Kronik Obstrüktif Akciğer Hastalığı Olan Yaşlı Bireylerde Dispne, Bakım Bağımlılığı ve Kırılganlık: İlişkisel Araştırma

Year 2024, Volume: 7 Issue: 2, 94 - 112, 31.08.2024

Merve Esen , Zehra Gök Metin

https://doi.org/10.54803/sauhsd.1435079

Abstract

Amaç: Kronik obstrüktif akciğer hastalığı ilerledikçe yaşlı yetişkinlerde şiddetli nefes darlığı da dahil olmak üzere semptom yükü giderek artmaktadır. Bu araştırma kronik obstrüktif akciğer hastalığı olan yaşlı bireylerde dispne, bakım bağımlılığı ve kırılganlık değişkenleri arasındaki ilişkiyi belirlemek amacıyla yürütüldü.
Yöntem: Tanımlayıcı-korelasyonel tasarıma sahip olan araştırmaya 105 katılımcı dahil edildi. Araştırma verileri Dispne-12 Ölçeği, Bakım Bağımlılığı Ölçeği ve Edmonton Kırılganlık Ölçeği kullanılarak toplandı. Korelasyon ve regresyon analizleri kullanıldı.
Bulgular: Dispne medyan puanı 24 (orta ila yüksek), bakım bağımlılığı 61 (düşük) ve kırılganlık puanı 10 (orta) olarak bulundu. Yaş (β = 0,171, p = 0,013), kronik obstrüktif akciğer hastalığı evresi (β = 0,465, p<0,001) ve gelir durumunun (β = 0,907, p=0,049) dispnenin belirleyicileri olduğu ve varyansın %67,1’ini açıkladığı belirlendi. Yaş (β = -0,43, p<0,001), KOAH evresi (β = 0,506, p<0,001) ve gelir durumunun (β =- 0,147, p<0,001) bakım bağımlılığını yordadığı bulundu. Yaş ve kronik obstrüktif akciğer hastalığı evresinin yanı sıra, eğitim durumu (β =0,172, p<0,011), komorbid durumların (β =0,172, p<0,011) ve komorbiditelere yönelik kullanılan tedavilerin (β =0,126, p<0,049) ise kırılganlığın belirleyicileri olduğu ortaya çıktı.
Sonuç: Bu araştırma ile ileri evre kronik obstrüktif akciğer hastalığı olan, eğitim seviyesi düşük, gelir düzeyi düşük ve ek hastalıkları olan yaşlı bireylerin bakım bağımlılığı ve kırılganlığının daha yüksek olduğu ortaya çıkarıldı. Hemşireler, kırılganlık açısından yüksek riskli olan Kronik obstrüktif akciğer hastalığı olan yaşlı bireyleri belirlemek için dispne şiddeti ve bakım bağımlılığını eş zamanlı olarak değerlendirmelidir. Kronik obstrüktif akciğer hastalığı olan bireylerde dispne yönetimi ve böylelikle bakım bağımlılığı ve kırılganlığın azaltılmasında ileri yaş, ileri evre hastalık, eğitim düzeyi, gelir durumu ve eşlik eden komorbiditeleri dikkate alan ileri çalışmalara gereksinim bulunmaktadır.

Keywords

Bakım bağımlılığı, dispne, hemşire, kırılganlık, kronik obstrüktif akciğer hastalığı

Dyspnea, Care Dependency, and Frailty in Older Adults with Chronic Obstructive Pulmonary Disease: A Correlational Study

Abstract

Objective: As chronic obstructive pulmonary disease (COPD) progresses, older adults have an increased symptom burden, including severe dyspnea. The present study aimed to investigate the relationship between dyspnea, care dependency, and frailty in older adults with COPD.
Methods: The current study was a descriptive-correlational study. One hundred and five participants were included. Data were collected face-to-face using the Dyspnea-12 Scale, Care Dependency Scale, and Edmonton Frailty Scale. Correlation and regression analysis were performed.
Results: The median score for dyspnea was 24 (moderate to high), 61 (low) for care dependency, and 10 (moderate) for frailty. Age (β=0.171, p=.013), COPD stage (β=0.465, p<.001), and income status (β=0.907, p=.049) were the predictors of dyspnea and explained 67.1% of the variance. Age (β=-0.43, p<.001), COPD stage (β = 0.506, p<0.001), and income status (β=- 0.147, p<.001) were also identified as the predictors of care dependency. Besides age and COPD stage, educational status (β=0.172, p<.049) were the predictors of frailty.
Conclusions: This study implied that older adults who had advanced stage COPD, were lower educated, had low-income levels, and comorbidities perceived higher care dependency and frailty. Nurses should assess both dyspnea and care dependency to identify older adults with COPD at risk for increased frailty. Studies considering COPD stage, education level, income status, and comorbidities on dyspnea management, and alleviating care dependency and frailty are warranted.

