ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Age Factors , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Case Management , Comorbidity , Depression/epidemiology , Depression/etiology , Drug Interactions , France/epidemiology , Humans , Malnutrition/epidemiology , Malnutrition/prevention & control , Palliative Care , Patient Care Team , Patient Education as Topic , Prevalence , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/psychology , Pulmonary Disease, Chronic Obstructive/rehabilitation , Respiratory System Agents/adverse effects , Respiratory System Agents/therapeutic use , RiskABSTRACT
OBJECTIVE: The management of COPD aims to improve integrated indices such as health-related quality of life (HRQoL). Experts recommend repeated and methodical assessment of HRQoL, particularly by the use of questionnaires. Though these tools give pertinent information for groups of patients, they have limitations in describing the progress in one patient or indicating the prognosis. The purpose of this study is to validate a brief, self-administered HRQoL questionnaire, designed for the individual follow-up of COPD patients over a period of 3-6 months. METHOD: Following an initial validation of the contents and a review of the literature, 166 COPD patients completed an experimental version of a questionnaire including 24 items, three theoretical components (functional, psychological and relational) and 11 sub-dimensions. RESULTS: Confirmative factor analyses show a hierarchical model in respect of the current criteria (chi(2)=62.042; dl=41; ratio chi(2)/ddl=1.51; p<0.02; CFI=0.955; TLI=0.939; RMSEA=0.056; SRMR=0.054) composed of 11 items (one by a theoretical sub-dimension) distributed in three components (functional=3; psychological=4; relational=4). CONCLUSION: The questionnaire obtained, named VQ11, possesses an internal validation which satisfies international psychometric standards. It remains necessary to demonstrate whether the questionnaire satisfies the criteria of external validation and that it reveals thresholds of clinical change.
