Asthma in the Elderly Population - Case Study Example

Asthma in Elderly Population of 65 Years and above in Victoria Student’s Name Institutional Affiliation Table of Content Introduction ………………………………………………….……………………………………3 Background …………………………………………………………………………………….....3 Planning a preventive health program …………………………………………………………....4 Diagnostic challenges and Prevalence ………………………...………………………………….5 Morbidity and Mortality ……………………………………………………………………….....6 Quality of life ………………………………………………………………..……………………7 Treatment of Asthma Condition in Elderly people ………………………….……………………7 Asthma management ………………………………………………………….…………………..9 Conclusion ………………………………………………………………...…………………… 10 References ……………………………………………………………………………………….12 Asthma in Elderly Population of 65 Years and above in Victoria Introduction The prevalence of asthma in the society has been indicated to affect older people and hence associated with the increased rates of morbidity and mortality rates. The latter statistics show proof that older people that are over 65 years in Victoria suffer disproportionately from asthma and other respiratory diseases. This is related to the multi-faceted and pulmonary changes of ageing, dyspnea perceptions, challenges and difficulty in the diagnosis of asthma and the associated medication burden and co-morbidities making asthma unique in older people aged 65 years and above. Such a unique problem of asthma in senior citizens deserves particular examination, and thus, is appropriate to consider specific therapeutic interventions in seeking appropriate mechanism in treatment and diagnosis. Therefore, the paper aims to elaborate on providing preventive health program for asthma; community assessment and evidence-based program plan for older people aged 65 years and above in Vitoria. Background The coverage of older people is indicated as being 65 years of age and above. This age group has been significantly affected by asthma that consists of about 13% of the population above 65 years in Victoria (Peterson & Naunton, 2008). There are associated symptoms of asthma such as wheezing, and shortness of breath, usually manifesting in the form of obstruction of airflow. With asthmatic condition, airway inflammation and air wall remodeling cause air obstruction due to the thickening of basement membranes and other soft and smooth muscles such as hypertrophy. Inflammation also causes induced sputum in the airways triggering eosinophils, which is observed from the majority of people suffering from asthma (Adair, Hoy, Dettrick, & Lopez, 2012). The issues associated with old age cigarette smoking has a history of the diagnostic uncertainty of existence of obstructive airways, and hence, the confusion on correct treatment among the patients falling in this group. However, the most important fact is that asthma demonstrates variable and reversible airflow obstruction. There is clinical evidence suggesting differences of asthma of older-age groups from that of younger people regarding the severity of the symptoms observed and lung functioning. Thus, classification of asthma diagnosis by age-group is common. The early onset considers persistent asthma to the old age but for late onset, asthma shows the first diagnosis after achieving an age of 65 years and above (Poulos, Correll, Toelle, Reddel, & Marks, 2014). The late onset asthma patients suffer from low serum levels and eosinophils consisting of both serum and sputum. At the late onset atopic asthma, there is a high-level of predicted sputum and allergen sensitization, and it can occur irrespective of age. It is also associated with methacholine bronchoprovocation test as demonstrated in Normative Ageing Study (Boyd, 2005). Therefore, asthma preventive measures needs an understanding of whether it’s at an early or late onset before taking appropriate diagnostic considerations. This would ensure easy identification of the symptoms as it depends on persistent and perseverance. Planning A Preventive Health Program Normal ageing is associated with some effects such as thoracic restriction, and hence, becoming stiffer. The old age contributes to calcification of ribs, which leads to evident challenges in the functioning of the diaphragm that consequently affects the respiratory system. The ageing population is also normally associated with the reduction of elastic recoil as result lungs losing elastic fibres. According to Smith, & Leggat (2006), such a group suffering from reduced elastic recoil gets breathing problems associated with asthmatic condition. The latter leads to increased residual volume from airways through loss of elastic recoil, and hence, leading to air trapping. Decrease in the vital lungs capacity due to stiffer chest walls and other muscles weakening leads to mechanical disadvantages especially in ageing lungs. Diagnostic Challenges And Prevalence In most cases, the late onset asthma diagnosis is usually difficult and delayed as some contributing factors concerning patient and physician arises. Asthmatic condition among the elderly group is not easily recognized as it has reduced awareness especially in bronchoconstriction (Esther & Amanda, 2014). This is as a result of methacholine challenges whereby it is comparable to younger asthmatic patients. The Borg dyspnea score indicates that elderly asthmatic conditions show less breathlessness in comparison to young asthmatic patients, thus causing difficulty in comparing bronchoconstriction (Poulos et al., 2014). Even after realizing dyspnea, the older patients tend to associate the symptoms with the old age, and therefore, not necessarily report it to the doctor early. This typically happens in low socio-economic status groups whereby the problem of accessing