Management of chronic obstructive pulmonary disease in the elderly

Technological advances and digital solutions to improve quality of life in older adults with chronic obstructive pulmonary disease: a systematic review

BACKGROUND

Several technological advances and digital solutions have been proposed in the recent years to face the emerging need for tele-monitoring older adults with Chronic Obstructive Pulmonary Disease (COPD). However, several challenges have negatively influenced an evidence-based approach to improve Health-Related Quality of Life (HR-QoL) in these patients.

AIM

To assess the effects of tele-monitoring devices on HR-QoL in older adults with COPD.

METHODS

On November 11, 2022, PubMed, Scopus, Web of Science, and Cochrane were systematically searched for randomized controlled trials (RCTs) consistent with the following PICO model: older people with COPD as participants, tele-monitoring devices as intervention, any comparator, and HR-QoL as the primary outcome. Functional outcomes, sanitary costs, safety, and feasibility were considered secondary outcomes. The quality assessment was performed in accordance with the Jadad scale.

RESULTS

A total of 1845 records were identified and screened for eligibility. As a result, 5 RCTs assessing 584 patients (423 males and 161 females) were included in the systematic review. Tele-monitoring devices were ASTRI telecare system, WeChat social media, Pedometer, SweetAge monitoring system, and CHROMED monitoring platform. No significant improvements in terms of HR-QoL were reported in the included studies. However, positive effects were shown in terms of the number of respiratory events and hospitalization in patients telemonitored by SweetAge system and CHROMED platform.

DISCUSSION

Although a little evidence supports the role of tele-monitoring devices in improving HR-QoL in older patients, positive effects were reported in COPD exacerbation consequences and functional outcomes.

CONCLUSION

Tele-monitoring solutions might be considered as sustainable strategies to implement HR-QoL in the long-term management of older patients with COPD.

[Chronic obstructive pulmonary disease in the elderly]

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases. Its prevalence increases with the age, and causes a high morbidity and mortality in the elderly population. COPD is currently considered as an inflammatory disease characterised by a pulmonary obstruction that is not fully reversible, and is associated with a high comorbidity. The treatment in the elderly does not differ much from that used in young adults, although the high comorbidity, the multiple prescription drugs and the use of different inhalation devices means that treatment has to be adapted to each patient. The presence of exacerbations, inactivity, systemic inflammation and dyspnea leads to a decrease in activity and loss of physical function. In this review we will update the physiology, diagnosis and treatment of COPD in the elderly, and the prevention of geriatric syndromes in this disease.

COPD, chronic bronchitis and capacity for day-to-day activities: negative impact of illness on the health-related quality of life

The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15-5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92-9.29) and exercise (OR 2.66, 95% Cl 1.21-5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32- 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98-5.44), IADL (OR 3.27, 95% Cl 2.43-4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.

[Hospitalizations due to chronic obstructive pulmonary disease in the elderly]

INTRODUCTION

Hospitalizations for decompensation of chronic obstructive pulmonary disease (COPD) mainly occur in the elderly. The aim of this study was to describe the characteristics of octogenarians admitted for COPD and to compare these characteristics with those in a younger group.

MATERIAL AND METHODS

All patients hospitalized for COPD in an acute care hospital over three time periods were studied. All patients met spirometric criteria for COPD. A questionnaire evaluating items on prior admissions, days of hospital stay and readmissions in the subsequent year was completed. Data on comorbidity (the Charlson index), functional dependency (Katz index), depression (Yesavage scale), domiciliary medication, socioeconomic position, social resources, and quality of life, among other factors, were gathered.

RESULTS

We studied 390 patients, with a mean age of 72 years (SD 9.6), of whom 88 (22%) were aged more than 80 years old. The mean length of hospital stay was 11.4 days, FEV(1) at discharge was 39% of the theoretical value, and 55% of the patients were readmitted in the following year, with no differences between age groups. Patients older than 80 years had a lower body mass index (P<.03), greater comorbidity (P<.001), greater functional dependency (P<.001) and worse scores on the Pffeifer (P<.001) and Yesavage scales (P<.01).

