Breathlessness in the elderly during the last year of life sufficient to restrict activity

Johnson, Miriam J.; Bland, J. Martin; Gahbauer, Evelyne A.; Ekström, Magnus; Sinnarajah, Aynharan; Gill, Thomas M.; Currow, David

Abstract

OBJECTIVES: Breathlessness is prevalent in older people. Symptom control at the end of life is important. This study investigated relationships between age, clinical characteristics and breathlessness sufficient to have people spend at least one half a day in that month in bed or cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN: Secondary data-analysis SETTING: General community PARTICIPANTS: 754 non-disabled persons, aged 70 and older. Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was the percentage of months with restricting breathlessness reported during the last year of life. RESULTS: Data regarding breathlessness were available for 548/589 (93.0%) decedents (mean age 86.7 years (range 71 to 106; males 38.8%). 311/548 (56.8%) reported restricting breathlessness at some time-point during the last year of life but no-one reported this every month. Frequency increased in the months closer to death irrespective of cause. Restricting breathlessness was associated with anxiety, (0.25 percentage point increase in months breathlessness per percentage point months reported anxiety, 95% CI 0.16 to 0.34, P<0.001), depression (0.14, 0.05 to 0.24, P=0.002) and mobility problems (0.07, 0.03 to 0.1, P=0.001). Percentage months of restricting breathlessness increased if chronic lung disease was noted at the most recent comprehensive assessment (6.62 percentage points, 95% CI 4.31 to 8.94, P<0.001), heart failure (3.34, 0.71 to 5.97, P<0.01), and ex-smoker status (3.01, 0.94 to 5.07, P=0.002), but decreased with older age (─0.19, ─0.37 to ─0.02, P=0.03). CONCLUSION: Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.

Citation

Johnson, M. J., Bland, J. M., Gahbauer, E. A., Ekström, M., Sinnarajah, A., Gill, T. M., & Currow, D. (2016). Breathlessness in the elderly during the last year of life sufficient to restrict activity. Journal of the American Geriatrics Society, 64(1), 73-80. https://doi.org/10.1111/jgs.13865

• Journal Article Type: Article
• Acceptance Date: Jun 22, 2015
• Online Publication Date: Jan 19, 2016
• Publication Date: 2016-01
• Deposit Date: Aug 6, 2015
• Publicly Available Date: Nov 23, 2017
• Journal: Journal of the American Geriatrics Society
• Print ISSN: 0002-8614
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: 1
• Pages: 73-80
• DOI: https://doi.org/10.1111/jgs.13865
• Keywords: Dyspnea, Breathlessness, Prevalence, End of life, Elderly
• Public URL: https://hull-repository.worktribe.com/output/377454
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/jgs.13865/abstract
• Additional Information: Authors' accepted manuscript of article: Johnson, M. J., Bland, J. M., Gahbauer, E. A., Ekström, M., Sinnarajah, A., Gill, T. M. and Currow, D. C. (2016), Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors. Journal of the American Geriatrics Society, 64: 73–80. doi: 10.1111/jgs.13865
• Contract Date: Nov 23, 2017