healthcare contributes to under-reporting the cases to the doctors earlier enough for a diagnosis. Studies show that the older populations of 65 years and over score substantially low with an under-diagnosis of about 50% in Victoria (Esther & Amanda, 2014). In the sample studied in Victoria, about 3.9% of the elderly Australian patients have been reported diagnosed with asthma in the local health facilities and about 4.1% of the patients were reported being undiagnosed and having asthma condition (Peterson & Naunton, 2008). In another cross-sectional survey undertaken on patients aged over 65 years on asthma treatment in Victoria, an estimated prevalence population untreated with asthma is about 1.7%. In this study, about 64% constituting the majority were indicated to have moderate or severe disease depending on the spirometric parameters (Baker, Marks, Poulos & Williamson, 2004). Reduction in the reliability of spirometry values especially in the elderly population has contributed to diagnostic challenges. The current asthma prevalence in people of over 65 years has been documented to range between 7.5 to 12.5% in the Australia. Narrowing down to Victoria, the data indicate the prevalence is about 10% female predominating in this category covering 65 years and above (Adair, Hoy, Dettrick, & Lopez, 2012). This has been contributed by controversial diagnosis in overlapping chronic obstructive airways disease. Careful examination of airway diseases has shown that people over 65 years experience obstructive lung diseases syndromes overlap with the asthmatic condition (Baker et al., 2004). Morbidity and Mortality Elderly people with the asthmatic condition have been experiencing increased death rate as asthma-related deaths are over-represented in age groups of 65 years and above. In average, about 69% deaths between the years 2003-2007of the Australian elderly people are associated with asthma (Boyd, 2005). The pattern of mortality among the older individuals with the asthmatic condition is at peak during the winter months hence suggesting the cold weather as a potential contributor to the rise in mortality. Due to improvement and increased healthcare services utilization by the older age-group people of above 65 years in Victoria, more that 36 percent of the aged people screened indicated an asthma condition. This was confirmed by the medical practitioners in the emergency department that admission for asthmatic patients of over 65 years age is higher than those below that age group. Furthermore, once they are admitted, the older people tend to have significant longer stay in the hospital compared to younger individuals with the same asthmatic condition. Quality Of Life Asthma contributes to reduced quality of life and increased impairment on daily living activities. The quality of life is significantly affected by physical and social behaviour, and hence, depressive life. People living with asthma especially the elderly experience many challenges such as difficulty in accessing to healthcare, identification of the asthma symptoms, and general direct economic factors. A cross-sectional study of people living with asthma in Victoria has genuinely dealt with the quality of life and comparing it with the elderly of over 65 years asthmatic population (Ampon at al., 2005). From the study, asthma is severe to elderly population as a direct cost, and hospitalization expenses are higher than any other age-group. Therefore, the burden of health facilitation and treatment is greater for the elderly people, and especially those of over 65 years. Treatment Of Asthma Condition In Elderly People The administering of pharmacological treatment to asthmatic people of 65 years and above requires physicians to be more careful. This age-group population faces challenges of experiencing medication side effects and suffering from drug-drug interactions. Some therapies such as beta-agonist results to tremor and every dose contribute to serum potassium and tachycardia reductions. It requires minimizing systemic absorption by recommended spacer devices under oropharyngeal deposition. The use of inhaler therapy and theophylline is also important for patients experiencing uncontrolled asthma. Many precautions are supposed to be undertaken while administering theophylline to elderly people as advanced effects are severe if the drug level gets above therapeutic range (Campbell, McLennan, Coates, Frith, Gluyas, Latimer, 1992). Patients with established cardiac or liver diseases are affected by drug toxicity, and hence they require careful monitoring. This would help to reduce the risk situation and adverse side effects such as nausea, insomnia, and even gastro-oesophageal reflux among others. The moderate inhaled steroids-dose does not have any systematic side effects to the elderly population. The common side effects such as oral candidiasis and hoarseness voice are experienced. In additional of spacer device, these dose-dependent side effects can be easily managed. In these 65 years and above age-groups, therapies are supposed to be administered cautiously to prevent further complications. The asthmatic condition should be treated, and regular follow-up sessions are initiated (Goldney, Ruffin, Fisher & Wilson, 2003). This would help in the reorganization of the asthma symptoms and treatment arrangement are undertaken to control it from advancing. Furthermore, early asthma recognition helps in differentiating it from other airways complications. Omalizumab therapy is essential for elderly patients experiencing allergic asthma. This kind of medication is important to elderly asthmatic patients as it helps in controlling allergies. In a qualitative study of Victoria asthmatics