Kudos to Christine Tocchi, assistant professor, and her entire team for the submission of their NIH R21 application entitled "Symptom Phenotypes in Homebound Elderly." This proposal requests funding for a two-year period with a start date of April 1, 2019.
Homebound elderly experience high symptom distress due to multimorbidity. This population often suffers from co-occurring symptoms of varying intensities. When not treated, co-occurring symptoms lead to a vicious cycle of ongoing, escalating symptoms, diminished quality of life, and increased healthcare utilization. From research in other disease-specific populations such as oncology and heart failure, some symptoms tend to occur together. Historically, research indicates groups of patients with severe symptoms tend to have poor health outcomes. Unfortunately, there is a dearth of research related to the symptom experience in homebound elderly with multimorbidity. There needs to be an understanding of the symptom experience by the homebound elderly over time and the ability to identify which groups (phenotypes) are at greater risk for poor health outcomes.
The purpose of this study is to identify symptom phenotypes of homebound elderly with multimorbidity and how they are associated with quality of life, functional status, and healthcare utilization. This R21 project has 2 aims and 1 exploratory aim: 1) identify symptom phenotypes based on trends of occurrence and severity of symptom patterns from baseline to 3-months controlling for demographic characteristics (sex, socioeconomic status, race, ethnicity); 2) examine the association of symptom phenotypes and chronic conditions (HF, stroke, pneumonia, COPD); and 3) exploratory aim to describe the differences between symptom phenotypes in patient outcomes (functional status, quality of life, and hospital and emergency department visits). Results from this study will inform future research on the development of decision support algorithm for symptom management and person-centered symptom self-management interventions in the homebound elderly population.