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. 2024 Nov;72(11):3346-3359.
doi: 10.1111/jgs.19158. Epub 2024 Aug 31.

Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study

Anand S Iyer  1   2   3   4   5 , Rachel D Wells  3   4 , Avery C Bechthold  4 , Margaret Armstrong  3   4 , Ronan O'Beirne  6 , Jun Y Byun  4 , Jazmine Coffee-Dunning  3   4 , J Nicholas Odom  3   4 , Russell G Buhr  7   8   9 , Angela O Suen  10 , Ashwin A Kotwal  11   12 , Leah J Witt  10   11 , Cynthia J Brown  13 , Mark T Dransfield  1   5 , Marie A Bakitas  2   3   4
Affiliations

Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study

Anand S Iyer et al. J Am Geriatr Soc. 2024 Nov.

Abstract

Background: Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence.

Objective: To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD).

Design: Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement.

Setting: Ambulatory, virtual.

Participants: Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.

Results: NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) "Barriers to care", (2) "Family caregiver needs", (3) "Functional status and mobility issues", (4) "Illness understanding", and (5) "COPD care complexities". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized "Functional status and mobility issues", family caregivers prioritized "Family caregiver needs", and clinicians and health system leaders prioritized "COPD care complexities". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.

Conclusions: Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges.

Implications: Patient-centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment.

Keywords: COPD; caregiver; geriatrics; intervention development; intervention mapping; nominal group technique; palliative care; rapid qualitative analysis.

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Conflict of interest statement

ASI has received grant support (K76 AG064327) from the National Institute on Aging of the National Institutes of Health, John A. Hartford Foundation, and the American Federation for Aging Research and is employed by the Veterans Health Administration. The findings and positions in this manuscript do not necessarily reflect those of the National Institutes of Health or the United States Federal Government. He reports consulting fees from AstraZeneca, Verona, and Medscape during this study but outside the scope of this study.

RB reports personal consulting fees from Viatris/Theravance Biopharma, Dynamed/American College of Physicians. Dr. Buhr is employed by the Veterans Health Administration, the findings and positions in this manuscript do not necessarily reflect those of the United States Federal Government.

MTD reports grant funding from the Department of Defense, American Lung Association, and National Institutes of Health, royalties from UpToDate, consulting fees from Aer Therapeutics. Apreo, AstraZeneca, Genentech, GSK, Novartis, Pulmonx, Teva. MTD also sits on the Board of Directors of the COPD Foundation.

RDW, RO, AB, MA, JCD, JDO, AOS, AK, LJW, JB, CJB, and MAB report no relevant conflicts.

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