Admission to hospital with exacerbation of chronic obstructive pulmonary disease: the effect of age-related factors and service organisation

Martin Joseph Connolly ^1*, Derek Lowe ², Katharine Anstey ², Harold Hosker ², Michael Pearson ² and Mike Roberts ³

¹ University of Auckland, New Zealand
² Royal College of Physicians, United Kingdom
³ Whipps Cross, United Kingdom

^* To whom correspondence should be addressed. E-mail: martin.connolly{at}waitematadhb.govt.nz.

Accepted 20 July 2006

Abstract

Background: Exacerbations of chronic obstructive pulmonary disease have a high mortality, that gets worse with advancing age . It is unknown whether this is due to age-related deficiencies in process of care. We assessed, for patients with exacerbations admitted to UK hospitals: [1] whether there were age-related differences in process of care that might affect outcome; [2] whether different models of care affected process and outcome.

Methods: 247 hospital units audited activity and outcomes (in-patient 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 employed to assess relationships between process and outcome at P<0.001.

Results: 7514 patients (36% >75 years) were included. Patients >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 receive non-invasive ventilation when acidotic. Overall in-patient and 90-day mortality was 7.4% and 15.3% respectively. In-patient and 90-day adjusted odds mortality for those >85 years (versus <65) was 3.25 and 2.54 respectively. Mortality was unaffected by admitting physician (COE vs. general vs. respiratory). Age predicted LOS but not readmission. Age-related deficiencies in process of care did not predict in-patient or 90-day mortality, readmission or LOS.

Conclusions: Management of COPD exacerbations varies with age in UK hospitals. In-patient and 90-day mortality is approximately 3 times higher in very elderly patients with COPD exacerbation than in their younger counterparts. Age-related deficiencies in process of care were not associated with mortality in this study 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 exacerbation of COPD.

Keywords: chronic obstructive pulmonary disease, elderly, hospital readmission, length of stay, mortality

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