Respiratory Conditions in Older Adults

 

OVERVIEW

There are normal changes in respiratory function that occur with aging. However, symptomatic changes such dyspnea, cough, and an inability to do activities of daily are not normal changes of aging. They require further investigation, particularly a careful history, to determine exposures, the onset and frequency of symptoms, and how the symptoms are managed. It is important to keep in mind that people with chronic respiratory conditions often avoid care until their symptoms are critical (Chen et al., 2023; Labaki and Han, 2020; Li et al., 2020; Reddel et al., 2022; WHO, 2022). This contributes to morbidity and mortality associated with these chronic conditions. A thorough history is critical to distinguishing acute from chronic conditions in order to recognize if the situation is urgent. Given that adverse childhood events (ACEs) are associated with chronic conditions such as chronic obstructive pulmonary disease (COPD), it is important to approach the patient using trauma-informed care approach to build trust, respect, and open communication, and for shared decision-making (Oral et al., 2016; Sonu et al., 2019).

 

BACKGROUND

Chronic and acute respiratory conditions are common around the globe and they collectively account for an elevated level of mortality. Estimates around the incidence and prevalence of chronic respiratory conditions are lower than what is reported, so the actual burden of the disease is less understood than ideally it would (Adeloye et al., 2022; Park et al., 2023). COPD and asthma are two of the most common chronic obstructive respiratory conditions. There are a host of conditions that contribute to restrictive lung disease. Respiratory conditions share common risk factors such as poor air quality, noxious fumes, smoking, and infections as contributors to the condition (Agustí et al., 2023; Chen et al., 2023; Reddel et al., 2022). Prevention strategies include vaccinations and promoting healthy lifestyle strategies such as adequate sleep, optimal nutrition, exercise, and stress reduction (Agustí et al., 2023; Partridge et al., 2018; Reddel et al., 2022).

PARAMETERS OF ASSESSMENT

In addition to observing the person for obvious signs of distress and changes in mentation, a careful history capturing exposures (chemical or infective), smoking history, and onset and frequency of symptoms is helpful in the diagnosis of chronic and acute respiratory conditions. The symptoms of chronic and acute conditions can mimic one another. Spirometry testing is key to diagnosing chronic obstructive respiratory conditions such as asthma and COPD and can be helpful in the diagnosis of restrictive conditions (Agustí et al., 2023; Martinez-Pitre et al., 2023). Reversibility is a key feature distinguishing COPD from asthma on spirometry testing (Reddel et al., 2022). Chest x-ray is the gold standard for diagnosing pneumonia, while chest CT scan is essential in the diagnosis of bronchiectasis (Martinez-Pitre et al., 2023; Metlay et al., 2019).

NURSING CARE STRATEGIES

There are many things to consider when caring for someone who has a chronic or acute respiratory condition. The goal of care is to reduce inflammation and potential for infections. Preventive measures include avoidance of noxious chemicals including infections, smoking cessation, receiving age-appropriate vaccinations, proper sleep, hydration, nutrition, and maintaining activity (Agustí et al., 2023; Partridge et al., 2018; Reddel et al., 2022). If a person has challenges in any of these areas, it is important to recognize that referrals may be needed, such as to a pulmonary rehabilitation program. Discussion with the patient about their goals of care is essential. Providing a referral to palliative care is an important part of any chronic disease management, as is the need to assess the home services and caregivers for added support (Reuben et al., 2022).

EVALUATION OF EXPECTED OUTCOMES

The ideal expected outcome is the patient being actively involved in their own self-care, which in turn minimizes acute episodes and reduces morbidity and mortality. Avoidance of triggers that exacerbate respiratory conditions is another important outcome that will lead to reduced incidence of acute events (Agustí et al., 2023; Chen et al., 2023; Reddel et al., 2022). Educational outcomes include knowledge about a stepwise action plan for asthma management and when to report distressing symptoms. Proper use of inhalers, including spacers, which maximize the intended impact of the medication while minimizing side effects, is also an important outcome (Reddel et al., 2022). Patients who have well-established goals of care, optimize their health, and are able to maintain a high quality of life are other important outcomes (Fulmer, 2023; Reuben et al., 2022).

FOLLOW-UP MONITORING OF CONDITION

Patients should be encouraged to visit with their provider regularly (e.g., 3–4 times per year) even when they do not have symptoms of distress (Agustí et al., 2023; Partridge et al., 2018; Reddel et al., 2022). This allows for time for the providers to know the patient outside of periods of distress. It also provides an opportunity to promote healthy lifestyle interventions to maximize the patient’s quality of life.

