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[Functional decline and presence of symptoms in palliative care: Cause or consequence?]
Alfredo Zamora-Mur1, María Nabal-Vicuña2, Aranzazu Zamora-Catevilla3
1Unidad de Valoración Sociosanitaria y Equipo de Soporte Hospitalario de Cuidados Paliativos, Servicio de Geriatría, Hospital de Barbastro, Huesca, España.
Introduction:
Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms.
Material And Methods:
A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST).
Results:
The study included 638 cases, of which 53.9% (N=344) were male, 56% (N=357) with cancer and 44% (N=281) geriatric. The mean age was 79.64 years+- 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST.
Conclusions:
The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients.
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