Support for Older Adults with Asthma Improves Outcomes
Asthma is often thought of as a disease of childhood. And it is slightly more common in kids than it is in adults. But adults get asthma too, including older adults. Here are a few asthma statistics:1
- More than 25 million people in the U.S. have asthma, which is about 1 in every 13 people
- 8.4% of kids have asthma
- 7.7% of adults have asthma
- These rates are increasing in all age, sex and racial groups
- Asthma is more common in adult women than adult men
- In children, asthma is more common in boys than girls
A study on older adults with asthma
Experts agree that older adults who have asthma tend to struggle more with asthma control and have poorer health outcomes than their younger counterparts.2 A recent study published in the JAMA Internal Medicine journal explored whether needs-tailored interventions could improve outcomes for older adults with asthma.2
Details of the study
Researchers based mainly in New York City developed and tested a comprehensive, patient-tailored asthma self-management support intervention program. This treatment approach was specifically aimed at the needs of older adults with asthma. It was designed to help them achieve better clinical outcomes, as well as enhance their self-management of asthma.2
- Participants were adults 60 years and older with persistent, uncontrolled asthma (mean age was 67.8)
- 85% of the participants were women; 15% were men
- 1349 patients were assessed for eligibility, with 406 of them meeting eligibility criteria and consenting to participate
- One-third received home-based treatment; one-third received clinic-based care, while the remaining third were the control group
- All care was provided by asthma care coaches
All patients who received the allocated treatment were screened for psychosocial, physical, cognitive, and environmental barriers. These were barriers that could interfere with their asthma control and self-management. The assessments focused mainly on these barriers:3
- Poor inhaler technique
- Intermittent use of the asthma controller medicine
- Cost of asthma medication
- Evidence of cockroaches in the patient's home
Once the barriers for each patient were determined, the asthma care coaches carried out specific actions aimed at minimizing each of these barriers. These actions included:3
- Training focused on correct inhaler technique
- Information about the chronic nature of asthma
- Different roles and use of controller and rescue medications
- Advice to dealing with medication cost issues
- Referrals to low cost pest control services
Patients were followed intermittently by their coaches for 12 months. Inhaler technique and proper medication use were assessed throughout. New problems were dealt with as they arose.
Findings of the study
Researchers used these measures to judge the effectiveness of the intervention program:2
- Asthma Control Test
- Asthma Quality of Life Questionnaire
- Medication Adherence Rating Scale
- Metered dose inhaler technique
- Emergency department visits for asthma care
The main goals they were shooting for in relation to the care provided by the asthma coaches included:
The results of the study were positive. In fact, researchers found that tailoring education about asthma and medication use to the specific needs of older adults worked. They noted significant improvements in both asthma control and medication use in the two groups who received care.
Specifically, they found:2
- Scores on the asthma control test were better in the intervention groups vs the control group.
- Emergency visits were also lower at 12 months for the intervention groups vs the control group.
- Quality of life was also better in the intervention groups.
- Medication adherence and inhaler technique were also consistently better in the intervention groups.
Interestingly, there was no significant difference in outcomes between those who received home-based vs. clinic-based care.
Older adults with asthma need customized care
Past studies have shown that older adults who have asthma tend to have worse control and outcomes than those who are younger. Perhaps this is at least partly due to the fact that older adults have different challenges when it comes to asthma care and control. Unfortunately, traditional asthma care is typically not customized to the specific needs and barriers of the older adult patient.2
The positive results from this study strongly suggest that planning interventions and care around those specific needs and barriers can be beneficial. It can lead to better asthma control and more effective self-management. I'd love to hear from our readers and community about your experiences as an older adult with asthma. Have you faced and overcome challenges unique to your age group?
Have you experienced a collapsed lung?