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- W2052857230 abstract "Numerous physiological changes in lung function occur with aging. These include a decline in forced expiratory volume (FEV1), an increase in residual volume, ventilation-perfusion mismatch, diminished respiratory muscle strength and less effective ciliary muscle strength. These changes place the older person at increased risk of mortality from chronic obstructive pulmonary disease (COPD). COPD occurs in approximately 15% of older persons and is the third most common cause of death.1 Older persons with COPD have a number of unique complications including osteoporosis and hip fracture, sarcopenia, cognitive impairment, male hypogonadism, malnutrition, and decreased awareness of hypoxia. Over one-half of older persons with COPD are frail,2e6 and the presence of frailty increases mortality substantially in older persons with COPD.7 COPD is a common cause of disability8 and a major cause of 30 day readmission after discharge from hospital.9,10 A hospital discharge coordinator intervention has been shown to reduce COPD hospitalizations.10 It has been suggested that many hospital admissions could be avoided by direct admissions to subacute (nursing home) care11 or by increasing the acuity of homebased primary care.12,13 Support of family caregivers is also important in this regard.14 Modern diagnosis of COPD is made using the Global Initiative for Obstructive Lung Disease criteria, which are objectively based on spirometry. These require a FEV1 of less than 80% if predicted and a postbronchodilator FEV1/forced vital capacity of less than 70% of predicted.1 Cognitive dysfunction may limit the ability of older persons to meet these criteria. COPD diagnosis is missed in up to 80% of older persons.15 Zarowitz et al16 suggested that in nursing homes persons with a diagnosis of asthma, shortness of breath at rest, or on exertion and smoking 19 or more pack years are highly likely to have COPD. A 6-minute walk distance of approximately less than 350 meters is highly predictive of exacerbation and death in persons with COPD.17 COPD is amajor cause of undernutrition inolder persons.18e20Many persons with COPD have early satiety as the thermic energy of eating results in hypoxia leading to severe dyspnea during the meal. Food intake can be improved by providing multiple small meals (6 or more) during the day or caloric/protein supplements between meals.21,22 All persons with COPD should be screened for anorexia using the Simplified Nutrition Assessment Questionnaire.23,24 Weekes et al25" @default.
- W2052857230 created "2016-06-24" @default.
- W2052857230 creator A5006935353 @default.
- W2052857230 date "2014-03-01" @default.
- W2052857230 modified "2023-10-16" @default.
- W2052857230 title "Chronic Obstructive Pulmonary Disease: A Disease of Older Persons" @default.
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- W2052857230 doi "https://doi.org/10.1016/j.jamda.2013.12.078" @default.
- W2052857230 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24513223" @default.