Descriptive Epidemiology of Chronic Obstructive Pulmonary Disease in U.S. Nursing Home Residents with Heart Failure

Abstract

Background: As individuals age, there is an increasing risk of developing multiple chronic diseases. Heart failure (HF) and Chronic Obstructive Pulmonary Disease (COPD) are two of the leading causes of morbidity and mortality, affecting approximately 64 million people and 16 million people, respectively, in the United States alone. Understanding how these multiple chronic conditions affect older adults is important to improve their physical functioning, cognition, and quality of life.

Methods: Using national contemporary data from the : 1) Minimum Data Set, (MDS), 2) Medicare Master Beneficiary Summary File, and 3) Medicare hospitalization data (Part A, MEDPAR), with detailed information on virtually all nursing home residents in the United States (2002-2018), this dissertation fills important research gaps by providing descriptive epidemiological data about COPD among older nursing home residents with heart failure, and the role of psychological distress (anxiety and depression) among these individuals.

Results: The average age of the study sample was 81.3 years, 67.3% were women, and 77.45% were Non-Hispanic Whites. There was a slightly higher prevalence of COPD among the men (56.7%) than among the women (52.4%) with heart failure. The prevalence of anxiety was 37.2%, while the prevalence of depression was 57.6% among nursing home residents diagnosed with COPD. This pulmonary condition was less frequently noted in residents of advanced age and racial/ethnic minorities, and more frequently diagnosed in current tobacco users and residents with additional comorbid conditions including pneumonia, anxiety, obesity, diabetes mellitus, and coronary artery disease. A higher proportion of unspecified heart failure type was found in both men and women with COPD, than reduced and preserved ejection fractions, respectively.

Conclusions: Findings from this dissertation highlight the high prevalence of COPD among older nursing home residents with heart failure, and challenges in the clinical management of this understudied population given their complex clinical profile. The present findings reinforce the need to adopt nonpharmacological, pharmacological, and multidisciplinary care approaches to effectively manage COPD and heart failure, psychological distress (anxiety and depression) in these individuals and associated comorbid conditions.