Palliative Care Needs and Symptom Patterns of Hospitalized Elders Referred for Consultation

Context. To provide effective palliative care (PC) to the geriatric population, an understanding of the reasons for consultation, main diagnoses related to referral, and symptom severity in chronic disease states is essential. Objectives. We compared the baseline characteristics, referral patterns, and symptom severity among older and younger patients referred for inpatient PC consultation. Methods. We conducted a retrospective review of 2382 inpatient PC consultations. We excluded "reconsultations" and patients under the age of 18. Patient characteristics (reason for consultation and diagnosis) and symptom severity were compared across three age groups: Younger, <65 years of age; Older, 65-84 years of age; and Oldest, 85 years of age and older. Multivariable logistic regression adjusted for the effects of gender, ethnicity, and diagnostic subset was performed. Results. Most patients referred for inpatient PC consultation were older than the age of 65. Oldest patients were consulted on earlier and more often for "end-of-life care." Oldest adults were less likely to report pain, anxiety, and nausea (adjusted odds ratios [AOR] of 0.25, 0.39, and 0.19, respectively) and more likely to report anorexia than Younger adults (AOR = 1.66). There was no clear difference between age groups in reporting of dyspnea and depression. Conclusion. Older adults in need of PC appear to have symptom burdens and consultation referral patterns that are different from those of younger patients. Further research is needed to determine whether these symptom patterns are caused by psychosocial factors, whether these reflect true differences among age groups, and whether symptom measurement instruments should be tailored to patient age. J Pain Symptom Manage 2011;42:410-418. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.