Document Detail


Effect of coexisting chronic obstructive pulmonary disease and cognitive impairment on health outcomes in older adults.
MedLine Citation:
PMID:  23035917     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine the extent to which the co-occurrence of chronic obstructive pulmonary disease (COPD) and cognitive impairment affect adverse health outcomes in older adults.
DESIGN: Multicenter longitudinal cohort study.
SETTING: California, Pennsylvania, Maryland, and North Carolina.
PARTICIPANTS: Three thousand ninety-three community-dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty-one had chronic obstructive pulmonary disease (COPD) at study baseline.
MEASUREMENTS: Follow-up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda-Mu-Sigma method, which accounts for age-related changes in lung function. Cognitive impairment was evaluated using the modified Mini-Mental State Examination and claims data. Outcomes were respiratory-related and all-cause hospitalizations and death.
RESULTS: Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory-related (adjusted hazard ratio (aHR) = 4.10, 95% confidence interval (CI) = 1.86-9.05) and all-cause hospitalizations (aHR = 1.34, 95% CI = 1.00-1.80) and death (aHR = 2.29, 95% CI = 1.18-4.45). In particular, individuals with both conditions had a 48% higher rate of all-cause hospitalizations (adjusted synergy index (aSI) = 1.48, 95% CI = 0.19-11.31) and a rate of death nearly three times as high (aSI = 2.74, 95% CI = 0.43-17.32) as the sum of risks for each respective outcome associated with having COPD or cognitive impairment alone. Nevertheless, tests for interaction were not statistically significant for the presence of synergism between the two conditions contributing to each of the outcomes. Therefore, it cannot be concluded that the combined effect of COPD and cognitive impairment is greater than additive.
CONCLUSION: Coexisting COPD and cognitive impairment have an additive effect on respiratory-related and all-cause hospitalizations and death. Optimizing outcomes in older adults with COPD and cognitive impairment will require that how to improve concurrent management of both conditions be determined.
Authors:
Sandy S Chang; Shu Chen; Gail J McAvay; Mary E Tinetti
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2012-10-04
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  60     ISSN:  1532-5415     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-12     Completed Date:  2012-12-31     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1839-46     Citation Subset:  IM    
Copyright Information:
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Affiliation:
Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT 06520, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cognition Disorders / complications*
Female
Hospitalization / statistics & numerical data*
Humans
Longitudinal Studies
Male
Pulmonary Disease, Chronic Obstructive / complications*
Grant Support
ID/Acronym/Agency:
KL2 RR024138/RR/NCRR NIH HHS; KL2RR024138/RR/NCRR NIH HHS; P30 AG021342/AG/NIA NIH HHS; P30 AG021342/AG/NIA NIH HHS; UL1 RR024139/RR/NCRR NIH HHS; UL1 RR024139/RR/NCRR NIH HHS; UL1 TR000142/TR/NCATS NIH HHS
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