RELEVANT PRACTICE GUIDELINES

A. Global Initiative for Chronic Obstructive Lung Disease (GOLD): https://goldcopd.org/2023-gold-report-2/

B. Global Initiative for Asthma Patient Resources (GINA): https://ginasthma.org/gina-patient-guide-you-can-control-your-asthma/

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Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 29, Flanagan, J. & Connolly, M. (2025) Respiratory Care

 

REREFENCES

Abudiab, S., & Fuller-Thomson, E. (2022). Flourishing despite Chronic Obstructive Pulmonary Disease (COPD): Findings from a Nationally Representative Survey of Canadians aged 50 and older. International Journal of Environmental Research and Public Health, 19(23), 16337. https://doi.org/10.3390/ijerph192316337. Evidence Level IV.

Agarwal, A. K., Raja, A., & Brown, B. D. (2022). Chronic obstructive pulmonary disease. In StatPearls [Internet]. StatPearls Publishing. Evidence Level IV.

Agustí, A., Celli, B. R., Criner, G. J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M. K., Martinez, F. J., Montes de Oca, M., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D. D., Singh, D., Stockley, R., López Varela, M. V., Wedzicha, J. A., … Agustí, C. F. (2023). Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. The European Respiratory Journal, 61(4), 2300239. https://doi.org/10.1183/13993003.00239-2023. Evidence Level IV.

American Lung Association. (2023). COPD trends brief. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief. Evidence Level VI.

Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34(5), 396–403. https://doi.org/10.1016/j.amepre.2008.02.002. Evidence Level V.

Adeloye, D., Song, P., Zhu, Y., Campbell, H., Sheikh, A., Rudan, I., & NIHR RESPIRE Global Respiratory Health Unit. (2022). Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: A systematic review and modelling analysis. The Lancet. Respiratory Medicine, 10(5), 447–458. https://doi.org/10.1016/S2213-2600(21)00511-7. Evidence Level I.

Baptist, A. P., & Busse, P. J. (2018). Asthma over the age of 65: All’s well that ends well. The Journal of Allergy and Clinical Immunology in Practice, 6(3), 764–773. https://doi.org/10.1016/j.jaip.2018.02.007. Evidence Level V.

Bellelli, G., Bruni, A., Malerba, M., Mazzone, A., Aliberti, S., Pesci, A., & Annoni, G. (2014). Geriatric multidimensional assessment for elderly patients with acute respiratory diseases. European Journal of Internal Medicine, 25(4), 304–311. https://doi.org/10.1016/j.ejim.2014.03.002. Evidence Level V.

Campisi, J. (2016). Cellular senescence and lung function during aging. Yin and Yang. Annals of the American Thoracic Society, 13(Suppl. 5), S402–S406. https://doi.org/10.1513/AnnalsATS.201609-703AW. Evidence Level V.

Centers for Disease Control and Prevention. (2022a). 2000 National Health Interview Survey data. National Center for Health Statistics. Retrieved March 14, 2022, from https://www.cdc.gov/asthma/nhis/2020/table3-1.htm. Evidence Level IV.

Centers for Disease Control and Prevention. (2022b). Chronic obstructive pulmonary disease (COPD). https://www.cdc.gov/copd/index.html. Evidence Level VI.

Centers for Disease Control and Prevention. (2022c). Pneumonia. https://www.cdc.gov/pneumonia/index.html. Evidence Level VI.

Cho, S. J., & Stout-Delgado, H. W. (2020). Aging and lung disease. Annual Review of Physiology,82, 433–459. https://doi.org/10.1146/annurev-physiol-021119-034610. Evidence Level IV.

Chen, C. W., Chen, Y. Y., Lu, C. L., Chen, S. C., Chen, Y. J., Lin, M. S., & Chen, W. (2015). Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: A nationwide cohort study. International Journal of Chronic Obstructive Pulmonary Disease, 10, 1147–1154. https://doi.org/10.2147/COPD.S85831. Evidence Level IV.

Chen, X., Zhou, C. W., Fu, Y. Y., Li, Y. Z., Chen, L., Zhang, Q. W., & Chen, Y. F. (2023). Global, regional, and national burden of chronic respiratory diseases and associated risk factors, 1990–2019: Results from the Global Burden of Disease Study 2019. Frontiers in Medicine, 10, 1066804. https://doi.org/10.3389/fmed.2023.1066804. Evidence Level IV.

Dadonaite, B., & Roser, M. (2018). Pneumonia. https://ourworldindata.org/pneumonia. Evidence Level V.

Erdal, B. S., Clymer, B. D., Yildiz, V. O., Julian, M. W., & Crouser, E. D. (2012). Unexpectedly high prevalence of sarcoidosis in a representative U.S. Metropolitan population. Respiratory Medicine, 106(6), 893–899. https://doi.org/10.1016/j.rmed.2012.02.007. Evidence Level IV.

