Range and Severity of Symptoms Over Time Among Older Adults With Chronic Obstructive Pulmonary Disease and Heart Failure

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Abstract
Symptoms are central to patients' subjective assessment of their health status and quality of life.1 In less severe illness, symptoms shape how patients think about and experience their illness.2 In more advanced disease, symptoms may have a profound effect on patients' lives as reflected in the association between certain symptoms and both will to live3 and desire for physician-assisted suicide.4 Despite this importance of symptoms to patients, little is known about the trajectory of a broad range of symptoms among persons with chronic disease. Disease management guidelines for chronic obstructive pulmonary disease (COPD) and heart failure (HF), 2 of the most prevalent chronic diseases among older persons, provide detailed strategies for managing symptoms. However, these guidelines have a narrow focus on symptoms that are considered to “belong” to an individual disease. For example, the Global Initiative for Chronic Obstructive Lung Disease guideline5 discusses management of dyspnea, cough, and sputum production. The American College of Cardiology Foundation and the American Heart Association guideline6 for HF focuses on the evaluation of dyspnea and fatigue. These guidelines consider only a broader range of symptoms among persons at the very end of life.5,6