LTC Resources - Lungs & Respiration

Respiratory diseases affect individuals of all ages, however as individuals age, lung function deteriorates as a result of a number of physiological changes which can lead to reduced lung function and capacity. Ventilatory lung function deteriorates about 2 times faster after age 50 yr.  Dyspnea, the subjective experience of breathlessness has been identified as the sixth vital sign.(3)

Chronic respiratory diseases have a major impact not only on the individual with the disease, but also the family, the community, and the health care system. Some of the most common chronic diseases in the elderly are chronic obstructive pulmonary disease (COPD) which includes emphysema and/or chronic bronchitis, lung cancer, sleep apnea and lung disease(s) as a result of occupational hazards or exposure. The true prevalence of COPD is underestimated because a diagnosis is often not made until the patient is over 55 years of age.

The two most important risk factors for chronic respiratory diseases are tobacco smoke (through smoking and/or exposure to second-hand smoke) and indoor and outdoor air quality. Those who smoke cigarettes increase their risk of developing lung cancer, chronic obstructive pulmonary disease (COPD) and asthma.(2)  Complications from influenza can lead to pneumonia in the elderly and may result in hospitalizationand even death.(1)

Why is it important?

  • Most individuals with COPD are not diagnosed until the disease is well advanced. The true prevalence of COPD is underestimated because a diagnosis is often not made until the patient is over 55 years of age and has advanced changes in the lung tissue.(3)
  • While COPD was once more common in men than women, it is now on the rise in women.(4) 
  • In 2000/2001, COPD was the seventh most common cause of hospitalization for men and the eighth most common cause of hospitalization for women, in Canada. COPD was the 4th leading cause of hospitalization in Ontario.  Hospitalizations were greater for patients over 65 years of age.(2)
  • Chronic obstructive pulmonary disease, along with influenza and pneumonia, were the most common causes of death due to respiratory diseases among Canadian seniors in 2006. There are higher mortality rates for individuals over 75 yr. as a result of COPD.(2)
  • Canadian health care costs for COPD represent an enormous burden. The three major lung diseases namely lung cancer, asthma and COPD, cost $12 billion in 2010, including $3.4 billion in direct health-care costs (drugs, hospitals, physicians) and $8.6 billion in indirect costs (such as premature death and long term disability).(2)
  • Smoking is less prevalent among seniors than among the younger population, with 9% of Canadians aged 65 years and older being current smokers (either daily or occasional) and 47% being former smokers. Smoking is much more common among Aboriginal seniors, with 24% of those age 65 years and older not living on a reserve, being daily smokers. (2)
  • Seniors are more at risk for serious complications if they contract influenza which can lead to hospitalization and/or death.(1)

Key Considerations

    • Early recognition of exacerbation of lung disorders and symptom management is key to the prevention of frequent hospitalization and possible acute respiratory failure.
    • Clinicians need to support and reinforce the individuals’ disease self-management strategies.(3)
    • Spirometric testing should be performed to target and establish early diagnosis in at risk individuals.(3)
    • Individuals with COPD often experience an imbalance between energy intake and expenditure despite a normal diet.
    • Individuals with COPD generally have increased energy expenditure to breathe which results in increased caloric intake needs. Protein depletion is a common feature of COPD.(3)
    • Annual influenza vaccination is recommended for individuals over 65yr. and for individuals less than 65 years of age in long-term care homes who have chronic health conditions or who are immunocompromised. There is a 70% reduction in mortality from influenza following vaccination.(2)
    • Current practice advocates pneumococcal vaccine for high risk individuals. The vaccine has efficiency in COPD patients of up to 65% (2)
    • An interprofessional approach will best support the individual with chronic respiratory disease.

References

1.   Ontario Ministry of Health and Long-Term Care.  (2008).  About the Flu.  Retrieved March 14, 2014 from:
      http://www.health.gov.on.ca/en/public/programs/publichealth/flu/about_flu.aspx

2.   Public Health Agency of Canada. (2013).   Chronic Respiratory Diseases.  Retrieved March 14, 2014 from:
      http://www.phac-aspc.gc.ca/cd-mc/crd-mrc/index-eng.php

3.   Registered Association of Nurses of Ontario. (2010). Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with
      Chronic Obstructive Pulmonary Disease (COPD)
.  Retrieved May 2014 

4.   Statistics Canada. (2011). Retrieved May 2104 from:
      http://www.statcan.gc.ca/pub/82-625-x/2010002/article/11273-eng.htm