Adults, especially older ones, may sometimes struggle to convey the specifics of their symptoms and quality of life to healthcare providers.
This can be due to various reasons, including cognitive impairments. In such instances, healthcare providers often have to rely on proxies—typically family caregivers—to provide this critical information.
The Study: How Well Do Proxies Report?
A new study led by Kurt Kroenke, M.D., of the Regenstrief Institute and Indiana University School of Medicine, sheds light on the accuracy of such proxy reporting.
The research involved 576 older adult participants and their proxies, and evaluated their agreement using widely recognized scales like the PHQ-9 for depression, GAD-7 for anxiety, and the PEG for pain.
Key Findings
Level of Agreement: The study found a 50-60% agreement rate between patients and proxies on symptom severity related to pain, depression, and anxiety, as well as functional status.
Type of Symptoms: Interestingly, there was a higher likelihood of agreement for physical symptoms (like pain and functionality) than psychological symptoms (like depression and anxiety).
Stress Factor: Caregivers who were under significant stress were more likely to over-report the severity of symptoms.
Overestimation and Underestimation: Proxies tended to overestimate symptoms at lower levels of severity and underestimate them at higher levels.
Implications for Clinical Care
“Unlike measurable signs like blood pressure and blood sugar, many symptoms can’t be objectively quantified. The clinician often has to rely on scales and patient or proxy reports,” Dr. Kroenke noted.
The study highlights the utility of proxy reporting, particularly when the patient is unable to communicate effectively.
Balancing Act: Self-reports vs. Proxy Reports
Dr. Kroenke also emphasized that even when a patient is capable of self-reporting, the perspective of a proxy can be complementary and valuable for treatment decisions.
On a broader scale, the study found that the averages of self-reports and proxy reports generally align, confirming the usefulness of including proxy data in research.
Demographics
The study included a racially diverse set of participants, with approximately half being White and the other half nearly evenly split between Black patients and their caregivers.
Conclusion
While proxy reporting may not be the ideal method for gauging symptoms, it’s often the best available option, especially for patients who cannot self-report.
Dr. Kroenke likens this to the use of rapid COVID tests during the pandemic, stating, “They may not be the best, but they are the best available and provide valuable information.”
As a pioneer in the field of symptomology, Dr. Kroenke’s work underscores the importance of comprehensive reporting and diagnosis, reminding the medical community that effective treatment often requires a multi-faceted approach.
If you care about pain, please read studies about vitamin K deficiency linked to hip fractures in old people, and these vitamins could help reduce bone fracture risk.
For more information about wellness, please see recent studies that Krill oil could improve muscle health in older people, and eating yogurt linked to lower frailty in older people.
The study was published in the Journal of Patient-Reported Outcomes.
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