• Christine S Ritchie, Kristine R Hearld, Alden Gross, Richard Allman, Patricia Sawyer, Kendra Sheppard, Amanda Salanitro, Julie Locher, Cynthia J Brown, and David L Roth.
• *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.
• Med Care. 2013 Oct 1; 51 (10): 949-55.

BackgroundWith 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.ObjectiveWe aimed to develop and evaluate a simple symptom screen using data obtained from a representative sample of community-dwelling older adults.MethodsPsychometric 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.ResultsOver 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 (χdf=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.ConclusionsAmong 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.

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