Multidimensional symptom burden among institutionalised older adults: Associations with functional status, psychological factors and quality of life

Abstract

Background/Objectives: Population ageing has increased the number of institutionalised older adults with multimorbidity, frailty, a high symptom burden, and complex care needs. However, data on symptom burden in residential care facilities remains limited. This study aimed to characterise the epidemiological profile of institutionalised older adults and examine the associations between symptom burden assessed using the Integrated Palliative Care Outcome Scale (IPOS) and sociodemographic characteristics, functional status, multimorbidity, depressive symptoms, loneliness, and quality of life. Methods: A cross-sectional correlational study was conducted between March and October 2023 in 19 residential care facilities in Portugal. Residents with preserved cognitive capacity according to education-adjusted MMSE cut-off scores completed validated instruments assessing symptom burden, functional status, depressive symptoms, loneliness, and quality of life. Results: The final sample comprised 306 institutionalised older adults (mean age: 85.1 years; 68.6% women). Participants had a moderate symptom burden (mean IPOS score: 18.0 ± 14.0). Depressive symptoms showed the most consistent associations with symptom burden across IPOS outcomes, while functional status showed domain-specific associations. Other associations were less robust after correction for multiple testing. Multimorbidity was not independently associated with IPOS score. Conclusions: These findings highlight the importance of comprehensive multidimensional assessment and support the integration of palliative care principles into long-term residential care to better address the complex needs of institutionalised older adults.