Journal of Medicine and the Person

, Volume 9, Issue 3, pp 99–103 | Cite as

Co-morbidities in chronic respiratory patients: limitations or opportunities for caring?

  • Ernesto Crisafulli
  • Elena Venturelli
  • Andrea Iattoni
  • Enrico M. Clini
Review

Abstract

In a population of chronic respiratory patients, a new subset with clinical complexity and with multiple coexisting organ failure and diseases is rapidly growing. Mainly due to the aging process, the associated frailty—not strictly related to the patient’s age—consists in a progressive and physiologic decline in multiple body systems leading to a substantial loss of functions and physiologic reserve. It is commonly acquainted that frailty, co-morbidities (several medical conditions associated) and disability (decline in physical functions) overlap each other: both frailty and co-morbidities can predict physical disability, whereas disability per se may exacerbate frailty and co-morbidities. As specific interventions (as rehabilitation) targeting at the physical activity, the old population have been shown to improve physical function and have a benefit along the full spectrum of health status. However, there is a substantial need for a multidimensional and personalized care approach: patient’s complexity, in fact, may play a role in determining the patient’s response to treatment. In particular, each disease as a single entity might reduce the response to treatment, depending on its effect on body functions and target therapies. Notwithstanding, the clinical complexity of these patients and the presence of several co-morbidities do not preclude per se the application and the effectiveness of a comprehensive rehabilitation program targeted to the individual’s needs.

