title: Managing patients with COPD exacerbation: does age matter?
abstract: BACKGROUND
  there is little information about the relationship between age and management of COPD exacerbation (AECOPD), although older persons are known to be at a greater risk of hospital admission.
  
  
  METHODS
  we have investigated responses from the clinical and patient questionnaire elements of the 2008 UK COPD audit, splitting the data into age decile.
  
  
  RESULTS
  age ranged from 27 to 102. Patient-reported data suggested older patients had inferior knowledge of COPD, undertook less self-care and were less likely to recognise symptoms of exacerbation prior to hospitalisation. Clinician-reported data showed that although older patients had severe disease and symptoms, greater co-morbidity at presentation and higher mortality, fewer were seen in hospital or followed up subsequently by respiratory specialists. Older patients were more likely to have a DNR order signed within 24 h of admission, irrespective of co-morbidities or performance status. The observations were particularly applicable to those aged 80 or above.
  
  
  CONCLUSIONS
  clinicians should consider increasing age as a specific risk factor in the management of COPD. Acute units and community teams should review carefully their protocols and pathways for how they assess, manage, discharge and follow-up older patients with COPD exacerbation.
authors.affiliation: Clinical Standards Department, Royal College of Physicians, 11 St Andrews Place Regents Park, London NW1 4LE, UK. robert.stone@tst.nhs.uk
authors.forename: Robert A
authors.initials: RA
authors.lastname: Stone
authors.forename: Derek
authors.initials: D
authors.lastname: Lowe
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Potter
authors.forename: Rhona J
authors.initials: RJ
authors.lastname: Buckingham
authors.forename: C Michael
authors.initials: CM
authors.lastname: Roberts
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Pursey
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D003266:Continuity of Patient Care; D018450:Disease Progression; D005260:Female; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D016414:Resuscitation Orders; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom