COPD’s prevalence among older people is well known, as are its characteristics: frequent hospitalizations, escalating care and treatment costs, and declining quality of life. With the rise of COPD in people age 65+, the demand for home-based care is expected to increase. This article examines challenges, current practices, and aspects of patient and caregiver empowerment.

The challenges of treating elderly people with COPD

COPD patients and family caregivers learn over time that there are multiple unpredictable factors that affect COPD treatment for older adults, and that comorbidities and cognitive decline often complicate the process of managing the disease effectively. As stages of the disease unfold, symptom relief, ADL functionality, and planning for the next stages often become the focus.

As the medical truths of COPD advancement emerge, the overall “disease burden” is often intensified by the emotional realities of the patient and family caregivers. The result is often a collective sense of defeat.

For medically directed home care to have an optimal positive effect, it must address the physiological path of the disease and the psychosocial dimensions of care as well.

30 percentage

of older COPD patients not aware of disease management practices

As reported in Plos One (2017), an early study of COPD patients’ understanding of disease management shows that nearly one third may be unaware of key aspects of COPD care. This, the study noted, can result in a feeling of “powerlessness.”

COPD care at home: A list of services and capabilities

Can home health services reduce mortality rates of COPD patients? Conclusive evidence is lacking

However, as reported in American Journal of Respiratory and Critical Care Medicine, there is evidence that home care can improve patient satisfaction, increase positive health behaviors, and reduce emergency room visits and hospital stays – especially for COPD patients with multiple hospitalizations in the year prior to receiving home care.

For the record, SeniorBridge delivers medically directed home care led by a Nurse Care Manager, and an MSW (where appropriate). The team they lead includes LPNs, HHAs, and other personnel including social workers. Based on their input, here is a list of home care capabilities that have proven effective in adapting to the changing needs of COPD patients.

  • Equipment management: Oxygen, ventilators, CPAP, nebulizers, monitors, adaptive equipment.
  • IV administration as needed
  • Pulmonary rehabilitation: Facilitating exercise.
  • Ongoing patient and caregiver education: The disease process, symptom management, airway management, clearing secretions.
  • Medication management: Including steroids, inhalers, meds for thinning mucus and airway clearance, and steroids for dyspnea
  • Smoking cessation
  • Breathing exercises
  • Counseling: Family dynamics, emotional support, access to an LCSW.
  • Nutrition
  • Caregiver respite
  • ADL support

“You can really empower people if you plan with them and analyze the barriers to sticking with a treatment plan.”

Abby Conway, RN, BSN, MSN SeniorBridge Associate Director

Taking control of life with COPD: 4 aspects of patient empowerment

A 2017 Plos One qualitative study explained how patients and family caregivers view and understand COPD disease management. The study identified 4 core strategies for categorizing actions related to COPD and enhancing patient and caregiver empowerment. Here is a synopsis, with some supporting details based on SeniorBridge experience.

  1. “Managing life with COPD.” Staying in communication with medical providers. Providing relief for family caregivers. Managing home medical devices. Understanding and managing medications. Optimizing the home environment for safety.
  2. “Striving to keep abreast of life.” Receiving information on relevant events. Participating in care activities. Creating ways to remain independent. Receiving ongoing COPD education.
  3. “Preparing for battle with the disease.” Accepting the role of family members. Developing new skillsets. Maintaining exercise and activity. Planning for change.
  4. “Stabilizing the patient’s life.” Cooperating with all care team members. Evolving patient care skills at home.

The study concluded that “empowerment programs…are central to reducing the severity or frequency of exacerbations, preventing hospitalization, and improving health-related quality of life.”

6 ways palliative care helps

The late stages of COPD, a 2016 BMC Palliative Care study claimed, “has clearly been forgotten by medical research in recent years. There exists consensus regarding the need to integrate palliative care…but the difficulty in establishing a prognosis for the disease, establishing limits for life support measures, the lack of information about the disease’s natural course and ignorance as to the most effective health-care structure…may be responsible for their late inclusion or non-inclusion.”

Home-based palliative care has been shown in qualitative study to be effective as a “supportive service that can help address the care needs, increase satisfaction with care, reduce rehospitalizations, and thus increase the patient’s [quality of life].”

The evidence cited above shows that the value of palliative COPD care exists in 6 areas:

  1. Spiritual and emotional support
  2. Education about diagnosis and prognosis
  3. Access to care at home
  4. Advanced care planning
  5. Care coordination
  6. Symptom management

At SeniorBridge, our experience with COPD patients is extensive. Given the increase of COPD globally, we anticipate a more significant role for medically directed home care in the years ahead.

“Patients and caregivers reported spiritual and emotional support as meaningful aspects of the care they receive in the 30-days post hospitalization Home Based Palliative Care intervention.”

Journal of the COPD Foundation 2020

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
The American Journal of Respiratory and Critical Care Medicine (2020)
Plos One (2017)
US National Library of Medicine/NIH (2012)
BMC/Springer Nature (2016)
US National Library of Medicine/NIH (2020)

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