Disability and recovery of independent function in obstructive lung disease: The cardiovascular health study

Vincent S. Fan, Emily R. Locke, Paula Diehr, Anthony Wilsdon, Paul Enright, Sachin Yende, Mark V Avdalovic, Graham Barr, Vishesh K. Kapur, Rachel Thomas, Jerry A. Krishnan, Gina Lovasi, Stephen Thielke

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease.

Methods: We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥ 1 instrumental activity of daily living (IADL) or ≥ 1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression.

Results: The prevalence of IADL impairment was higher with moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p < 0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95% confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥ 28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95% CI 0.69-0.86 and >7 blocks: RR 0.73 and 95% CI 0.61- 0.86). Increased strength (RR 1.16 and 95% CI 1.05-1.29) was associated with resolving IADL impairment.

Conclusions: Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.

Original languageEnglish (US)
Pages (from-to)329-338
Number of pages10
JournalRespiration
Volume88
Issue number4
DOIs
StatePublished - Nov 7 2014

Fingerprint

Obstructive Lung Diseases
Recovery of Function
Activities of Daily Living
Spirometry
Health
Muscle Strength
Chronic Obstructive Pulmonary Disease
Exercise
Research

Keywords

  • Activities of daily living
  • Chronic airflow obstruction
  • Disability

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Fan, V. S., Locke, E. R., Diehr, P., Wilsdon, A., Enright, P., Yende, S., ... Thielke, S. (2014). Disability and recovery of independent function in obstructive lung disease: The cardiovascular health study. Respiration, 88(4), 329-338. https://doi.org/10.1159/000363772

Disability and recovery of independent function in obstructive lung disease : The cardiovascular health study. / Fan, Vincent S.; Locke, Emily R.; Diehr, Paula; Wilsdon, Anthony; Enright, Paul; Yende, Sachin; Avdalovic, Mark V; Barr, Graham; Kapur, Vishesh K.; Thomas, Rachel; Krishnan, Jerry A.; Lovasi, Gina; Thielke, Stephen.

In: Respiration, Vol. 88, No. 4, 07.11.2014, p. 329-338.

Research output: Contribution to journalArticle

Fan, VS, Locke, ER, Diehr, P, Wilsdon, A, Enright, P, Yende, S, Avdalovic, MV, Barr, G, Kapur, VK, Thomas, R, Krishnan, JA, Lovasi, G & Thielke, S 2014, 'Disability and recovery of independent function in obstructive lung disease: The cardiovascular health study', Respiration, vol. 88, no. 4, pp. 329-338. https://doi.org/10.1159/000363772
Fan, Vincent S. ; Locke, Emily R. ; Diehr, Paula ; Wilsdon, Anthony ; Enright, Paul ; Yende, Sachin ; Avdalovic, Mark V ; Barr, Graham ; Kapur, Vishesh K. ; Thomas, Rachel ; Krishnan, Jerry A. ; Lovasi, Gina ; Thielke, Stephen. / Disability and recovery of independent function in obstructive lung disease : The cardiovascular health study. In: Respiration. 2014 ; Vol. 88, No. 4. pp. 329-338.
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abstract = "Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease.Methods: We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥ 1 instrumental activity of daily living (IADL) or ≥ 1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression.Results: The prevalence of IADL impairment was higher with moderate (23.9{\%}) and severe (36.9{\%}) airflow obstruction compared to normal spirometry (22.5{\%}; p < 0.001). Among participants with severe airflow obstruction, 23.5{\%} recovered independence in IADLs and 40.5{\%} recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95{\%} confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥ 28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95{\%} CI 0.69-0.86 and >7 blocks: RR 0.73 and 95{\%} CI 0.61- 0.86). Increased strength (RR 1.16 and 95{\%} CI 1.05-1.29) was associated with resolving IADL impairment.Conclusions: Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.",
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AU - Enright, Paul

AU - Yende, Sachin

AU - Avdalovic, Mark V

AU - Barr, Graham

AU - Kapur, Vishesh K.

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N2 - Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease.Methods: We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥ 1 instrumental activity of daily living (IADL) or ≥ 1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression.Results: The prevalence of IADL impairment was higher with moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p < 0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95% confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥ 28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95% CI 0.69-0.86 and >7 blocks: RR 0.73 and 95% CI 0.61- 0.86). Increased strength (RR 1.16 and 95% CI 1.05-1.29) was associated with resolving IADL impairment.Conclusions: Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.

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