Assessment and impact of symptoms among medicare beneficiaries: Implications for policy makers, managed care organizations, and primary care clinics

Physical symptoms are prevalent in the community and medical clinics, but many patients have no identifiable disease associated with their symptoms. Most symptoms are treated medically with little improvement in cases with no known etiology. Behavioral interventions may be able to improve outcomes. However, behavioral treatments may not be reimbursed. To improve acceptance and reimbursement, psychologists need to identify poorly managed problems and to empirically validate interventions to improve symptoms or functioning. Pain is the most common symptom, and few studies have looked at general pain reports among older adults. The current project characterizes the impact of pain among older adult Medicare beneficiaries in the community and in primary care to show the need for improved treatments. Additionally, this project tests the effectiveness of a laboratory-based written self-disclosure intervention in primary care. Two separate studies were conducted. The first study was a cross-sectional survey of 7,999 community-dwelling Medicare beneficiaries age 65 years and older. Mean age was 73.4 years. Of the participants, 59% were female, 56% were married, and were 84% Caucasian. Data were from the Behavioral Risk Factor Surveillance System, 2000. Pain interfered with function for 26% of participants an average of 15.4 days of the past 30 days. Those with pain interference had poorer physical and mental health status and quality of life. The second study consisted of 105 Medicare beneficiaries age 65 years and older in primary care who were randomly assigned to treatment or comparison writing conditions. Mean age was 73.4 years. Of the participants, 63% were female, 51% were married, and 61% were Caucasian. At baseline, 88% had pain, and 61% had functional impairment from pain. High pain is associated with more depressive symptoms, psychosocial distress, and worse global health status. At 1 month and 6 months after intervention, no treatment effect was seen. Pain is associated with poor health status across multiple domains among our samples. Written self-disclosure does not appear to be an effective stand-alone intervention for this primary care population. This project shows the need for better management of pain symptoms. However, additional research is needed to identify specific effective behavioral interventions.