 (95% CI = 1.55-2.32), and 2.38 (95% CI = 2.00-2.83) for older adults with one, two, three, and four or more symptoms, respectively.

Conclusions: Symptoms frequently co-occur among community-dwelling older adults and are strongly associated with increased risk of a range of adverse outcomes. Symptoms represent a potential treatment target for improving outcomes and should be systematically captured in health records. J Am Geriatr Soc 67:223-231, 2019.

Keywords: disability; falls; hospitalization; multimorbidity; symptom burden.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Comorbidity*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Independent Living / statistics & numerical data*
  • Male
  • Medicare
  • Prevalence
  • Prospective Studies
  • Symptom Assessment / statistics & numerical data*
  • United States / epidemiology