Older Adults with Chronic Lung Disease Report Less Limitation Compared with Younger Adults with Similar Lung Function Impairment

Abstract

Rationale: Disability guidelines are often based on pulmonary function testing, but factors other than lung function influence how an individual experiences physiologic impairment. Age may impact the perception of impairment in adults with chronic lung disease. Objectives:To determine if self-report of physical functional impairment differs between older adults with chronic lung disease compared with younger adults with similar degrees of lung function impairment. Methods:The Lung Tissue Research Consortium provided data on 981 participants with chronic obstructive pulmonary disease and interstitial lung disease who were well characterized with clinical, radiological, and pathological diagnoses. We used multiple logistic regression to determine if responses to health status questions (from the Short Form-12 and St. George's Respiratory Questionnaire) related to perception of impairment differed in older adults (age > 65 yr, n = 427) compared with younger adults (age , 65 yr, n = 393).Measurements and Main Results: Pulmonary function was higher in older adults (median FEV 1 %, 70) compared with younger adults (median FEV 1 %, 62) (P , 0.001), whereas the median 6-minute-walk distance was similar between groups (372 m vs. 388 m, P = 0.21). After adjusting for potential confounders, older adults were less likely to report that their health limited them significantly in performing moderate activities (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.22-0.58) or climbing several flights of stairs (OR, 0.51; 95% CI, 0.34-0.77). The odds of reporting that their physical health limited the kinds of activities they performed were reduced by 63% in older adults (OR, 0.37; 95% CI, 0.24-0.58), and, similarly, the odds of reporting that their health caused them to accomplish less than they would like were also lower in older adults (OR, 0.39; 95% CI, 0.25-0.60). The OR for reporting that their breathing problem stops them from doing most things or everything was 0.35 (95% CI, 0.22-0.55) in older adults versus younger adults. Conclusions:Older adults with chronic lung disease were less likely to report significant impairment in their activities compared with younger adults, suggesting they may perceive less limitation.

Examining the Effects of Age on Health Outcomes of Chronic Obstructive Pulmonary Disease: Results From the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate Endpoints Cohorts

“…Older patients (age ≥65 years) had significantly lower total SGRQ scores than younger patients (age <65 years), indicating better health status. 38 However, older adults in the Lung Tissue Research Consortium had better lung function as measured by FEV 1 , FVC, and diffusing capacity of the lungs for carbon monoxide and similar 6-minute walk distance compared with younger adults, whereas older patients in the current study had worse lung function and decreased exertional tolerance. Similarly, results from the Subpopulations and Intermediate Outcome Measures in COPD Study demonstrated that patients over age 65 years had better quality of life compared with patients age 50-64 years.…”

The relationship between multiple chronic diseases and depressive symptoms among middle-aged and elderly populations: results of a 2009 korean community health survey of 156,747 participants

“…Moreover, an awareness of chronic diseases could also affect emotional disorders [ 40 ]. In particular, middle-aged adults have many roles in social and familial activities; therefore, disease awareness at an early age of onset, role limitations, and impairments may cause a number of psychological problems [ 41 – 43 ]. The depressive symptoms associated with chronic diseases have various causes, such as the increased risk of complications [ 4 ], increased economic loss due to healthcare utilization and cost [ 44 ], increased functional disabilities [ 45 ], limitations of physical activity [ 8 ], and loss of productive work time [ 46 ].…”

Age-Related Differences in Health-Related Quality of Life in COPD

“…This finding is in agreement with findings from studies of the general population and persons with other chronic diseases, including fibromyalgia, 20 gastroesophageal reflux, 21 HIV infection, 22 and breast cancer. 23 Using data from patients with chronic lung diseases (advanced COPD and interstitial lung diseases), Berry et al 3 recently found that older adults had lower odds of reporting health-related limitations. Our investigation, restricting the population to COPD, confirmed a similar pattern of differences.…”

“…1,2 Studies of HRQL in COPD show that, independent of lung function, younger adults tend to report worse scores than do older adults, suggesting a pattern of more negative perception of health among younger subjects. 3,4 Little is known about the reasons for these differences and how they may impact the provision of care in COPD.…”