A recent study found that community-dwelling older adults with chronic obstructive pulmonary disease (COPD) were more likely to experience geriatric conditions.
In a study published in Frontiers in Medicine, researchers found that older adults living in the community were more likely to report geriatric conditions—such as falling, frailty, and impaired physical function—if they had a diagnosis of chronic obstructive pulmonary disease (COPD).
The authors of this study stated that COPD affects older adults more than middle-aged adults, noting a 2006 study that estimated COPD prevalence in adults 65 years and older at 15.0% compared with only 8.0% in adults aged 40 to 65 years. The aim of this study, they wrote, was to “report the prevalence of geriatric physical and psychosocial conditions among community-dwelling older adults with COPD.”
The researchers conducted a cross-sectional study of respondents in the National Social Life, Health, and Aging Project (NSHAP). NSHAP is the first longitudinal, nationally representative study that assessed social relationships, physical and mental health, function, and cognition in older adults, aged 57 to 85 years at first interview, across the United States.
The first round of data collection occurred from 2005 to 2006 and enrolled 3005 adults (1551 women, 1454 men) of 4017 eligible adults. All adults enrolled resided in the community, with none in assisted living or skilled nursing facilities.
Data collection involved 3 components: an in-home questionnaire, a biomeasure collection, and a self-administered leave-behind questionnaire. Participants who were deemed too cognitively impaired to give formal consent and accurately respond to the questionnaires and the interview were excluded from the study.
To identify a diagnosis of COPD, participants were asked if a doctor had ever diagnosed them with emphysema, chronic bronchitis, or chronic obstructive lung disease. A “yes” or “no” answer was used to divide the participants into comparator groups. Participants were asked to self-identify gender, race, smoking history, and relationship status on their questionnaires. Educational levels were identified as less than high school, bachelor’s degree, and vocational certificate.
Geriatric conditions assessed in the study included comorbidities other than COPD on a scale of 0 to 25.5; activities of daily living (ADL) disability; impaired physical function, identified by a timed up and go; extreme low physical activity, diagnosed as less than once a month of moderate physical activity; modified frailty; any fall in the last 12 months; polypharmacy, separated into 3 categories of less than 4, 4 to 10, or more than 10 medications; and any urinary incontinence in the last 12 months.
Cognitive impairment was identified by participants getting a score of less than 6 on the Short Portable Mental Status Questionnaire. Significant depressive symptoms were assessed using the NSHAP Depressive Symptoms Measure, with a score of 9 or greater indicating major depressive symptoms. Moderate polypharmacy was defined as taking greater than 4 medications and severe polypharmacy was defined as taking greater than 10 medications.
Of the 3005 participants in the study, 322 of the participants reported a diagnosis of COPD or emphysema. Participants with a diagnosis of COPD were older than those without (mean [SD], 69.6 [7.4] years vs 67.8 [7.7] years) and more often self-identified as white/Caucasian. Participants with COPD reported lower educational levels (completed bachelor’s degree: 19.1% vs 25.2%), had a lower prevalence of being partnered (65.8% vs 75.6%), and were more commonly current or former smokers (77.8% vs 57.0%).
Older adults with COPD had more multimorbidity than those without COPD, with a significantly higher mean (SD) modified Charlson comorbidity score (2.6 [1.9] vs 1.6 [1.6]). They also had a higher prevalence of asthma (34.6%vs 7.1%), heart failure (15.4% vs 7.4%), history of myocardial infraction (19.5% vs 10.7%), history of cerebral vascular events or strokes (14.7% vs 7.3%), and arthritis (68.4% vs 49.5%).
Those with COPD also more frequently reported impaired physical function (75.8% vs 56.6%; adjusted odds ratio [OR], 2.1; 95% CI, 1.1-3.7), extreme physical inactivity (18.7% vs 8.1%; adjusted OR, 2.3; 95% CI, 1.5-3.5), falling in the last year (28.4% vs 20.5%; adjusted OR, 1.4; 95% CI, 1.01-2.0), and moderate (80.6% vs 58.4%; adjusted OR, 2.7; 95% CI, 2.0-3.8) and severe (37.5% vs 16.1%, adjusted OR, 2.9; 95% CI, 2.0-4.2) polypharmacy.
Older adults with COPD were more likely to report extreme social disengagement (4.5% vs 2.1%; adjusted OR, 0.7; 95% CI, 0.1-4.8) and loneliness (57.7% vs 42.1%; unadjusted OR, 1.9; 95% CI, 1.4-2.5), and more often displayed depressive symptoms (32.0% vs 18.9%; adjusted OR, 1.9; 95% CI, 1.4-2.7). However, there was no significant difference in moderate social disengagement or cognitive impairment between older adults with COPD and those without COPD. The researchers concluded that these social evaluations were more directly correlated to relationship status than diagnosis of COPD or place of residence.
Some of the limitations of this study included the fact that NSHAP lacked spirometric data to verify obstructive lung disease or stratify outcomes by COPD severity. There may also be overlap with other airway diseases for those who self-reported asthma but not COPD. Self-reported disease data may also have affected the accuracy of Charlson Comorbidity Index scores. However, this is a common way of assessing COPD, as the CDC also uses self-report to assess the prevalence of COPD.
The study authors also noted the age difference between the COPD group and the non-COPD group. The COPD group was, on average, 2 years older than the non-COPD group. Although the results were adjusted for age, the researchers recognized that there may be results that do not account for age effects. The frailty assessment was adapted and not validated, as hand grip data and absence of weight loss were omitted in round 1. Lastly, NSHAP lacks COPD-specific quality of life questions, such as cough and breathlessness, which are important to evaluate the severity of COPD and its relationship to social disengagement and physical function.
The researchers wrote that their study demonstrated that “COPD is frequently coprevalent with multiple, nonrespiratory domains of age-related vulnerability.” They concluded that geriatric conditions disproportionally affect community-dwelling older adults with COPD, which indicates that a “beyond the lung” approach to care is needed for this subset of patients.
Witt LJ, Wroblewski KE, Pinto JM, et al. Beyond the lung: geriatric conditions afflict community-dwelling older adults with self-reported chronic obstructive pulmonary disease. Front Med. 2022;9:814606. doi:10.3389/fmed.2022.814606