Effect of Coexisting Chronic Obstructive Pulmonary Disease and Cognitive Impairment on Health Outcomes in Older Adults

Authors

  • Sandy S. Chang MD, MHS,

    Corresponding author
    • Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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  • Shu Chen MS,

    1. Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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  • Gail J. McAvay PhD,

    1. Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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  • Mary E. Tinetti MD

    1. Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
    2. Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
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Address correspondence to Sandy S. Chang, Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, P.O. Box 208025, 333 Cedar St., New Haven, CT 06520. E-mail: sandy.chang@yale.edu

Abstract

Objectives

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.

Design

Multicenter longitudinal cohort study.

Setting

California, Pennsylvania, Maryland, and North Carolina.

Participants

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.

Measurements

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.

Results

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.

Conclusion

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.

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