Dynamic changes in quality of life in older patients with chronic obstructive pulmonary disease: a 7-year follow up

Abstract

Purposes: Chronic obstructive pulmonary disease (COPD) is a major cause of the rapid decline of health-related quality of life (HRQoL), associated with accelerated frailty in older populations. This study aimed to analyse the long-term dynamic changes of HRQoL and the predictive factors for the rapid decline of HRQoL in older patients with COPD.

Methods: Overall 244 patients with COPD, aged ≧ 65 years from one medical centre were enrolled between March 2012 and July 2020. Further, we prospectively assessed HRQoL scores with utility values, using EuroQol Five-Dimension (EQ-5D) questionnaires. Additionally, long-term dynamic changes in HRQoL were analysed using the Kernel smoothing method and examined the factors contributing to the deterioration of HRQoL using a linear mixed effects model.

Results: Older patients with COPD with forced expiration volume (FEV1) < 50% of prediction entered the phase of rapid and continuous decline of HRQoL ~ 2 years after enrolment, but patients with FEV1 ≥ 50% of prediction without rapidly declined HRQoL during 7 years follow up. Therefore, FEV1 < 50% of prediction is a novel predictor for the rapid decline of HRQoL. The course of rapidly declining HRQoL occurred, initially in the usual activities and pain/discomfort domains, followed by the morbidity, self-care, and depression/anxiety domains ~ 2 and 4 years after enrolment, respectively. The mixed effects model indicated that both FEV1 < 50% of prediction and a history of severe acute exacerbation (SAE) requiring hospitalisation were contributing factors for deterioration in HRQoL .

Conclusions: Both FEV1 < 50% of prediction and exacerbations requiring hospitalisation were contributing factors for the deterioration of HRQoL in long-term follow up. Additionally, FEV1 < 50% of prediction was a novel predictor for patients entering the phase of rapid decline of HRQoL.

Keywords: Chronic obstructive pulmonary disease; Dynamic change.; Quality of life.

Fig. 1

Dynamic changes of utility values of quality of life (QoL) in older COPD patients with different stages of pulmonary function. The dynamic change of utility values of EQ-5D-3 L was analysed by a kernel smoothing method. Patients with FEV1 < 50% of prediction entered the phase of rapid declined of utility values approximately 2 years later and a more rapid decline was started approximately 4 years later from the beginning of follow-up

Fig. 2

Dynamic changes of health domains in ‘usual activities’ (A) and ‘pain/discomfort’ (B) for older COPD patients with different stages of pulmonary function. The dynamic change of domain scores of EQ-5D-3 L was analysed by a kernel smoothing method. Distinctly worsened scores in patients with FEV1 < 50% of prediction were noticed at approximately 2 years later from the beginning of follow-up in the (A) ‘usual activity’ and (B) ‘pain/discomfort’ domains. The dynamic change of ‘pain/discomfort’ domain reached a plateau approximately 4 years later from the beginning of follow-up, but continuous rapid progression of domain scores in the ‘usual activity’ domain

Fig. 3

Dynamic changes of health domains in ‘mobility’ (A), ‘self-care’ (B), and ‘anxiety/depression’ (C) for older COPD patients with different stages of pulmonary function. The dynamic change of domain scores of EQ-5D-3 L was analysed by a kernel smoothing method. Distinctly worsened scores in patients with FEV1 < 50% of prediction were noticed at approximately 4 years later from the beginning of follow-up in the (A) ‘mobility’, (B) ‘self-care’ and (C) ‘anxiety/depression’ domains