Obstructive Airways Disease: A Hidden Disability in the Aged

Elderly people living in Britain have a high prevalence of chronic obstructive airways disease, reflecting the number who began smoking in their younger days. Smoking uptake reached its peak in the cohort of men born between 1910 and 1920 [1]. Community-dwelling elderly people cite chest problems as a cause of severe disability second only to musculo-skeletal disorders [2], yet doctors have been slow to recognize the problem. Elderly people with moderate or severe respiratory disease and impairment may not appear to be disabled. They do not occupy rehabilitation beds for long periods, and do not rely greatly on community services for physical support. Most are able to wash, dress and mobilize independently within the home, although simple acts of washing and dressing may take perhaps an hour and leave them exhausted. It is not surprising that the medical community does not have, as yet, validated tools for measuring disability in this elderly group. Most of the questionnaires used in younger patients with airways disease measure 'quality of life' rather than disability or activities of daily living (ADL) and are not validated in older people [3-5]. Standard ADL scales employed in other disabling conditions are only just beginning to be assessed in obstructive airways disease [6]. A survey of the UK and US literature revealed that only 10% of published papers in respiratory journals related either in whole or in part to elderly subjects and that only 4% of papers in geriatrics journals dealt with respiratory topics. Elderly respiratory patients seem to have fallen between stools occupied by respiratory physicians on the one side and geriatricians on the other. General practitioners, conversely, are familiar with the scale of the medical problem (if not the level of disability); for every 1000 patients over the age of 65 years, there are over 700 GP respiratory consultations per annum [7].