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Measuring Symptoms in Community-dwelling Older Adults

The Psychometric Properties of a Brief Symptom Screen

Ritchie, Christine S., MD, MSPH*; Hearld, Kristine R., PhD; Gross, Alden, PhD, MHS; Allman, Richard, MD§; Sawyer, Patricia, PhD§; Sheppard, Kendra, MD§; Salanitro, Amanda, MD; Locher, Julie, PhD§; Brown, Cynthia J., MD, MSPH§; Roth, David L., PhD

doi: 10.1097/MLR.0b013e3182a53d1f
Brief Reports

Background: With aging, the probability of experiencing multiple chronic conditions has increased, along with symptoms associated with these conditions. Symptoms form a central component of illness burden, and distress. To date, most symptom measures have focused on a particular disease population.

Objective: We aimed to develop and evaluate a simple symptom screen using data obtained from a representative sample of community-dwelling older adults.

Methods: Psychometric analyses were conducted on 10 self-reported dichotomous symptom indicators collected during in-person interviews from a sample of 1000 community-dwelling older adults. Symptoms included shortness of breath, feeling tired or fatigued, problems with balance or dizziness, perceived weakness in legs, constipation, daily pain, stiffness, poor appetite, anxiety, and anhedonia.

Results: Over one third of the individuals (37.4%) had 5 or more concurrent symptoms. Stiffness and feeling tired were the most common symptoms. Confirmatory factor analyses were performed on the 10 symptoms for single factor and bifactor (physical and affective) models of symptom reporting. Goodness-of-fit indices indicated better fit for the bifactor model (χ2df=10=89.6; P<0.001), but the practical significance of the improvement in fit was negligible. Differential item functioning analyses showed some differences of relatively high magnitude in location parameters by race; however, because the differential item functioning was in different directions, the impact on the overall measure was most likely lessened.

Conclusions: Among community-dwelling older adults, a large proportion experienced multiple co-occurring symptoms. This Brief Symptom Screen can be used to quickly measure the overall symptom load in older adult populations, including those with multiple chronic conditions.

*University of California San Francisco, San Francisco, CA

Department of Biostatistics, School of Public Health, University of Alabama, Tuscaloosa, AL

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

§Department of Medicine, School of Medicine, University of Alabama, Tuscaloosa, AL

Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN

Center on Aging and Health, Johns Hopkins University, Baltimore, MD

C.S.R. was supported by the [Birmingham VA Medical Center, the San Francisco VA Medical Center], NIA (1K07AG31779); NINR (1R01NR013347-01; PI: Covinsky), S.D. Bechtel Jr. Foundation (PI: Lee); AHRQ (R18-HS017786) HRSA-10-091 UAB Geriatric Education Center; Donald W. A2Q32 Reynolds Foundation; NCI (5U01CA093344-08; PI: Fouad); NIH/NIA (R01 AG015062; PI: Allman); NIH/NIA (R01 AG033094; PI: Locher JL & Ard J); NIH/NINR (UC4 NR012584-01; PI: Abernethy & Kutner; ACS (RSGHP-09-004-01-CPHPS; PI: Locher); Commonwealth Fund and Retirement Research Foundation (PI: Ritchie); and NIA UCSF Older 27 Americans Independence Center (P30 AG004281; PI: Covinsky). A.G. was supported by a post-doctoral fellowship (T32AG023480). K.R.H. was supported by NIH/NIA (AG033094; PIs: Jamy Ard & Julie Locher); NIANINDS (U01NS041588; PI: G Howard); and NIH/NIA (AG039588; PI: V Howard). R.M.A. was supported by the [Birmingham VA Medical Center], NIH/NIA (R01 AG15062); NIH/NIA (P30 AG031054); The John A. Hartford Foundation (00-0439); NIH/NIA (P30 AG031054-02S1-Diversity Supplement); VA (E6660R; PI: Brown); NIH/NIA (R01 AG17896; PI: Bamman); and NIH/NHLBI (R01 HL085561; PI: Ahmed). P.B.S. was supported by NIH/NIA (R01 AG15062; PI: Allman); NIH/NIA (5P30AG031054-02; PI: Allman); and HRSA (HRSA-10-091 UAB Geriatric Education Center; PI: Ritchie). K.S. was supported by NIH/NIA (R01 AG015062; 37 PI: Allman); John A Hartford Foundation Southeast Center of Excellence in Geriatric Medicine (2008-0143; PI: Allman); and AHRQ 39 (5T32HS013852; PI: Saag). J.L.L. was supported by NIH/NIA (R01 AG033094; PI: Locher JL & Ard J); ACS (RSGHP CPHPS-116828); NIH/NIA (R21 AG027560); HRSA (UB6HP22824; PI: McCormick L); 41 NIH/NIDDK (5P30DK056336; PI: Allison DB); Egg Nutrition Center/American Egg Board [Gower B, Locher JL (Co-PI)]; AHRQ (R18-43 HS017786; PI: Ritchie CS); NIH/NIA (R01 AG015062; PI: Allman RM); South Carolina Clinical & Translational Research, with an academic home at the Medical University of South Carolina, NIH/NCRR 45 (UL1 RR029882); AHRQ (U18 HS016956-01; PI: Saag KG); The Triolotical Society (PI: Magnuson); and Eli Lilly and Company (B3D-US-X016; PI: Curtis J). C.J.B. was supported by the [Birmingham VA Medical Center], VA Rehabilitation Research and Development Scientific Merit (E7036R); National Institutes on Aging R01 AG015062 (PI: Allman); HRSA-10-091 UAB Geriatric Education Center; and the Donald W. Reynolds Foundation. D.L.R. was supported by NIH/NINDS (1 R01 NS075047); NIH/NINDS (1 R01 NS045789); NIH/NIA (1 P30 AG022838-06; PI: Ball); CDC (98047/CCU409679; PI: Davies); NIH/NIA (5 R01 AG005739-23; PI: Ball); NIH/NIA (1 K07 AG031779; PI: Ritchie); NIH/NCMHD (1RC2MD004778; PI: Fouad/Scarinci); NIH/NIA (2 R01 AG015062; PI: Allman); NIH/NIA (1 R01 AG033094; PI: Locher/Ard); and NIH/55 NIAAA (5R01AA017880; PI: Tucker).

The authors declare no conflict of interest.

Reprints: Christine S. Ritchie, MD, MSPH, 3333 California Street, Suite 380, San Francisco, CA 94143-1265. E-mail:

© 2013 by Lippincott Williams & Wilkins.