Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study.
To determine the prevalence and outcomes of breathlessness in older Americans.



Community-dwelling older adults.



Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).



Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.



Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63%), multimorbidity (≥2 chronic conditions) (45%), current smokers (38%), heart disease (36%), obesity (body mass index ≥30.0 kg/m2) (33%), and education less than high school (32%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95% CI = 1.32-2.02).



One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40% greater risk of worsened function and 60% greater risk of death over the next 5 years.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California. aksmith@ucsf.edu.|San Francisco Veterans Affairs Medical Center, San Francisco, California. aksmith@ucsf.edu.
Alexander K
AK
Smith
Discipline of Supportive and Palliative Care, Flinders University, Bedford Park, South Australia, Australia.
David C
DC
Currow
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.|Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.
Amy P
AP
Abernethy
Hull York Medical School, The University of Hull, Hull, East Yorkshire, United Kingdom.
Miriam J
MJ
Johnson
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.|Discipline of Supportive and Palliative Care, Flinders University, Bedford Park, South Australia, Australia.
Yinghui
Y
Miao
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
W John
WJ
Boscardin
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.|Jewish Home of San Francisco, San Francisco, California.
Christine S
CS
Ritchie
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000503:physiopathology*; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000503:physiopathology*; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods; D014481:United States / Q000453:epidemiology
breathlessness; decline; older