scholarly journals IMPROVING THE HEALTH BEHAVIOURS OF COPD PATIENTS: IS HEALTH LITERACY THE ANSWER?

2020 ◽  
pp. 268-278
Author(s):  
Tracy A. Freeze ◽  
◽  
Leanne Skerry ◽  
Emily Kervin ◽  
Andrew Brillant ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Literacy ◽  
Qualitative Interviews ◽  
Health Behaviours ◽  
Future Research ◽  
Chronic Obstructive ◽  
Processing Capacity ◽  
Obstructive Pulmonary Disease ◽  
Medication Delivery ◽  
Medication Refill

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality (Vogelmeier et al., 2017). Adherence to prescribed medications and adequate medication inhalation technique (MIT) is critical for optimal management of COPD, as is the proper use of the medication delivery device.O’Conor et al. (2019) found that lower health literacy (HL) was associated with both poor medication adherenceand MIT. HL, according to the Process-Knowledge Model, consists of both processing capacity and knowledge (Chin et al., 2017). COPD most commonly occurs in older adults (Cazzola, Donner, & Hanania, 2007). Older adults tend to have lower processing capacity (Chin et al., 2017). The purpose of this study was to determine if HL was associated with medication refill adherence (MRA)and/or MIT. Fifty-seven participants completed a questionnaire package that included demographic questions, measures of HL, and assessments of MRA and MIT. A subset of twenty patients participated in qualitative interviews. Results indicated that lower HL was associated with both lower MRA and poor MIT, and qualitative findings revealed the need for further information. Future research should focus on testing educational materials that have been designed and/or reformatted to meet the lower processing capacity of older adults.

scholarly journals Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Peter Treitler ◽  
Stephen Crystal ◽  
Richard Hermida ◽  
Jennifer Miles
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
The Elderly ◽  
Opioid Use Disorder ◽  
Chronic Obstructive ◽  
Medicare Beneficiaries ◽  
Older Individuals ◽  
Opioid Use ◽  
Policy And Practice ◽  
Obstructive Pulmonary Disease

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 36 (5) ◽  
pp. 248-257
Author(s):  
H. Edward Davidson ◽  
Peter Radlowski ◽  
Lisa Han ◽  
Theresa I. Shireman ◽  
Carole Dembek ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Characteristics ◽  
Symptom Burden ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Nursing Facility ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Medication Delivery

OBJECTIVE AND DESIGN: To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD). PATIENTS AND SETTING: Residents 60 years of age and older with a COPD diagnosis and≥ 6 months' nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities. OUTCOME MEASURES: Data, extracted from residents' charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. At enrollment, residents completed the modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT™). Spirometry and PIFR were also assessed. RESULTS: Residents' (N = 179) mean age was 78.0 ± 10.6 years, 63.7% were female, and 57.0% had low PIFR. Most prevalent comorbidities were hypertension (79.9%), depression (49.2%), and heart failure (41.9%). The average forced expiratory volume in 1 second (FEV11) % predicted was 45.9% ± 20.9%. On the CAT, 78.2% scored≥ 10 and on the mMRC Dyspnea Scale, 74.1% scored≥ 2, indicating most residents had high COPD symptom burden. Only 49.2% were receiving a scheduled long-acting bronchodilator (LABD). Among those with low PIFR prescribed a LABD, > 80% used dry powder inhalers for medication delivery. CONCLUSION: This study highlights underutilization of scheduled LABD therapy in nursing facility residents with COPD. Low PIFR was prevalent in residents while the majority used suboptimal medication delivery devices. The findings highlight opportunities for improving management and outcomes for nursing facility residents with COPD.

Patient Journey: Implications for Improving and Integrating Care for Older Adults with Chronic Obstructive Pulmonary Disease

2012 ◽  
Vol 31 (2) ◽  
pp. 223-233 ◽  
Author(s):  
Karen Jackson ◽  
Nelly D. Oelke ◽  
Jeanne Besner ◽  
Alexandra Harrison
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Older Adults ◽  
Nous Avons ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Qualité Des Soins ◽  
Patient Journey ◽  
Obstructive Pulmonary Disease ◽  
Soutien Social ◽  
Soins De Santé

RÉSUMÉBeacoup de patients, surtout les patients plus âgés, interagissent avec fournisseurs multiples, tout en avant accès aux services des soins de santé dans une variété de milieux divers pendants longues périodes. Comprendre les expériences des patients plus âgés pendant leurs voyages à travers le système de santé est essentielle pour améliorer l’intégration des services et la qualité des soins. Dans cette étude, nous avons résumé les expériences de quatre patients vivant avec la maladie pulmonaire obstructive chronique en interaction avec le système des soins de santé pendant une période de trois mois après la sortie de l’hôpital. Guidé par la méthodologie d’étude de cas, on a réunis les données par le biais des entretiens semi-structurés et des journaux de patients. Trois grands thèmes - le soutien social, la navigation à travers le système, et l’accès aux soins – ont émergé à partir des données. L’attention à la communication entre fournisseur-patient et prestataire-fournisseur, ainsi que le soutien social du patient, et les besoins des soins auto-administrés, pourraient améliorer l’intégration et les résultats des soins. Pour réaliser de ce que les patients perçoivent comme une système integrée et efficace, il faudra du temps et de l’engagement.

Morbidity and mortality associated with prescription cannabinoid drug use in COPD

Thorax ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 29-36
Author(s):  
Nicholas T Vozoris ◽  
Priscila Pequeno ◽  
Ping Li ◽  
Peter C Austin ◽  
Anne L Stephenson ◽  
...  
Keyword(s):  
Older Adults ◽  
Population Based ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cox Proportional Hazard ◽  
Equivalent Number ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression

IntroductionRespiratory-related morbidity and mortality were evaluated in relation to incident prescription oral synthetic cannabinoid (nabilone, dronabinol) use among older adults with chronic obstructive pulmonary disease (COPD).MethodsThis was a retrospective, population-based, data-linkage cohort study, analysing health administrative data from Ontario, Canada, from 2006 to 2016. We identified individuals aged 66 years and older with COPD, using a highly specific, validated algorithm, excluding individuals with malignancy and those receiving palliative care (n=185 876 after exclusions). An equivalent number (2106 in each group) of new cannabinoid users (defined as individuals dispensed either nabilone or dronabinol, with no dispensing for either drug in the year previous) and controls (defined as new users of a non-cannabinoid drug) were matched on 36 relevant covariates, using propensity scoring methods. Cox proportional hazard regression was used.ResultsRate of hospitalisation for COPD or pneumonia was not significantly different between new cannabinoid users and controls (HR 0.87; 95% CI 0.61–1.24). However, significantly higher rates of all-cause mortality occurred among new cannabinoid users compared with controls (HR 1.64; 95% CI 1.14–2.39). Individuals receiving higher-dose cannabinoids relative to controls were observed to experience both increased rates of hospitalisation for COPD and pneumonia (HR 2.78; 95% CI 1.17–7.09) and all-cause mortality (HR 3.31; 95% CI 1.30–9.51).ConclusionsNew cannabinoid use was associated with elevated rates of adverse outcomes among older adults with COPD. Although further research is needed to confirm these observations, our findings should be considered in decisions to use cannabinoids among older adults with COPD.

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