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

Leah J Witt,Jayant M Pinto,Megan Huisingh-Scheetz,Valerie G Press,William Dale,Kristen E Wroblewski,Martha K Mcclintock,Esther Wang,Steven R White

doi:10.3389/fmed.2022.814606

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.

Highlights

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and fifth cause of disability in the world [1,2,3]
The primary objective of this study is to report the prevalence of geriatric physical and psychosocial conditions among community-dwelling older adults with COPD using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample
The Short Portable Mental Status Questionnaire (SPMSQ) cognitive assessment did not uncover significant differences in cognitive impairment in those with self-reported COPD compared to those without (12.9 vs. 17.6%, adjusted OR 0.6, 95% confidence intervals (CI) 0.2, 1.9, p = 0.4)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and fifth cause of disability in the world [1,2,3]. The development of geriatric conditions can complicate management of chronic diseases like COPD. A syndrome of multisystem impairment defined and assessed variably, is perhaps the best studied geriatric condition in COPD [10]. Eisner et al found that in those with COPD, developing “non-respiratory impairment” (e.g., loss of lower extremity muscle strength) and functional limitations were associated with increased risk of disability [13]. The prevalence and impact of other geriatric conditions such as multimorbidity, activities of daily living disability, physical function impairment, falls, polypharmacy, urinary incontinence, and social frailty among those with COPD have been largely understudied

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Conclusion