CONCLUSIONS

Octogenarians hospitalized for COPD exacerbations have greater comorbidity, depressive features and functional dependency than younger patients. Nevertheless, no differences were found in the length of hospital stay or in readmissions in the following year.

Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE

There is a paucity of survival data regarding the prognosis of elderly patients following acute exacerbations of COPD (AECOPD). We undertook a study to examine long-term mortality rates and to identify clinical and laboratory predictors of these outcomes.

METHODS

A retrospective cohort study was conducted of 786 consecutive elderly (>65 years) patients admitted to general medicine acute-care wards for AECOPD. Factors determining short- and long-term mortality were analysed.

RESULTS

The mean (+/-SD) age of the study population was 75.8 +/- 7.3 years (range 65-100 years). The in-hospital mortality rate for the entire cohort was 7.25%. The risk of mortality at 1, 3 and 5 years was 28%, 47% and 54%, respectively. In univariate analysis age (hazard ratio 1.52; 95% confidence interval: 1.23-1.91), FEV(1) (1.45; 1.73-2.35), active cancer (1.23; 1.64-2.32), current smoking (1.74; 1.35-2.11), ischaemic heart disease (1.58; 1.28-2.02), congestive heart failure (1.55; 1.23-2.26) and maintenance use of oral glucocorticosteroids (1.58; 1.11-2.79) were significantly associated with mortality. In multivariate analysis, only current smoking (1.89; 1.18-1.93), ischaemic heart disease (1.41; 1.07-1.68), PaCO(2) on admission (1.49; 1.03-1.60), hospital readmission (2.23; 1.40-2.18) and FEV(1) (1.41; 1.12-1.54) were independent predictors of mortality.

CONCLUSIONS

This study provides new insights into the predictive factors associated with long-term prognosis in elderly patients admitted for acute exacerbations of COPD, which differ from those previously identified for younger patients.

Correlation between cognitive impairment and dependence in hypoxemic COPD

We studied 149 patients with stable chronic obstructive pulmonary disease (COPD). Three clusters were generated (high, mid, and low level of cognitive function) based on 11 neuropsychologic scores; personal independence in basic/instrumental activities of daily living (BADL/IADL) of clusters was compared by discriminant analysis. Pattern of BADL/IADL was cluster-specific in 79.2% of high and 54.9% of low clusters, but only 20.8% of mid cluster. Self-administering drugs, continence, managing money, and dressing items had the greatest discriminatory capacity. Clusters had comparable respiratory function. In older COPD patients, dependence parallels cognitive impairment only to some extent. Indices of COPD severity are poor correlates of dependence.

Examining the Role of Gender in Health-Related Quality of Life: Perceptions of Older Adults With Chronic Obstructive Pulmonary Disease

The purpose of this cross-sectional study was to explore the impact of gender on health-related quality of life perceptions among 67 older adults with chronic obstructive pulmonary disease who were living with a spouse. Physical and psychosocial health-related quality of life perceptions as well as demographic and illness-related variables were compared by gender. A correlation and regression analysis revealed women experienced significantly greater psychosocial impairment, while preliminary support was found for symptom-related impairment among men. Initial recommendations for nursing interventions include incorporating anticipatory guidance from older adults with late stages of chronic obstructive pulmonary disease as well as exploring the impact of symptoms.

Treatment of chronic obstructive pulmonary disease in older adults

This article summarizes some distinctive features of chronic obstructive pulmonary disease in the elderly and the ensuing diagnostic and therapeutic needs. It focuses on atypical presentation, systemic effects of the disease and comorbid conditions. The role of nonpharmacological measures, such as rehabilitation, physical exercise and nutritional support, is discussed. Finally, the author emphasizes that a comprehensive geriatric approach should guide the planning of therapy and monitoring of its efficacy.

Use of Antibiotics in Elderly Patients with Exacerbated COPD: The OLD-Chronic Obstructive Pulmonary Disease Study

OBJECTIVES

To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice.

DESIGN

Observational study.

SETTING

General medicine acute care wards.

PARTICIPANTS

Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD.

MEASUREMENTS

Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses.

RESULTS

Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27-3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0-2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home.

CONCLUSION

The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity.