Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: Effect of age related factors and service organisation.

Show simple item record Connolly, Martin en Lowe, D en Anstey, K en Hosker, HS en Pearson, MG en Roberts, CM en British Thoracic Society and the Royal College of Physicians Clinical Effectiveness Evaluation Unit (CEEu) en
dc.coverage.spatial England en 2012-03-23T02:03:04Z en 2006-10 en
dc.identifier.citation Thorax 61(10):843-848 Oct 2006 en
dc.identifier.issn 0040-6376 en
dc.identifier.uri en
dc.description.abstract Background: Exacerbations of chronic obstructive pulmonary disease (COPD) have a high rate of mortality which gets worse with advancing age. It is unknown whether this is due to age related deficiencies in process of care. A study was undertaken in patients with COPD exacerbations admitted to UK hospitals to assess whether there were age related differences in the process of care that might affect outcome, and whether different models of care affected process and outcome. Methods: 247 hospital units audited activity and outcomes (inpatient death, death within 90 days, length of stay (LOS), readmission within 90 days) for 40 consecutive COPD exacerbation admissions in autumn 2003. Logistic regression methods were used to assess relationships between process and outcome at p<0.001. Results: 7514 patients (36% aged ≥75 years) were included. Patients aged ≥75 years were less likely to have blood gases documented, to have FEV1 recorded, or to be given systemic corticosteroids. Those admitted under care of the elderly (CoE) physicians were less likely to enter early discharge schemes or to receive non-invasive ventilation when acidotic. Overall inpatient and 90 day mortality was 7.4% and 15.3%, respectively. Inpatient and 90 day adjusted odds mortality rates for those aged ≥85 years (versus ≤65 years) were 3.25 and 2.54, respectively. Mortality was unaffected by admitting physician (CoE v general v respiratory). Age predicted LOS but not readmission. Age related deficiencies in process of care did not predict inpatient or 90 day mortality, readmission, or LOS. Conclusions: Management of COPD exacerbations varies with age in UK hospitals. Inpatient and 90 day mortality is approximately three times higher in very elderly patients with a COPD exacerbation than in younger patients. Age related deficiencies in the process of care were not associated with mortality, but it is likely that they represent poorer quality of care and patient experience. Recommended standards of care should be applied equally to elderly patients with an exacerbation of COPD. en
dc.language eng en
dc.publisher BMJ Publishing Group Ltd. en
dc.relation.ispartofseries Thorax en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.subject Acute Disease en
dc.subject Adrenal Cortex Hormones en
dc.subject Adult en
dc.subject Age Factors en
dc.subject Aged en
dc.subject Aged, 80 and over en
dc.subject Blood Gas Analysis en
dc.subject Delivery of Health Care en
dc.subject Female en
dc.subject Forced Expiratory Volume en
dc.subject Great Britain en
dc.subject Health Resources en
dc.subject Hospital Mortality en
dc.subject Hospitalization en
dc.subject Humans en
dc.subject Male en
dc.subject Middle Aged en
dc.subject Prognosis en
dc.subject Prospective Studies en
dc.subject Pulmonary Disease, Chronic Obstructive en
dc.subject Recurrence en
dc.subject Regression Analysis en
dc.title Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: Effect of age related factors and service organisation. en
dc.type Journal Article en
dc.identifier.doi 10.1136/thx.2005.054924 en
pubs.issue 10 en
pubs.begin-page 843 en
pubs.volume 61 en
dc.rights.holder Copyright: BMJ Publishing Group Ltd. en
dc.identifier.pmid 16928716 en
pubs.end-page 848 en
pubs.publication-status Published en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 112444 en
dc.identifier.pii thx.2005.054924 en
pubs.record-created-at-source-date 2012-02-02 en
pubs.dimensions-id 16928716 en

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