Keywords

Care Dependency, Chronic Obstructive Pulmonary Disease, Dyspnea, Frailty, Geriatrics, Nurse

References

• GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD Report. 2023. Retrieved from https://goldcopd.org/2023-gold-report-2/
• WHO global air quality guidelines. Particulate matter (PM2.5 and PM10), ozone, nitrogendioxide, sulfurdioxide and carbonmonoxide. 2021. https://www.who.int/publications/i/ item/9789240034228/.
• Örnek T, Tor M, Kıran S, & Atalay F. Prevalence of chronic obstructive pulmonary disease in Zonguldak province of Turkey. Tuberkuloz ve Toraks. 2015; 63(3):170-177.
• Mariniello DF, D’Agnano V, Cennamo D, Conte S, Quarcio G, Notizia L, ... & Perrotta F. Comorbidities in COPD: Current and future treatment challenges. Journal of Clinical Medicine. 2024; 13(3): 743.
• Nazir SA, & Erbland ML. Chronic obstructive pulmonary disease: an update on diagnosis and management issues in older adults. Drugs & Aging. 2009; 26: 813-831.
• López-Campos JL, Tan W, & Soriano JB. Global burden of COPD. Respirology. 2016; 21(1): 14-23. https://doi.org/10.1111/resp.12660
• Rutten EP, Gopal P, Wouters EF, Franssen FM, Hageman GJ, Vanfleteren LE. ... & Reynaert, NL. Various mechanistic pathways representing the aging process are altered in COPD. Chest. 2016;149(1):53-61.
• Kim SH, Lee H, Kim Y, Rhee CK, Min KH, Hwang YI, ... & Moon JY. Recent prevalence of and factors associated with chronic obstructive pulmonary disease in a rapidly aging society: Korea National Health and Nutrition Examination Survey 2015-2019. Journal Korean Medicine Sciences.2023; 38(14):e108.
• GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD Report. 2020. https://goldcopd.org/gold-reports/
• MacNee W. Is chronic obstructive pulmonary disease an accelerated aging disease? Annals of the American Thoracic Society. 2016;13(Supplement5):S429-S437. https://doi.org/10.1513/AnnalsATS.201602-124AW
• Anzueto A, & Miravitlles M. Pathophysiology of dyspnea in COPD. Postgraduate Medicine. 2017;129(3):366-374. https://doi.org/10.1080/00325481.2017.1301190
• Sharma S, & Sharma P. Prevalence of dyspnea and its associated factors in patients with chronic obstructive pulmonary disease. Indian Journal of Respiratory Care. 2019;8(1):36. 10.4103/ijrc.ijrc_21_18
• Schlecht N, Schwartzman K, & Bourbeau J. Dyspnea as clinical indicator in patients with chronic obstructive pulmonary disease. Chronic Respiratory Disease. 2005;2(4):183-191. https://doi.org/10.1191/1479972305cd079oa
• Nakken N, Janssen DJ, Wouters EF, van den Bogaart EH, Muris JW, de Vries GJ, . . . van Vliet M. Changes in problematic activities of daily living in persons with COPD during 1 year of usual care. Australian Occupational Therapy Journal.2020;67:447-457. https://doi.org/10.1111/1440-1630.12664
• Hanlon P, Guo X, McGhee E, Lewsey J, McAllister D, & Mair FS. Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD. NPJ Primary Care Respiratory Medicine. 2023; 33(1): 1.
• Marengoni A, Vetrano DL, Manes-Gravina E, Bernabei R, Onder G, & Palmer K. The relationship between COPD and frailty: a systematic review and meta-analysis of observational studies. Chest. 2018;154(1):21-40. https://doi.org/10.1016/j.chest.2018.02.014
• Chen X, Mao G, & Leng SX. Frailty syndrome: an overview. Clinical Interventions in Aging. 2014;9:433. https://doi.org/10.2147/CIA.S45300
• Lahousse L, Ziere G, Verlinden VJ, Zillikens MC, Uitterlinden AG, Rivadeneira F, . . . Ikram MA. Risk of frailty in elderly with COPD: a population-based study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences.2016;71(5):689-695. https://doi.org/10.1093/gerona/glv154
• Wang L, Zhang X, & Liu X. Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis. BMC Pulmonary Medicine. 2023; 23(1): 164.
• Dias LDS, Ferreira ACG, da Silva Junior JLR, Conte MB, & Rabahi MF. Prevalence of frailty and evaluation of associated variables among COPD patients. International Journal of Chronic Obstructive Pulmonary Disease. 2020; 1349-1356.
• Maddocks M, Brighton LJ, Alison JA, Ter Beek L, Bhatt SP, Brummel NE, ... & Osadnik CR. Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report. Annals of the American Thoracic Society. 2023; 20(6): 767-780.
• Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, Giménez-Giménez LM, Escolar-Reina P, & Medina-Mirapeix F. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Therapeutic Advances in Respiratory Disease. 2017;11(10):383-392. https://doi.org/10.1177/1753465817726314
• Ierodiakonou D, Kampouraki M, Poulonirakis I, Papadokostakis P, Lintovoi E, Karanassos D, Dimopoulou S. Determinants of frailty in primary care patients with COPD: the Greek UNLOCK study. BMC Pulmonary Medicine.2019;19(1):1-9. https://doi.org/10.1186/s12890-019-0824-8
