Gaps in asthma care of the oldest adults.
OBJECTIVE
To assess the adequacy of asthma care reported by a group of older adults who were subsequently hospitalized for their asthma.


METHODS
Prospective cohort study.


METHODS
Fifteen managed care organizations in the United States.


METHODS
Adults with asthma, enrolled in managed care.


METHODS
Patient survey of demographics, asthma symptoms, health status, comorbid conditions, asthma treatment, asthma knowledge, and asthma self-management at baseline and 1 year later.


RESULTS
Of 254 older adults, 38 (15.0%) reported being hospitalized for asthma at 1-year follow-up. Of these, 22.9% owned a peak flow meter (PFM). Of those with allergies, only about half (56.0%) had been told how to avoid allergens and had been referred for formal allergy testing. Adrenergic drug use was high in some patients. Nearly all (94.6%) used beta-agonist metered-dose inhalers (MDIs); 60.0% reported theophylline; 17.1% reported beta-agonist MDI overuse (>8 puffs per day); 10.5% reported beta-agonist MDI over-use and theophylline; and 13.2% reported both beta-agonist MDI over-use and oral beta-agonist use. Only 18.4% of respondents rated their overall asthma attack knowledge as excellent. Compared with nonhospitalized older adults, the hospitalized group reported care that was more consistent with guidelines, but also higher rates of potentially toxic combinations of adrenergic drugs. Compared with younger hospitalized adults, older hospitalized adults had clear deficiencies, including lower use of PFMs (55.3% vs 22.9%) and worse asthma self-management knowledge.


CONCLUSIONS
There are many opportunities to improve both the pharmacologic and non-pharmacologic care of older adults with asthma. Overuse of and potentially toxic combinations of inhaled and oral sympathomimetics should probably be avoided. Older asthmatics may also benefit from increased specialty referral, PFM use, allergy testing, and asthma teaching.
Wolfenden
Linda L
LL
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
Diette
Gregory B
GB
Skinner
Elizabeth Ann
EA
Steinwachs
Donald M
DM
Wu
Albert W
AW
D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States