Flanagan, J. (2010a), The life patterns of individuals who had been recently hospitalized for an exacerbation of chronic obstructive pulmonary disease. Journal of Nursing and Healthcare of Chronic Illness, 2, 205–214. https://doi.org/10.1111/j.1752-9824.2010.01064.x. Evidence Level IV.

Flanagan, J. (2010b). From the field notes: Reflections on using health as expanding consciousness (HEC) as a caregiver and researcher. International Journal for Human Caring, 14(3), 68. Evidence Level IV.

Fulmer, T. (2023). Discovering the 4Ms: A framework for creating age-friendly health systems. Retrieved April 21, 2023 from https://www.johnahartford.org/blog/view/discovering-the-4ms-a-framework-for-creating-age-friendly-health-systems/. Evidence Level VI.

Gan, H., Hou, X., Zhu, Z., Xue, M., Zhang, T., Huang, Z., Cheng, Z. J., & Sun, B. (2022). Smoking: A leading factor for the death of chronic respiratory diseases derived from Global Burden of Disease Study 2019. BMC Pulmonary Medicine,22(1), 149. https://doi.org/10.1186/s12890-022-01944-w. Evidence Level IV.

Gibson, P. G., McDonald, V. M., & Marks, G. B. (2010). Asthma in older adults. The Lancet, 376(9743), 803–813. https://doi.org/10.1016/S0140-6736(10)61087-2. Evidence Level V.

Global Burden of Disease Chronic Respiratory Disease Collaborators. (2020). Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet. Respiratory Medicine, 8(6), 585–596. https://doi.org/10.1016/S2213-2600(20)30105-3. Evidence Level I.

Gut-Gobert, C., Cavaillès, A., Dixmier, A., Guillot, S., Jouneau, S., Leroyer, C., Marchand-Adam, S., Marquette, D., Meurice, J. C., Desvigne, N., Morel, H., Person-Tacnet, C., & Raherison, C. (2019). Women and COPD: Do we need more evidence? European Respiratory Review,28(151), 180055. https://doi.org/10.1183/16000617.0055-2018. Evidence Level V.

Hall, R., Hall, I. P., & Sayers, I. (2019). Genetic risk factors for the development of pulmonary disease identified by genome-wide association. Respirology (Carlton, Vic.), 24(3), 204–214. https://doi.org/10.1111/resp.13436. Evidence Level V.

Hena K. M. (2020). Sarcoidosis epidemiology: Race matters. Frontiers in Immunology,11, 537382. https://doi.org/10.3389/fimmu.2020.537382. Evidence Level IV.

Holcombe, S. A., Wang, S. C., & Grotberg, J. B. (2017). The effect of age and demographics on rib shape. Journal of Anatomy,231(2), 229–247. https://doi.org/10.1111/joa.12632, Evidence Level IV.

Kang, Y., Fang, X. Y., Wang, D., & Wang, X. J. (2021). Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia. BMC Infectious Diseases, 21(1), 314. https://doi.org/10.1186/s12879-021-06006-w. Evidence Level IV.

Kennedy-Malone, L. (2022). Changes with aging, In L. Kennedy-Malone & E. G. Duffy (Eds.), Advanced practice nursing in the care of older adults (pp. 190–275). F. A. Davis Company. Evidence Level V.

Labaki, W. W., & Han, M. K. (2020). Chronic respiratory diseases: A global view. The Lancet. Respiratory Medicine, 8(6), 531–533. https://doi.org/10.1016/S2213-2600(20)30157-0. Evidence Level V.

Li, X., Cao, X., Guo, M., Xie, M., & Liu, X. (2020). Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: Systematic analysis for the Global Burden of Disease Study 2017. BMJ (Clinical research ed.), 368, m234. https://doi.org/10.1136/bmj.m234. Evidence Level I.

Mandell, L. A., & Niederman, M. S. (2019). Aspiration Pneumonia. The New England Journal of Medicine, 380(7), 651–663. https://doi.org/10.1056/NEJMra1714562. Evidence Level V.

Martinez-Garcia, M. A., Garcia-Ortega, A., & Oscullo, G. (2022). Practical tips in bronchiectasis for primary care. NPJ Primary Care Respiratory Medicine, 32(1), 33. https://doi.org/10.1038/s41533-022-00297-5. Evidence Level V.

Martinez-Pitre, P. J., Sabbula, B. R., & Cascella, M. (2023). Restrictive lung disease. In StatPearls [Internet]. StatPearls Publishing. Updated July 25, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560880/. Evidence Level V.

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory Critical Care Medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Nanda, A., Baptist, A. P., Divekar, R., Parikh, N., Seggev, J. S., Yusin, J. S., & Nyenhuis, S. M. (2019). Asthma in the older adult. Journal of Asthma, 57(3), 241–252. https://doi.org/10.1080/02770903.2019.1565828. Evidence Level V.

