Miriam J Johnson1, J Martin Bland2, Evelyne A Gahbauer3, Magnus Ekström4, Aynharan Sinnarajah5, Thomas M Gill3, David C Currow4. 1. Hull York Medical School, University of Hull, Hull, UK. 2. University of York, York, UK. 3. Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, Australia. 4. Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. 5. Palliative & End of Life Care, Alberta Health Services, Calgary, Alberta, Canada.
Abstract
OBJECTIVES: To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN: Secondary data analysis. SETTING: General community. PARTICIPANTS: Nondisabled persons aged 70 and older (N=754). MEASUREMENTS: Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life. RESULTS: Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71-106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI)=0.16-0.34, P<.001), depression (0.14, 95% CI=0.05-0.24, P=.003), and mobility problems (0.07, 0.03-0.1, P<.001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most-recent comprehensive assessment (6.62 percentage points, 95% CI=4.31-8.94, P<.001), heart failure (3.34 percentage points, 95% CI=0.71-5.97, P=.01), and ex-smoker status (3.01 percentage points, 95% CI=0.94-5.07, P=.004) but decreased with older age (-0.19 percentage points, 95% CI=-0.37 to -0.02, P=.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.
OBJECTIVES: To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN: Secondary data analysis. SETTING: General community. PARTICIPANTS: Nondisabled persons aged 70 and older (N=754). MEASUREMENTS: Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life. RESULTS: Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71-106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI)=0.16-0.34, P<.001), depression (0.14, 95% CI=0.05-0.24, P=.003), and mobility problems (0.07, 0.03-0.1, P<.001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most-recent comprehensive assessment (6.62 percentage points, 95% CI=4.31-8.94, P<.001), heart failure (3.34 percentage points, 95% CI=0.71-5.97, P=.01), and ex-smoker status (3.01 percentage points, 95% CI=0.94-5.07, P=.004) but decreased with older age (-0.19 percentage points, 95% CI=-0.37 to -0.02, P=.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.
Authors: Susan L Mitchell; Susan C Miller; Joan M Teno; Dan K Kiely; Roger B Davis; Michele L Shaffer Journal: JAMA Date: 2010-11-03 Impact factor: 56.272
Authors: Brienne Miner; Mary E Tinetti; Peter H Van Ness; Ling Han; Linda Leo-Summers; Anne B Newman; Patty J Lee; Carlos A Vaz Fragoso Journal: J Am Geriatr Soc Date: 2016-08-22 Impact factor: 5.562
Authors: Caroline Wright; Simon P Hart; Victoria Allgar; Anne English; Flavia Swan; Judith Dyson; Gerry Richardson; Maureen Twiddy; Judith Cohen; Jamilla Hussain; Miriam Johnson; Ian Hargreaves; Michael G Crooks Journal: ERJ Open Res Date: 2019-10-21
Authors: Kim de Nooijer; Lara Pivodic; Luc Deliens; Guido Miccinesi; Tomas Vega Alonso; Sarah Moreels; Lieve Van den Block Journal: BMJ Support Palliat Care Date: 2019-10-16 Impact factor: 3.568
Authors: Magnus Ekström; Miriam J Johnson; Bridget Taylor; Mary Luszcz; Pia Wohland; Diana H Ferreira; David C Currow Journal: NPJ Prim Care Respir Med Date: 2018-06-22 Impact factor: 2.871