• O’Donnell DE, Milne KM, James MD, de Torres JP, & Neder JA. Dyspnea in COPD: new mechanistic insights and management implications. Advances in Therapy. 2020; 37: 41-60.
• Janssen DJ, Schols JM, Wouters EF, & Spruit MA. One-year stability of care dependency in patients with advanced chronic organ failure. Journal of the American Medical Directors Association. 2014;15(2):127-132. https://doi.org/10.1016/j.jamda.2013.10.002
• Köberich S, Lohrmann C, & Dassen T. Care dependency in patients with chronic obstructive pulmonary disease and heart failure–a secondary data analysis of German prevalence studies. Scandinavian Journal of Caring Sciences.2014; 28(4):665-674. https://doi.org/10.1111/scs.12091
• Faul F, Erdfelder E, Lang AG, & Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007; 39(2):175-191.
• Yorke J, Moosavi SH, Shuldham C, & Jones PW. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax. 2010; 65(1):21-26. http://dx.doi.org/10.1136/thx.2009.118521
• Gök Metin Z, & Helvacı A. Validity and Reliability of Turkish Version of the Dyspnea-12 Scale. Journal of Hacettepe University Faculty of Nursing. 2018; 5(2):102-115.
• Dijkstra A, Tiesinga LJ, Goossen WT, & Dassen TW. Further psychometric testing of the Dutch Care Dependency Scale on two different patient groups. International Journal of Nursing Practice. 2002; 8(6): 305-314. https://doi.org/10.1046/j.1440-172X.2002.00384.x
• Yönt G, Akın Korhan E, Khorshid L, Eşer İ, & Dijkstra A. Bakım bağımlılığı ölçeğinin (Care Dependency Scale) yaşlı bireylerde geçerlik ve güvenirliğinin incelenmesi. Turkish Journal of Geriatrics. 2010;13:71.
• Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, & Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age and Ageing. 2006; 35(5):526-529. https://doi.org/10.1093/ageing/afl041
• Aygör HE, Fadıloğlu Ç, Şahin S, Aykar FŞ, & Akçiçek F. Validation of Edmonton frail scale into elderly Turkish population. Archives of Gerontology and Geriatrics. 2018; 76: 133-137. https://doi.org/10.1016/j.archger.2018.02.003
• Gruenberger JB, Vietri J, Keininger DL, & Mahler DA. Greater dyspnea is associated with lower health-related quality of life among European patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2017;12: 937.
• Lange P, Godtfredsen NS, Olejnicka B, Paradis BA, Curiac D, Humerfelt S, . . . Andersen EW. Symptoms and quality of life in patients with chronic obstructive pulmonary disease treated with aclidinium in a real-life setting. European Clinical Respiratory Journal. 2016; 3(1):31232. https://doi.org/10.3402/ecrj.v3.31232
• Helvaci A, Gok Metin Z, Ozdemir L, & Ergun P. The Effects of a nurse-led education and counseling program on dyspnea, health status, and care dependency in patients with chronic obstructive pulmonary disease: A feasibility study. Home Health Care Management & Practice. 2019; 31(4): 249-256. https://doi.org/10.1177/1084822319850819
• Kara N. Care Dependency in Chronic Obstructive Pulmonary Disease. (Master Thesis). Marmara University Health Sciences Institute, 2019. Istanbul.
• Türk G, & Üstün R. Determination of the Care Dependency of Individuals with Chronic Obstructive Pulmonary Disease (COPD). E- Journal of 9 Eylül University Facult of Nursing. 2018; 11(1):19-25.
• Kütükcü EÇ, Arıkan H, Sağlam M, Yağlı NV, İnal İnce D, Çiğdem Ö, Çöplü L. An investigation of the relationship between multidimensional disease severity and activities of daily living in patients with chronic obstructive pulmonary disease. Journal of Exercise Therapy and Rehabilitation. 2015;2(2): 53-60.
• Khdour MR, Kidne JC, Smyth BM, & McElnay JC. Clinical pharmacy‐led disease and medicine management programme for patients with COPD. British Journal of Clinical Pharmacology. 2009;68(4):588-598. https://doi.org/10.1111/j.1365-2125.2009.03493.x
• Uchmanowicz I, Jankowska-Polanska B, Chabowski M, Uchmanowicz B, & Fal AM. The influence of frailty syndrome on acceptance of illness in elderly patients with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. 2016; 11: 2401.
• Galizia G, Cacciatore F, Testa G, Della-Morte D, Mazzella F, Langellotto A, Rengo F. Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease. Aging Clinical and Experimental Research. 2011; 23(2):118-125. https://doi.org/10.1007/BF03351076
• Buckinx F, Rolland Y, Reginster JY, Ricour C, Petermans J, & Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. Archives of Public Health.2015;73(1): 1-7. https://doi.org/10.1186/s13690-015-0068-x
• Fairhall N, Kurrle S, Sherrington C, Lord S, Lockwood K, John B, Cameron I. Effectiveness of a multifactorial intervention on preventing development of frailty in pre-frail older people: study protocol for a randomised controlled trial. BMJ Open. 2015; 5(2): e007091-e007091. http://dx.doi.org/10.1136/bmjopen-2014-007091