Journal of the American Geriatrics Society | 2021
A supportive framework for the care of older adults with COPD
Abstract
Chronic obstructive pulmonary disease (COPD) is an irreversible and life-limiting disease and creates a considerable burden on patients. Older adults with COPD may experience frequent hospitalizations and a waning performance status that forms a downward spiral. Because of the complex needs of patients with COPD, and the unfortunate synergy between COPD and other common geriatric syndromes, a nuanced care strategy is necessary to support these patients. Absent access to specialized respiratory and supportive providers, the care for older patients with COPD falls to primary care, and geriatric specialty providers. Pressing issues in COPD care include poor disease understanding, the impact of COPD on function and quality of life, and patient-centered advance care planning (ACP). Given COPD s incurability and substantial impact on patients, a supportive framework, such as those used to improve quality of life in cancer care and heart failure management, could assist providers in structuring and conducting COPD-centered visits. Our framework approach, described in Figure 1, uses a sequence of questions to engage patients on the topics of disease understanding, symptom burden and impact, and advance care planning. We predict application of this structured approach would demonstrate improvements in patient satisfaction, quality of life, and rates of ACP completion.