Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

Abstract

Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease. Methods: We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥1 instrumental activity of daily living (IADL) or ≥1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression. Results: The prevalence of IADL impairment was higher with moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p < 0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95% confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95% CI 0.69-0.86 and <7 blocks: RR 0.73 and 95% CI 0.61-0.86). Increased strength (RR 1.16 and 95% CI 1.05-1.29) was associated with resolving IADL impairment. Conclusions: Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease

“…31 Although there was no difference in the impairment in basic ADL scores, a higher number of patients with COPD were impaired for IADLs. This finding is similar to previous studies, 29,32 and could be due to the deteriorative effect of COPD on exercise tolerance. 33 About 35.3% of patients with COPD in our study had cognitive impairment, similar to the study by Ranzini et al 34 Cognition is associated with functionality, treatment compliance, and adherence to rehabilitation programs in patients with COPD.…”

“…Although there was no difference in the impairment in basic ADL scores, a higher number of patients with COPD were impaired for IADLs. This finding is similar to previous studies, 29,32 and could be due to the deteriorative effect of COPD on exercise tolerance 33 …”

“…Patients with COPD had a high smoking index, lower formal education, more comorbidities, and poor socioeconomic status than non-COPD patients, similar to previous studies. 12,29,30 Patients with COPD had low BMI, which has been seen as a risk factor for lung function decline, whereas high BMI is shown to have a protective effect, also called the "obesity paradox." 31 Although there was no difference in the impairment in basic ADL scores, a higher number of patients with COPD were impaired for IADLs.…”

Chronic obstructive pulmonary disease comorbidities

“…Markers of frailty, including cognitive dysfunction [66 & ], chronic pain [67], geriatric conditions, and limitations with activities of daily living are as important in COPD as other classical comorbidities [68,69,70 & ], as they predict the development of disability and future dependencies and nursing care utilization. Full understanding of the interaction between aging and COPD is still lacking [71], but further studies of these mechanisms and their impact on COPD and other respiratory diseases could lead to new opportunities to improve and deliver care for COPD patients.…”

Childhood maltreatment exposure and physical functional limitations in late adulthood: examining subjective sleep quality in midlife as a mediator

“…Moreover, sleep quality only explained part of the association between the two vulnerable sub-groups and physical functional limitations in late adulthood, indicating that additional factors may explain the association between multiple maltreatment exposures and physical functional limitations in late adulthood. Childhood maltreatment has consistently been related to several chronic illnesses in adulthood, such as higher rates of cardiovascular diseases, and greater risk for developing asthma, diabetes, bladder problems, and chronic fatigue (Leeb, Lewis, & Zoltor, 2011;Suglia, Clark, Boynton-Jarrett, Kressin, & Koenen, 2014) -conditions that have also been implicated in higher rates of physical functional limitations among adults (Taylor & Lynch, 2011;Fan et al, 2014). Other studies have also linked childhood maltreatment to poorer mental health outcomes, such as higher levels of depression (Li, D'Arcy, & Meng, 2016).…”