Older adults are at risk for COPD of both the significant risk factors and changes in older adults according to the aging process1,4. The significant risk factors for COPD are smoking, pollution, chemical substances, and dust in the air2,5. Studies found that older people are exposed to the main risk factors for a long time due to inappropriate health behaviors, such as smoking and secondhand smoke. Moreover, their occupations cause them to be exposed to pollution, chemical substances, and dust in the air, causing many older people to suffer from COPD5,6. Other factors were the respiratory system and lung tissue changes with age1,4. In this regard, the decline in the respiratory structure among older people affects the strength of the respiratory muscles, ventilation balance, resistance to airflow, the retraction ability of the chest and lungs, and self-defense mechanisms of the respiratory tract, resulting in a decrease in lung volume, secretion retention, and an increase in the work of breathing1,7,8,9. Owing to these factors, the incidence of COPD in older people was higher than in other ages, and the GOLD stage of COPD among older patients is usually more advanced. Since the mean age of COPD diagnosis was 40 years, and the life expectancy of Thai people was 79, these patients often suffer from multimorbidity and polypharmacy burden along with living with COPD diagnosis for a longer time when compared with other age groups1,2,5,6.
Older people suffer from symptoms induced by the disease pathology when diagnosed with COPD. Older people have severe symptoms and many physical, mental, emotional, and social impacts. Regarding the physical aspect, the common symptom in older patients is dyspnea. It was found that older patients with COPD would experience dyspnea when exercising or doing activities. As for the psychological aspect, older patients suffer from shortness of breath or a feeling of dying. They cannot live everyday life like ordinary people, so it is necessary to limit daily routines, exercise, work, and activities that lower the quality of life of older patients with COPD2,5. In some cases, older patients cannot control or manage their symptoms, causing respiratory failure that quickly leads to disability and death. As for the emotional and psychosocial effects, it was found that the loss of existing abilities caused older adults to have less self-esteem and high perceived pressure, anxiety, fear, anger, or sometimes getting furious for no reason. In addition, depression can be found in older patients with COPD1,10.
Currently, care and treatment for patients with COPD are mostly symptomatic treatment, elimination of the cause or precipitating factor, and palliative care5,11. COPD treatment aims to relieve symptoms, prevent exacerbation, maintain pulmonary function, and promote quality of life. Disease preventions include inhalers and oxygen therapy in case of breathing difficulties. This treatment will start with an oxygen cannula at 1–2 L/min. In addition, studies have shown that a low oxygen supply during exercise enables patients to have better exercise tolerance. Symptoms exacerbation prevention can be done by reducing risk factors, such as smoking, secondhand smoke exposure, infection, and behaviors inappropriate with the disease. Pulmonary function maintenance focuses on avoiding risk factors, especially quitting smoking or changing occupations and exposure to precipitating factors, such as dust, smoke, and pollution, to stop or slow the pathology and disease progression. Finally, quality of life promotion is trying to maintain the ability to perform daily activities and socialize as before1,5,11. Because care and treatment for patients with COPD focus on self-care, symptom management, and behavioral modification, nurses play an essential role in providing care, advice, and encouragement to this population. Then older people can take care of themselves at home, carry out daily activities as usual, and have a good quality of life5,11,12.
The reviews by O’Donnell et al.13 and Volpato et al.14 have showed that interventions reducing inspiratory neural drive and regional lung hyperinflation and promoting breathing pattern and pulmonary blood flow can improve dyspnea and its psychological effects. These interventions included oxygen therapy, opiates, bronchodilators, inspiratory muscle training, combined exercise training, psychotherapy, self-management, relaxation therapy, music therapy, and pulmonary rehabilitation. Based on the literature review on intervention studies, researchers also developed many interventions for managing and caring for patients with COPD. However, these studies were conducted in adult patients or mixed-age groups. We realized that the pathogenesis, risk factors, and skills in perceiving information, learning, and understanding among older people might be limited and different from those of adults15,16. The aging process causes some degeneration of organ function and impairment, affecting health education for older people. These impairments include vision, hearing, attention, concentration, and less ability to remember information. Then, the provision of health education or knowledge needs to be specific in line with the limitations and requirements of older people17,18, and the previous interventions might be ineffective with older patients, especially Thai older patients who have specific lifestyles and contexts such as occupations relate to risk factors, foods and drinks, activities in daily, types of exercise and culture. Therefore, gerontology experts recommend that teaching older people should take a short time, be divided into sessions, and consist of explanations and practices. Practices must be simple and uncomplicated in a suitable place, and repeated teaching and training sessions should be provided. The teaching style considering the context and culture of older people should be concerned with using the proper media, large visible text, simple language, and age-friendly colors to be seen easily and clearly. In addition, teaching materials should be available for older people to take home and review15,17,18. To the best of our knowledge and based on our review, the existing nursing care methods or programs have not yet consistently responded to older people’s requirements and limitations. Consequently, developing a program specific to older people’s requirements and limitations is necessary.
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