targeting elderly population, about 37% of respondents raised issues on medication side-effect. This is a matter of concern to their health status and how it can be prevented. Furthermore, in the same report, about 41% of respondent surveyed shows voice changes and having dry, sore throat signs that indicated side effects (Baker et al., 2004). Elderly population has the great challenge of lack of medical care access. Financial hardship can cause this as the retirement benefits and the income are usually fixed. Physical frailty can also contribute to difficulties of visiting health facilities. In reality, qualitative research has reported that old age patients sometimes are reluctant in seeking emergency health care as they have believed of not deserving immediate attention. These are some of the factors that contribute to the elderly population to reduce the utilization of medical care. In connection to reluctance in accessing emergency health care, elderly patients have reduced their perceptions regarding some of the asthma symptoms (Esther & Amanda, 2014). The knowledge regarding air flow obstruction and cough reflex has improved and hence contributing to fewer delays in seeking medical attentions. However, the elderly are supposed to undertake earlier measures through seeking medical care. This helps in identifying asthma promptly, and effective action is taken in treatment and medications. Asthma Management Asthma action plans indicate important asthma management strategy as they are effective in improving the elderly asthmatic condition. In most cases, the asthma action plan is effective if provided in written form. According to the case-control study regarding the asthma deaths, it indicates that having the action plan in place helps as a protective factor against the asthma deaths. This has worked to other lower that 65 years age grouped and has worked. There are concerns that action plans are not provided to patients of 65 years and above suffering from asthma (Ampon et al., 2005). Most of the asthmatic elderly population seeks more information regarding their status and mostly preferring conversation method with their doctors or receipt sheet with written information. The asthma education strategies have been focused mainly on other age groups lower than 65 years. The action plans have worked efficiently and provide evidence positive results of self-management education. These action plans does not have any impact on the elderly population and hence challenges in self-management. Furthermore, asthma education strategy specifically for asthmatic elderly population provides efficacy evidence of which is not uniform among the patients (Goldney et al., 2003). This suggests the need for further studies and research to constitute effective education strategies and involving elderly population with asthma. The need of the advanced studies in the asthmatic conditions for patients over 65 years it to initiate appropriate mechanism for self-management. This would ensure the elderly patients to have more information regarding their asthmatic symptoms and seeking medication in the right time. Conclusion Asthma in the elderly population causes high mortality rates, and hence, initiating a requirement of having careful monitoring. In most cases, the asthmatic patients especially with 65 years and above, shows fewer symptoms of which they are reluctant to report and seek medical attention. Due to physical and cognitive disability among the elderly asthmatic population, inhaled therapies for asthma control are not taken regularly and adequately. The latter affects their health condition making it a challenge to monitor and manage asthma among the elderly. Intentionally, the elderly asthmatic patients lack consistency in taking their medications. Physicians are supposed to be keen in identifying such symptomatic factors in a patient to ensure they have completely adhered to the drug prescription for asthma treatment. The current controversies that have emerged in elderly asthma management relate to asthma education targeting 65 years and above. Thus, there is a need for improving awareness to elderly of asthmatic symptoms and having action plans. Asthma education would also sensitize elderly population to take appropriate measures in seeking treatment and managing their health condition appropriately. References Adair T, Hoy D, Dettrick Z & Lopez AD. (2012). 100 years of mortality due to chronic obstructive pulmonary disease in Australia: the role of tobacco consumption. International Journal of Tuberculosis & Lung Disease 16(12):1699–705. Ampon RD, Williamson M, Correll PK & Marks GB (2005). Impact of asthma on self-reported health status and quality of life: a population based study of Australians aged 18–64. Thorax 60:735–9 Baker DF, Marks GB, Poulos LM & Williamson M (2004). Review of proposed National Health Priority Area asthma indicators and data sources. AIHW cat. no. ACM 2. Available at. Canberra: Australian Institute of Health and Welfare. Boyd, M. L. (2005). Report on a national pilot study in general practice of decision support materials for the diagnosis of asthma in the older person. Woodville, S. Aust.: Health Observatory. Campbell D, McLennan G, Coates JR, Frith PA, Gluyas P, Latimer K.M. (1992). Accuracy of asthma statistics from death certificates in South Australia. The Medical Journal of Australia 156(12):860–3. Esther, C., & Amanda, J. (2014). Chronic Illness & Disability: principles for nursing practice. Sydney: Churchill Livingstone/Elsevier. Goldney RD, Ruffin R, Fisher LJ & Wilson DH (2003). Asthma symptoms associated with depression and lower quality of life: a population survey. Medical Journal of Australia 178:437–41 Read More