Effect of Coexisting Chronic Obstructive Pulmonary Disease and Cognitive Impairment on Health Outcomes in Older Adults
Version of Record online: 4 OCT 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 60, Issue 10, pages 1839–1846, October 2012
How to Cite
J Am Geriatr Soc 60:1839–1846, 2012.
- Issue online: 11 OCT 2012
- Version of Record online: 4 OCT 2012
- Clinical Translational Science Award. Grant Numbers: 2007–0009, P30 AG021342
- John A. Hartford Foundation for Excellence in Geriatric Medicine at Yale University. Grant Number: 2007–0009
- National Institute on Aging (NIA). Grant Numbers: P30 AG021342, UL1 RR024139, KL2 RR024138
- National Center for Advancing Translational Sciences (NCATS)
- National Institutes of Health (NIH)
- NIH roadmap for Medical Research
- chronic obstructive pulmonary disease;
- cognitive impairment;
- health outcomes;
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.
Multicenter longitudinal cohort study.
California, Pennsylvania, Maryland, and North Carolina.
Three thousand ninety-three community-dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty-one had chronic obstructive pulmonary disease (COPD) at study baseline.
Follow-up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda-Mu-Sigma method, which accounts for age-related changes in lung function. Cognitive impairment was evaluated using the modified Mini-Mental State Examination and claims data. Outcomes were respiratory-related and all-cause hospitalizations and death.
Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory-related (adjusted hazard ratio (aHR) = 4.10, 95% confidence interval (CI) = 1.86–9.05) and all-cause hospitalizations (aHR = 1.34, 95% CI = 1.00–1.80) and death (aHR = 2.29, 95% CI = 1.18–4.45). In particular, individuals with both conditions had a 48% higher rate of all-cause hospitalizations (adjusted synergy index (aSI) = 1.48, 95% CI = 0.19–11.31) and a rate of death nearly three times as high (aSI = 2.74, 95% CI = 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.
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.