Nanda, A., Mustafa, S. S., Castillo, M., & Bernstein, J. A. (2022). Air Pollution Effects in Allergies and Asthma. Immunology and Allergy Clinics of North America, 42(4), 801–815. https://doi.org/10.1016/j.iac.2022.06.004. Evidence Level V.

National Center for Health Statistics. (2021). Final data for 2019. National Vital Statistics Reports, 70(8). https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-08-508.pdf. Evidence Level IV.

National Institute of Health. (2022). Bronchiectasis: Causes and risk factors. https://www.nhlbi.nih.gov/health/bronchiectasis/causes. Evidence Level VI.

Nguyen, Y., Corre, F., Honsel, V., Curac, S., Zarouk, V., Fantin, B., Galy, A. (2020). Applicability of the CURB-6 pneumonia severity score for outpatient treatment of COVID-19. Journal of Infection, 81(3), e96–e98. https://doi.org/10.1016/j.jinf.2020.05.049. Evidence Level V.

Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: The future of health care. Pediatric Research, 79(1-2), 227–233. https://doi.org/10.1038/pr.2015.197. Evidence Level V.

Park, M. B., Lee, T. S., Lee, J. H., & Lee, J. (2023). Most patients with COPD are unaware of their health threats and are not diagnosed: A national-level study using pulmonary function test. Scientific Reports,13(1), 5893. https://doi.org/10.1038/s41598-023-32485-9. Evidence Level V.

Partridge, L., Deelen, J., & Slagboom, P. E. (2018). Facing up to the global challenges of ageing. Nature, 561(7721), 45–56. https://doi.org/10.1038/s41586-018-0457-8. Evidence Level V.

Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., Cruz, A. A., Duijts, L., Drazen, J. M., FitzGerald, J. M., Fleming, L. J., Inoue, H., Ko, F. W., Krishnan, J. A., Levy, M. L., Lin, J., Mortimer, K., Pitrez, P. M., Sheikh, A., Yorgancioglu, A. A., … Boulet, L. P. (2022). Global initiative for asthma strategy 2021. Executive summary and rationale for key changes. Archivos de bronconeumologia,58(1), 35–51. https://doi.org/10.1016/j.arbres.2021.10.003. Evidence Level V.

Regunath, H., & Oba, Y. (2024). Community-acquired pneumonia. In StatPearls [Internet]. StatPearls Publishing. https://www-ncbi-nlm-nih-gov.treadwell.idm.oclc.org/books/NBK430749/. Evidence Level V.

Reuben, D., Herr, K., Pacala, J., Pollock, B., Potter, J., & Semla,T. (Eds.). (2022). Geriatrics at your fingertips (24th ed., pp. 286–299). American Geriatrics Society. Evidence Level V.

Rinaldi, S., Balsillie, C., Truchon, C., Al-Mubarak, A., Mura, M., & Madill, J. (2022). Nutrition implications of intrinsic restrictive lung disease. Nutrition in Clinical Practice, 37(2), 239–255. https://doi.org/10.1002/ncp.10849.Evidence Level V.

Schneider, J. L., Rowe, J. H., Garcia-de-Alba, C., Kim, C. F., Sharpe, A. H., & Haigis, M. C. (2021). The aging lung: Physiology, disease, and immunity. Cell, 184(8), 1990–2019. https://doi.org/10.1016/j.cell.2021.03.005. Evidence Level V.

Silverman, E. K. (2020). Genetics of COPD. Annual Review of Physiology, 82, 413–431. https://doi.org/10.1146/annurev-physiol-021317-121224. Evidence Level V.

Song, P., Adeloye, D., Salim, H., Dos Santos, J. P., Campbell, H., Sheikh, A., & Rudan, I. (2022). Global, regional, and national prevalence of asthma in 2019: A systematic analysis and modelling study. Journal of Global Health, 12, 04052. https://doi.org/10.7189/jogh.12.04052G. Evidence Level I.

Sonu, S., Post, S., & Feinglass, J. (2019). Adverse childhood experiences and the onset of chronic disease in young adulthood. Preventive Medicine, 123, 163–170. https://doi.org/10.1016/j.ypmed.2019.03.032. Evidence Level V.

Torres, A., Cilloniz, C., Niederman, M. S., Menéndez, R., Chalmers, J. D., Wunderink, R. G., & van der Poll, T. (2021). Pneumonia. Nature Reviews. Disease Primers, 7(1), 25. https://doi.org/10.1038/s41572-021-00259-0. Evidence Level V.

World Health Organization (2022). Asthma. https://www.who.int/news-room/fact-sheets/detail/asthma. Evidence Level VI.

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