Witt Leah J, Wroblewski Kristen E, Pinto Jayant M, Wang Esther, McClintock Martha K, Dale William, White Steven R, Press Valerie G, Huisingh-Scheetz Megan
Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States.
Front Med (Lausanne). 2022 Feb 14;9:814606. doi: 10.3389/fmed.2022.814606. eCollection 2022.
Chronic obstructive pulmonary disease (COPD) predominantly affects older adults. However, the co-morbid occurrence of geriatric conditions has been understudied.
Characterize the prevalence of geriatric conditions among community-dwelling U.S. older adults with self-reported COPD.
We 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.
Self-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.
Geriatric 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.
慢性阻塞性肺疾病（COPD）主要影响老年人。然而，老年疾病的合并发生情况尚未得到充分研究。
描述美国社区居住的自我报告患有COPD的老年人中，老年疾病的患病率。
我们对来自国家社会生活、健康和老龄化项目（NSHAP）的3005名美国社区居住老年人（年龄57 - 85岁）进行了一项具有全国代表性的横断面研究。我们评估了自我报告患有COPD的个体与未患COPD个体相比，特定老年疾病（多种疾病共存、功能残疾、身体功能受损、身体活动不足、改良衰弱评估、跌倒、多重用药和尿失禁）以及社会心理指标（社交频率、过去一年的性活动、孤独感、认知障碍和抑郁症状）的患病率。使用多变量逻辑回归和线性回归，我们研究了COPD与这些老年身体和社会心理状况之间的关系。
自我报告的COPD患病率为10.7%，与先前的流行病学研究相似。患有COPD的个体比未患COPD的个体有更多的多种疾病共存[改良查尔森评分2.6（标准差1.9）对1.6（标准差1.6）]、更多的功能残疾（58.1%对29.6%；调整后的比值比3.1，95%置信区间2.3，4.3）、过去一年的跌倒（28.4%对20.8%；调整后的比值比1.4，95%置信区间1.01，2.0）、身体功能受损（75.8%对56.6%；调整后的比值比2.1，95%置信区间1.1，3.7）、更频繁报告极低的身体活动（18.7%对8.1%；调整后的比值比2.3，95%置信区间1.5，3.5）以及更高的衰弱患病率（16.0%对2.7%；调整后的比值比6.3，95%置信区间3.0，13.0）。他们经历了更严重的多重用药（≥10种药物，37.5%对16.1%；调整后的比值比2.9，95%置信区间2.0，4.2）。他们更频繁地报告极度社交隔离和更孤独，但当考虑关系状态时，与社会指标的关联被消除，因为患有COPD的个体伴侣关系较少。他们更频繁地认可抑郁症状（32.0%对18.9%，调整后的比值比1.9，95%置信区间1.4，2.7）。两组人群在认知障碍方面没有显著差异。
在自我报告患有COPD的社区居住老年人中，老年疾病很常见。COPD护理的“超越肺部”方法应以积极管理老年疾病为中心，这可能会改善COPD的管理和生活质量。
