Geriatric Vulnerability and Symptom Burden as Determinants of Palliative Care in Respiratory Disease.

Abstract

Older adults hospitalized with chronic respiratory diseases frequently experience high symptom burden and geriatric syndromes, yet palliative care (PC) referral remains inconsistent. Understanding how symptom burden and geriatric vulnerability influence PC utilization may support more equitable, needs-based referral models. To examine the association between symptom burden, geriatric syndromes, and inpatient PC consultation in adults aged ≥75 years hospitalized for respiratory diseases, and to assess whether ESAS-derived symptom clusters identify patients at increased risk of in-hospital mortality. We conducted a retrospective cohort study at a national respiratory referral centre in Mexico, including 449 patients with complete Edmonton Symptom Assessment System (ESAS) data and comprehensive geriatric assessment. K-means clustering identified low-, moderate-, and high-burden symptom profiles. Multivariable logistic regression evaluated factors associated with PC consultation and in-hospital mortality. Only 30% of patients received a PC consultation, more frequently among those with lung cancer than non-malignant respiratory diseases. Independent of diagnosis, PC consultation was associated with ADL dependence, pressure ulcers, and increasing symptom burden. Compared with the low-burden cluster, the odds of consultation were threefold higher in the moderate-burden cluster and fivefold higher in the high-burden cluster. In-hospital mortality increased across symptom clusters and was highest among patients receiving PC. Symptom burden and geriatric syndromes provide a more equitable framework for identifying PC needs than diagnosis alone. Systematic integration of ESAS and geriatric assessment into respiratory care may facilitate earlier, needs-based PC referral, particularly in health systems with limited PC capacity.