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Asthma in Older Patients
Factors Associated With Hospitalization
Gregory B. Diette, MD, MHS;
Jerry A. Krishnan, MD;
Francesca Dominici, PhD;
Ed Haponik, MD;
Elizabeth Ann Skinner, MSW;
Donald Steinwachs, PhD;
Albert W. Wu, MD, MPH
Arch Intern Med. 2002;162:1123-1132.
Background 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.
Objectives To determine whether 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.
Methods 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.
Results Among 6590 adults with asthma, 554 (8%) were 65 years or older and 1942
(29%) were aged 18 to 34 years. 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.
Conclusions 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.
From the Department of Medicine, School of Medicine (Drs Diette, Krishnan,
Haponik, Steinwachs, and Wu), and the Departments of Biostatistics (Dr Dominici),
Epidemiology (Drs Diette and Wu), and Health Policy and Management (Ms Skinner
and Drs Steinwachs and Wu), School of Hygiene and Public Health, The Johns
Hopkins University, Baltimore, Md.
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