Diette GB, Krishnan JA, Dominici F, et al. Arch Intern Med. 2002;162:1123–1132
Purpose of the Study.
Although older adults (≥65 years) with asthma have higher rates of hospitalization and death from asthma than younger adults, the reasons for this are not known. The purpose of this study was to determine if patterns of care were less favorable for older than younger adults with asthma and to assess whether patient characteristics such as symptom severity and comorbid illnesses explain the higher rate of hospitalization.
Study Population and Methods.
This study was a prospective cohort study of 6590 adults with asthma in 15 managed care organizations in the United States. Participants completed a survey of demographics, symptoms, health status, comorbid illnesses, treatment, access to care, self-care knowledge, physician specialty, and health care use.
Among 6590 adults with asthma, 554 (8%) were 65 years or older and 1942 (29%) were 18 to 34 years old. Older patients were more likely than younger patients to be men, white, non-Hispanic, and less educated. At baseline, older patients reported a greater frequency of asthma-related symptoms, such as daily cough (36% vs 22%; P < .001) and wheezing (27% vs 22%; P < .002). They were also more likely to report comorbid conditions, such as sinusitis (50% vs 38%), heartburn (35% vs 23%), chronic bronchitis (43% vs 16%), emphysema (19% vs 1%), congestive heart failure (8% vs 1%), and history of smoking (54% vs 34%; all P < .001). Care appeared to be better for the older patients compared with the younger, including more frequent use of inhaled corticosteroids, greater self-management knowledge, and fewer reported barriers to care. In the follow-up year, older patients were approximately twice as likely to be hospitalized (14%) than were younger patients (7%; P < .001). In multivariate analysis, however, older age was not predictive of future hospitalization (odds ratio: 1.05; 95% confidence interval: 0.68–1.61), after adjustment for sex, ethnicity, education, baseline asthma symptoms, health status, comorbid illnesses, and tobacco use. Factors independently associated with hospitalization included being female, nonwhite, less educated, and less physically healthy, and more frequent asthma symptoms.
Although the older adults with asthma had greater respiratory symptoms and more comorbidity than their younger counterparts, chronologic age was not an independent risk for hospitalization. Appropriate care for older adults with asthma should address asthma symptoms and other chronic conditions.
It was at least comforting to see that the older patients received at least the same level of care as the younger patients. It was not surprising to find that those patients who were generally not well and had more frequent asthma were more likely to be hospitalized for asthma.