One-year mortality in elderly stable patients with COPD

Area of Science:

• Geriatrics
• Pulmonology
• Public Health

Background:

• Hospitalized very old patients, including those with chronic obstructive pulmonary disease (COPD), have varying mortality risks.
• Comprehensive geriatric assessment is crucial for evaluating outcomes in elderly populations.

Purpose of the Study:

• To evaluate the one-year mortality risk in very old hospitalized patients, comparing those with and without COPD.
• To identify specific factors, including disease severity and comorbidities, that influence mortality in this demographic.

Main Methods:

• A retrospective study of 658 disabled patients discharged from a Geriatric Evaluation and Rehabilitation Unit (GERU).
• Patients were categorized into COPD (n=337) and non-COPD (n=321) groups.
• Multidimensional assessments included demographics, cognitive status (MMSE), physical health (IDS, drug use), functional disability (BADL, Tinetti, PPT), and nutritional status (PNI). Survival was tracked for one year post-discharge.

Main Results:

• COPD patients were older, more likely smokers, and had more comorbidities and drug use.
• Patients with functional impairment (IDS 2-4) had double the one-year mortality risk compared to symptomatic COPD (IDS 1) or non-COPD (IDS 0) groups, after adjustments.
• COPD patients with cor pulmonale (CP) and functional impairment (IDS 2-4) faced a fourfold increased mortality risk versus the IDS 1 COPD group, adjusted for covariates.

Conclusions:

• Hospitalized very old COPD patients with functional impairment have a significantly higher one-year mortality risk.
• The presence of cor pulmonale in functionally impaired COPD patients substantially elevates mortality risk.
• These findings underscore the importance of assessing functional status and comorbidities in elderly COPD patients for risk stratification.