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J Pain Symptom Manage. 2018 Feb;55(2):217-225. doi: 10.1016/j.jpainsymman.2017.09.002. Epub 2017 Sep 13.

Characteristics of Older Adults in Primary Care Who May Benefit From Primary Palliative Care in the U.S.

Author information

1
Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA; San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA. Electronic address: Nancy.dudley@ucsf.edu.
2
Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
3
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA.
4
San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
5
Dean's Office, School of Nursing, University of California, San Francisco, California, USA.
6
Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA.

Abstract

CONTEXT:

Older adults with advanced illness and associated symptoms may benefit from primary palliative care, but limited data exist to identify older adults in U.S. primary care to benefit from this care.

OBJECTIVES:

To describe U.S. primary care visits among adults aged 65 years and older with advanced illness.

METHODS:

Cross-sectional analysis of the National Ambulatory and Hospital Ambulatory Medical Care Surveys (2009-2011) was conducted using Chi-squared tests to compare visits without and with advanced illness with U.S. primary care defined by National Committee for Quality Assurance Palliative and End-of-Life Care Physician Performance Measurement Set International Classification of Diseases, Ninth Revision (ICD-9) codes for end-stage illness.

RESULTS:

Among visits by older adults to primary care, 7.9% visits were related to advanced illness. A higher proportion of advanced illness visits was among men vs. women (8.9% vs. 7.2%; P = 0.03) and adults aged 75 years and older, non-Hispanic whites (8.3%) and blacks (8.2%) vs. Hispanic (6.7%) and non-Hispanic other (2.5%) (P = 0.02), dually eligible for Medicare and Medicaid, and from patient ZIP Codes with lower median household incomes (below $32,793). A higher percentage of visits with advanced illness conditions to primary care was chronic obstructive pulmonary disease, congestive heart failure, dementia, and cancer, and symptoms reported with these visits were mostly pain, depression, anxiety, fatigue, and insomnia.

CONCLUSION:

In the U.S., approximately 8% primary care visits among older adults was related to advanced illness conditions. Advanced illness visits were most common among those most likely to be socioeconomically vulnerable and highlight the need to focus efforts for high-quality palliative care for these populations.

KEYWORDS:

Geriatrics; advanced illness; primary care; primary palliative care; socioeconomically vulnerable; symptoms

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