Older patients’ perceived burdens of their health problems: a cross-sectional analysis in 74 German general practices

Abstract

Ulrike Junius-Walker,1 Birgitt Wiese,1 Renate Klaaßen-Mielke,2 Gudrun Theile,1,3 Christiane Annette Müller,4 Eva Hummers-Pradier4 1Institute of General Practice, Hannover Medical School, Hannover, 2Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University, Bochum, Germany; 3Geriatric Clinic University Hospital, Zurich, Switzerland; 4Department of General Practice/Family Medicine, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany Background: Older patients often experience the burden of multiple health problems. Physicians need to consider them to arrive at a holistic treatment plan. Yet, it has not been systematically investigated as to which personal burdens ensue from certain health conditions. Objective: The objective of this study is to examine older patients’ perceived burden of their health problems. Patients and methods: The study presents a cross-sectional analysis in 74 German general practices; 836 patients, 72 years and older (mean 79±4.4), rated the burden of each health problem disclosed by a comprehensive geriatric assessment. Patients rated each burden using three components: importance, emotional impact, and impact on daily activities. Cluster analyses were performed to define patterns in the rating of these components of burden. In a multilevel logistic regression analysis, independent factors that predict high and low burden were explored. Results: Patients had a median of eleven health problems and rated the burden of altogether 8,900 health problems. Four clusters provided a good clustering structure. Two clusters describe a high burden, and a further two, a low burden. Patients attributed a high burden to social and psychological health problems (especially being a caregiver: odds ratio [OR] 10.4, 95% confidence interval [CI] 4.4–24.4), to specific symptoms (eg, claudication: OR 2.3, 95% CI 1.3–4.0; pain: OR 2.3, 95% CI 1.6–3.1), and physical disabilities. Patients rated a comparatively low burden for most of their medical findings, for cognitive impairment, and lifestyle issues (eg, hypertension: OR 0.2, 95% CI 0.2–0.3). Conclusion: The patients experienced a relatively greater burden for physical disabilities, mood, or social issues than for diseases themselves. Physicians should interpret these burdens in the individual context and consider them in their treatment planning. Keywords: patient preference, quality of life, older adults, general practice, cost of illness