Beyond the Lung: Geriatric Conditions Afflict Community-Dwelling Older Adults With Self-Reported Chronic Obstructive Pulmonary Disease

Abstract

RationaleChronic obstructive pulmonary disease (COPD) predominantly affects older adults. However, the co-morbid occurrence of geriatric conditions has been understudied.ObjectiveCharacterize the prevalence of geriatric conditions among community-dwelling U.S. older adults with self-reported COPD.MethodsWe conducted a nationally representative, cross-sectional study of 3,005 U.S. community-dwelling older adults (ages 57–85 years) from the National Social Life, Health, and Aging Project (NSHAP). We evaluated the prevalence of select geriatric conditions (multimorbidity, functional disability, impaired physical function, low physical activity, modified frailty assessment, falls, polypharmacy, and urinary incontinence) and psychosocial measures (frequency of socializing, sexual activity in the last year, loneliness, cognitive impairment, and depressive symptoms) among individuals with self-reported COPD as compared to those without. Using multivariate logistic and linear regressions, we investigated the relationships between COPD and these geriatric physical and psychosocial conditions.Main ResultsSelf-reported COPD prevalence was 10.7%, similar to previous epidemiological studies. Individuals with COPD had more multimorbidity [modified Charlson score 2.6 (SD 1.9) vs. 1.6 (SD 1.6)], more functional disability (58.1 vs. 29.6%; adjusted OR 3.1, 95% CI 2.3, 4.3), falls in the last year (28.4 vs. 20.8%; adjusted OR 1.4, 95% CI 1.01, 2.0), impaired physical function (75.8 vs. 56.6%; adjusted OR 2.1, 95% CI 1.1, 3.7), more frequently reported extreme low physical activity (18.7 vs. 8.1%; adjusted OR 2.3, 95% CI 1.5, 3.5) and higher frailty prevalence (16.0 vs. 2.7%; adjusted OR 6.3, 95% CI 3.0,13.0) than those without COPD. They experienced more severe polypharmacy (≥10 medications, 37.5 vs. 16.1%; adjusted OR 2.9, 95% CI 2.0, 4.2). They more frequently reported extreme social disengagement and were lonelier, but the association with social measures was eliminated when relationship status was accounted for, as those with COPD were less frequently partnered. They more frequently endorsed depressive symptoms (32.0 vs. 18.9%, adjusted OR 1.9, 95% CI 1.4, 2.7). There was no noted difference in cognitive impairment between the two populations.ConclusionsGeriatric conditions are common among community-dwelling older adults with self-reported COPD. A “beyond the lung” approach to COPD care should center on active management of geriatric conditions, potentially leading to improved COPD management, and quality of life.

Exacerbation Burden in COPD and Occurrence of Mortality in a Cohort of Italian Patients: Results of the Gulp Study

“…COPD mostly affects older adults, and the development of multimorbidity may complicate COPD management. 30 People living with COPD have almost twice the risk of heart failure and myocardial infarction when compared with those without COPD belonging to the same age, sex, race, and education level. 30 Even COPD patients with no history of cardiovascular disease have a higher risk of cardiovascular complications, such as myocardial infarction and stroke, following a moderate exacerbation.…”

“… 30 People living with COPD have almost twice the risk of heart failure and myocardial infarction when compared with those without COPD belonging to the same age, sex, race, and education level. 30 Even COPD patients with no history of cardiovascular disease have a higher risk of cardiovascular complications, such as myocardial infarction and stroke, following a moderate exacerbation. 14 We showed that cardiovascular comorbidities are a major risk factor for death in Italian patients with COPD.…”

Social dimensions of chronic respiratory disease: stigma, isolation, and loneliness

“…Close and cohabiting relationships may also affect the presence or absence of loneliness, but this association is not always straightforward. Witt et al [55] explored prevalence of geriatric conditions among 3005 community dwelling older adults. People with self-reported COPD (10.7% of the sample) reported more social disengagement and greater loneliness than people without COPD.…”

Pulmonary rehabilitation and physical interventions

“…In addition to the physiological consequences, physical activity avoidance has consequences in terms of participation in social interactions. This further contributes to the development of mental health problems as well as social isolation and loneliness [ 8 ].…”