Chronic obstructive pulmonary disease in the long-term care setting: current practices, challenges, and unmet needs

Area of Science:

• Pulmonary Medicine
• Geriatrics
• Healthcare Quality

Background:

• Chronic obstructive pulmonary disease (COPD) significantly impacts older individuals, particularly women and smokers.
• COPD is frequently underdiagnosed, undertreated, and underrepresented in elderly residents of long-term care (LTC) facilities.
• Care quality for LTC residents with COPD varies, necessitating facility and patient-centered improvements.

Purpose of the Study:

• To address the underutilization of effective COPD treatments in LTC settings.
• To develop a structured approach for selecting appropriate respiratory devices for LTC patients.
• To improve the quality of care for elderly individuals with COPD in long-term care.

Main Methods:

• Literature review on COPD prevalence, diagnosis, and treatment in LTC settings.
• Analysis of patient-specific factors influencing device selection (inspiratory flow, dexterity, cognition).
• Development of a COPD treatment algorithm tailored for LTC residents.

Main Results:

• Nebulization is underutilized in LTC despite its benefits for patients with impaired inspiratory flow, cognitive, or physical limitations.
• Existing inhalation devices may be unsuitable for many LTC residents due to functional impairments.
• A novel algorithm prioritizes patient-specific factors for optimal respiratory device selection.

Conclusions:

• Optimizing COPD care in LTC requires enhanced staff education and communication.
• Patient-centered care in LTC involves considering diagnosis, comorbidities, treatment ability, and preferences.
• The developed algorithm provides a framework for selecting appropriate respiratory devices, potentially improving COPD management in LTC settings.