Keywords

Elderly Co-morbidities Frailty Rehabilitation COPD 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    U.S. Department of Health and Human Services (2000) Tracking healthy people 2010, November 2000. U.S. Government Printing Office, Washington. Nasnewsletter;15:3Google Scholar
  2. 2.
    Fried L, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol 59:255–263Google Scholar
  3. 3.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:146–156CrossRefGoogle Scholar
  4. 4.
    Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R, Walston JD, Fried LP, Cardiovascular Health Study Research Group (2001) Associations of subclinical cardiovascular disease with frailty. J Gerontol Med Sci 56:158–166CrossRefGoogle Scholar
  5. 5.
    Hamerman D (1999) Toward an understanding of frailty. Ann Intern Med 130:945–950PubMedGoogle Scholar
  6. 6.
    Sevenoaks MJ, Stockley RA (2006) Chronic obstructive pulmonary disease, inflammation and co-morbidity—a common inflammatory phenotype? Respir Res 7:70PubMedCrossRefGoogle Scholar
  7. 7.
    Kriegsman DM, Deeg DJ, Stalman WA (2004) Comorbidity of somatic chronic diseases and decline in physical functioning: the Longitudinal Aging Study Amsterdam. Clin Epidemiol 57:55–65CrossRefGoogle Scholar
  8. 8.
    Global initiative for chronic obstructive pulmonary disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: NHLBI/WHO workshop report 2003, NIH Publication 2701. http://www.goldcopd.com/. Accessed on July 2011
  9. 9.
    Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, Gottdiener J, Fried LP, Cardiovascular Health Study (2002) Frailty and activation of inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 162:2333–2341PubMedCrossRefGoogle Scholar
  10. 10.
    Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC (1999) Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 48:445–469PubMedCrossRefGoogle Scholar
  11. 11.
    Yach D, Hawkes C, Gould CL, Hofman KJ (2004) The global burden of chronic diseases. Overcoming impediments to prevention and control. JAMA 291:2616–2622PubMedCrossRefGoogle Scholar
  12. 12.
    Ayis S, Gooberman-Hill R, Bowling A, Ebrahim S (2006) Predicting catastrophic decline in mobility among older people. Age Ageing 35:382–387PubMedCrossRefGoogle Scholar
  13. 13.
    Hoffman C, Rice D, Sung HY (1996) Persons with chronic conditions: their prevalence and costs. JAMA 276:1473–1479PubMedCrossRefGoogle Scholar
  14. 14.
    Charlson M, Charlson RE, Briggs W, Hollenberg J (2007) Can disease management target patients most likely to generate high costs? The impact of comorbidity. J Gen Intern Med 22:464–469PubMedCrossRefGoogle Scholar
  15. 15.
    WHO (2002) Active ageing: a policy framework. Geneva: World Health Organisation, 2002. Aging Male 5:1–37Google Scholar
  16. 16.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical Practice guidelines and quality of care for older patients with multiple comorbid diseases. JAMA 294:716–724PubMedCrossRefGoogle Scholar
  17. 17.
    Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L (2005) Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 3:223–228PubMedCrossRefGoogle Scholar
  18. 18.
    Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness. JAMA 288:1775–1779PubMedCrossRefGoogle Scholar
  19. 19.
    Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342:1032–1036PubMedCrossRefGoogle Scholar
  20. 20.
    Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummell K (2001) Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 323:719–724PubMedCrossRefGoogle Scholar
  21. 21.
    van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Crebolder HFJM (2000) Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 320:754–758PubMedCrossRefGoogle Scholar
  22. 22.
    Stuck AE, Egger M, Hammer A, Minder CE, Beck JC (2002) Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 287:1022–1028PubMedCrossRefGoogle Scholar
  23. 23.
    Hyde CJ, Robert IE, Sinclair AJ (2000) The effects of supporting discharge from hospital to home in older people. Age Ageing 29:271–279PubMedCrossRefGoogle Scholar
  24. 24.
    Hill-Westmoreland EE, Soeken K, Spellbring AM (2002) A meta-analysis of fall prevention programs for the elderly: how effective are they? Nurs Res 51:1–8PubMedCrossRefGoogle Scholar
  25. 25.
    Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 4:CD000340Google Scholar
  26. 26.
    Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328:680–683PubMedCrossRefGoogle Scholar
  27. 27.
    Daley MJ, Spinks WL (2000) Exercise, mobility and aging. Sports Med 29:1–12PubMedCrossRefGoogle Scholar
  28. 28.
    Roubenoff R (2000) Sarcopenia: a major modifiable cause of frailty in the elderly. J Nutr Health Aging 4:140–142PubMedGoogle Scholar
  29. 29.
    Spirduso WW, Cronin DL (2001) Exercise dose-response effects on quality of life and independent living in older adults. Med Sci Sports Exerc 33:598–608CrossRefGoogle Scholar
  30. 30.
    Keysor JJ (2003) Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence. Am J Prev Med 25:129–136PubMedCrossRefGoogle Scholar
  31. 31.
    Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL (1995) The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. Frailty and injuries: cooperative studies of intervention techniques. JAMA 273:1341–1347PubMedCrossRefGoogle Scholar
  32. 32.
    Beswick A, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371:725–735PubMedCrossRefGoogle Scholar
  33. 33.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330:1769–1775PubMedCrossRefGoogle Scholar
  34. 34.
    Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A (2002) A program to prevent functional decline in physically frail, elderly persons who live at home. NEJM 347:1068–1074PubMedCrossRefGoogle Scholar
  35. 35.
    Baltzan MA, Kamel H, Alter A, Rotaple M, Wolkove N (2004) Pulmonary rehabilitation improves functional capacity in patients 80 years of age or older. Can Respir J 11:407–413PubMedGoogle Scholar
  36. 36.
    Crisafulli E, Costi S, Luppi F, Cirelli G, Cilione C, Coletti O, Fabbri LM, Clini EM (2008) Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax 63:487–492PubMedCrossRefGoogle Scholar
  37. 37.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  38. 38.
    Fletcher CM (1960) Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the aetiology of chronic bronchitis (MRC breathlessness score). Br Med J 2:1665Google Scholar
  39. 39.
    Jones PW (2001) Health status measurement in chronic obstructive pulmonary disease. Thorax 56:880–887PubMedCrossRefGoogle Scholar
  40. 40.
    De Torres JP, Pinto-Plata V, Ingenito E, Bagley P, Gray A, Berger R, Celli B (2002) Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD. Chest 121:1092–1098PubMedCrossRefGoogle Scholar
  41. 41.
    Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH (1997) Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients. Am J Respir Crit Care Med 155:1278–1282PubMedGoogle Scholar
  42. 42.
    Vagaggini B, Costa F, Antonelli S, De Simone C, De Cusatis G, Martino F, Santerini S, Paggiaro P (2009) Clinical predictors of the efficacy of a pulmonary rehabilitation programme in patients with COPD. Respir Med 103:1224–1230PubMedCrossRefGoogle Scholar
  43. 43.
    Crisafulli E, Gorgone P, Vagaggini B, Pagani M, Rossi G, Costa F, Guarriello V, Paggiaro P, Chetta A, de Blasio F, Olivieri D, Fabbri LM, Clini EM (2010) Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J 36:1042–1048PubMedCrossRefGoogle Scholar
  44. 44.
    De Fazio I, Franzoni S, Frisoni GB, Gatti S, Cornali C, Stofler PM, Trabucchi M (2006) Predictive role of single diseases and their combination on recovery of balance and gait in disabled elderly patients. J Am Med Dir Assoc 7:208–211PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ernesto Crisafulli
    • 1
  • Elena Venturelli
    • 2
  • Andrea Iattoni
    • 2
  • Enrico M. Clini
    • 1
    • 2
  1. 1.Department of Pulmonary RehabilitationVilla Pineta HospitalPavulloItaly
  2. 2.D.A.I. Oncology, Haematology and Respiratory DiseasesUniversity of Modena-Reggio EmiliaModenaItaly

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