title: Hospitalisation of multiethnic older patients with AECOPD: exploration of the occurrence of anxiety, depression and factors associated with short-term hospital readmission.
abstract: BACKGROUND
  The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co-morbidities.
  
  
  OBJECTIVE
  This study was aimed to explore the occurrence of anxiety, depression and to identify the factors associated with hospital readmission among older patients after AECOPD discharge.
  
  
  METHODS
  A multicentre prospective study was conducted in Malaysia (from 1st September 2012 till 31st September 2013) among older patients (≥60 years) hospitalised for AECOPD. Anxiety and depression were assessed on discharge using previously validated questionnaires, Generalized Anxiety Disorder-7 (GAD-7 and Geriatric Depression Scale (GDS-15), respectively. Patients were followed up for a period of 3 months after discharge.
  
  
  RESULTS
  A total of 81 patients with a median age of 72 years (IQR 66.40-78.00) were recruited. Anxiety was observed in 34.57% while 38.27% had depression. Both anxiety and depression were detected in 25.93% of the patients. A history of frequent AECOPD admissions was found to be associated with developing depressive symptoms, while anxiety scores were associated with severe dyspnoea. Severe depression was more commonly identified among patients aged 60-75 and in those with a history of tuberculosis. A high readmission rate (40.74%) during the 3-month period was noticed. History of frequent AECOPD admissions (OR = 2.87; 95% CI 1.05-7.85, P = 0.040) and ischemic heart disease (IHD) (OR = 4.04; 95% CI 1.1-14.6, P = 0.032) were identified as the factors associated with the risk of hospital readmission.
  
  
  CONCLUSIONS
  Anxiety and depression were found to be relatively common among older patients with AECOPD. IHD and history of frequent COPD hospitalisation were associated with short-term readmission among the elderly.
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia.
authors.forename: Sana' M H
authors.initials: SMH
authors.lastname: Al Aqqad
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia.
authors.forename: Balamurugan
authors.initials: B
authors.lastname: Tangiisuran
authors.affiliation: Hospital Pulau Pinang, Jalan Residensi, George Town, Pulau Pinang, Malaysia.
authors.forename: Irfhan Ali
authors.initials: IA
authors.lastname: Hyder Ali
authors.affiliation: Jabatan Perubatan Respiratori, Hospital Sultanah Bahiyah, Lebuh Raya Darul Aman, Alor Setar, 05350, Kedah, Malaysia.
authors.forename: Razul Md Nazri
authors.initials: RMN
authors.lastname: Md Kassim
authors.affiliation: Hospital Umum Sarawak, Jalan Tun Ahmad Zaidi Adruce, Kuching, 93586, Sarawak, Malaysia.
authors.forename: Jyi Lin
authors.initials: JL
authors.lastname: Wong
authors.affiliation: Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Selangor, Malaysia.
authors.forename: Tengku Ismail
authors.initials: TI
authors.lastname: Tengku Saifudin
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D000071069:Multiple Chronic Conditions / Q000453:epidemiology; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D012307:Risk Factors
keywords: anxiety; chronic obstructive pulmonary disease; depression; elderly; exacerbation; patient readmission