Premium
Effect of Coexisting Chronic Obstructive Pulmonary Disease and Cognitive Impairment on Health Outcomes in Older Adults
Author(s) -
Chang Sandy S.,
Chen Shu,
McAvay Gail J.,
Tinetti Mary E.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04171.x
Subject(s) - medicine , copd , hazard ratio , confidence interval , cohort study , cohort , pulmonary disease , physical therapy , gerontology
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, P ennsylvania, M aryland, and N orth C arolina. Participants Three thousand ninety‐three community‐dwelling adults aged 65 and older from the C ardiovascular H ealth S tudy. 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 L ambda‐ M u‐ S igma method, which accounts for age‐related changes in lung function. Cognitive impairment was evaluated using the modified M ini‐ M ental S tate E xamination 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 (a HR ) = 4.10, 95% confidence interval ( C I) = 1.86–9.05) and all‐cause hospitalizations (a HR = 1.34, 95% C I = 1.00–1.80) and death (a HR = 2.29, 95% C I = 1.18–4.45). In particular, individuals with both conditions had a 48% higher rate of all‐cause hospitalizations (adjusted synergy index (a S I) = 1.48, 95% C I = 0.19–11.31) and a rate of death nearly three times as high ( aSI = 2.74, 95% C I = 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.