# Development and psychometric testing of symptom severity scale in older patients with cardiometabolic multimorbidity

## TL;DR

This study created and tested a new scale to measure symptom severity in older patients with multiple cardiometabolic conditions, finding it to be valid and reliable.

## Contribution

The novel contribution is the development and psychometric validation of the SSS-CM scale for older patients with cardiometabolic multimorbidity.

## Key findings

- The SSS-CM demonstrated a single-factor structure with strong internal consistency (Cronbach’s alpha of 0.978).
- Symptom severity was significantly negatively correlated with overall quality of life.
- The scale explained 65.753% of the total variance with factor loads between 0.658 and 0.898.

## Abstract

Given the high prevalence of multiple cardiometabolic disorders in the older population and their negative impact on quality of life, assessing symptom burden is of critical importance. No assessment tool is available to holistically measure the severity of common symptoms in cardiometabolic diseases. This study aimed to develop the “Symptom Severity Scale in Patients with Cardiometabolic Multimorbidity (SSS-CM)” and to perform psychometric testing in the Turkish older population.

This methodological study was conducted between August and November 2024 with patients (n = 388) aged ≥ 65 years with at least two cardiometabolic diseases (coronary heart disease, hypertension, diabetes mellitus, stroke, and dyslipidemia) who were followed up in the internal medicine, cardiology, and neurology clinics of a training and research hospital. Data was collected using the Patient Information Form, the SSS-CM, and the EQ-5D-3 L scale. The validity and reliability of the scale were tested using exploratory and confirmatory factor analyses, Cronbach’s alpha analysis, and Pearson correlation analysis.

The exploratory factor analysis determined that the scale had a single-factor structure explaining 65.753% of the total variance, and the factor loads ranged between 0.658 and 0.898. In confirmatory factor analysis, χ2/df = 1.739. Cronbach’s alpha internal consistency coefficient was found to be 0.978. Pearson correlation analysis showed a significant negative correlation between symptom severity and overall quality of life.

The SSS-CM is a valid and reliable measurement tool for assessing symptom severity in cardiometabolic older patients with complex care and treatment needs. This scale could contribute to assessing the effectiveness of symptom management interventions to alleviate symptoms and improve the quality of life among the older population. However, the findings should be interpreted with caution due to the purposive sampling from a single center setting in Turkey, which may limit the generalizability across different populations and healthcare systems.

Not applicable.

The online version contains supplementary material available at 10.1186/s12877-025-06370-1.