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Geriatric Syndromes and Dependency in Activities of Daily Living: Overlooked but Important Determinants of Health Status in COPD FREE TO VIEW

Carlos Martinez, MPH; Caroline Richardson; MeiLan Han, MS; Christine Cigolle, MPH
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University of Michigan, Ann Arbor, MI

Chest. 2014;146(4_MeetingAbstracts):34A. doi:10.1378/chest.1987594
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SESSION TITLE: COPD Diagnosis and Evaluation Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a disease of aging adults. Models investigating health status (HS) and health-related quality of life (QOL) in COPD have included the roles of sociodemographics, lung function, smoking status, and comorbid diseases. However, key geriatric conditions have been overlooked: geriatric syndromes (GS) and dependency in activities of daily living (ADL-dep). We investigated (1) the prevalence of GS and ADL-dep among American adults ≥51 years reporting COPD and (2) the association of GS and ADL-dep with baseline and 2-year change in HS.

METHODS: We analyzed participants age ≥51 years (n=16,785) in wave 2008 of the Health and Retirement Study, a nationally-representative longitudinal health interview survey, and followed them for 2 years. COPD, GS (falls/incontinence/vision impairment/hearing impairment) and ADL-dep (bathing, dressing, eating, transferring, using toilet) were self-reported using previously validated questions. Respondents reported baseline (2008) HS (excellent to poor) and 2-year (2010) HS, compared to previous interview (better/same/worse). We used logistic regression to examine the effect of GS/ADL-dep on baseline/change in HS among respondents with COPD. Covariates included: sociodemographics; smoking status; oxygen use, and persistent respiratory symptoms (as COPD severity proxies); 7 comorbidities (hypertension, heart, cancer, diabetes, stroke, musculoskeletal and psychiatric disease); and cognitive function.

RESULTS: COPD was reported by 10.9% of respondents (n=1,839, representing 7.6 million nationally), 34.7% of whom had ≥2 GS and 9.2%, ≥2 ADL-dep. In fully adjusted models, presence of ≥2 GS was associated with higher odds of fair/poor baseline HS (odds ratio [OR] 3.1; 95% confidence interval [CI] 2.3-4.3) and with 2-year worsening HS (OR 2.0; 95% CI 1.4-2.7). ADL-dep was also associated with higher odds of fair/poor baseline HS (OR 2.0; 95% CI 1.0-4.1), but not with 2-year worsening HS (OR 1.2, 95% CI 0.6-2.7). The impact GS/ADL-dep was greater than that due to individual comorbid diseases and comparable to having ≥3 comorbid diseases.

CONCLUSIONS: Beyond comorbid diseases, sociodemographics, and pulmonary factors, geriatric syndromes and ADL dependencies are important factors impacting HS in COPD. GS and ADL-dep should be a target for identification of COPD patients at high risk for worsening HS.

CLINICAL IMPLICATIONS: Geriatric conditions (GS/ADL-dep) impact HS/QOL in COPD, and could be used to identify subjects at risk of further deterioration.

DISCLOSURE: The following authors have nothing to disclose: Carlos Martinez, Caroline Richardson, MeiLan Han, Christine Cigolle

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