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SketchList.3D.v4.0.3675. V15.1 SpecMan.Pro.2006 SpecMAN.v5.2.3. Spectra.Precision.FAST.Improving identification and management of older patients with COPD.
Despite the known adverse consequences of poor quality of care in the elderly, elderly patients are significantly under-represented in randomized controlled trials. We hypothesized that we could decrease the undertreatment of elderly patients with chronic obstructive pulmonary disease (COPD) by evaluating changes in their care through centralized geriatrics consultation. From July 2000 to July 2002, all COPD patients seen at our institution were evaluated by geriatrics specialists. Patient characteristics, new symptoms, changes in comorbid conditions, physical functional status, and interventions were recorded at the time of initial evaluation and at follow-up. Patients were stratified into quintiles based on age. The relative hazard of a new diagnosis of obstructive sleep apnea (OSA) or depression after initiating geriatrics consultation was evaluated. Risk factors for hospitalization were also examined. Two hundred forty-nine patients were seen (mean age 71 +/- 8 years, 37% male). The majority of patients had emphysema (56.7%) and were hypercapnic at presentation (93.8%). After 1 year, 159 patients were seen (mean age 69 +/- 10 years, 38% male). The most common diagnoses were OSA (34%), depression (23%), and diabetes (15%). Independent risk factors for hospitalization included increasing age, dyspnea on exertion, and history of OSA. Patients who were evaluated by a geriatrics specialist showed a decrease in the prevalence of many previously missed diagnoses, and had more appropriate medical and surgical therapies. A simple geriatrics consultation was associated with a significant decrease in hospitalization and mortality in elderly COPD patients.DSL
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