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Unique To Older Adults > COPD > Aging & Health A To Z > Health in Aging

Aging & Health A to Z

COPD

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.
As older adults live longer, they may have more than one chronic disease.  Or, they may have a health problem that can lead to another condition or injury if not properly managed.   The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home.  These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.

Depression and COPD

When your COPD symptoms eventually become severe enough to interfere with your daily life, you may start to feel overwhelmed. It is not unusual for COPD patients to develop signs of depression. After all, life can become more challenging with COPD as routine physical activities and sleeping become more difficult.  You may feel tired much of the time, and have to cope with oxygen tanks when you go out in public. People with the disease are much more likely to become depressed than people without COPD. In fact, one out of two COPD patients gets depressed or anxious at some point in their illness.
If you have COPD and become depressed, it can actually make your health worse. Depression in people with COPD has been linked to:

• More problems with carrying out daily functions
• Decreased quality of life
• More frequent flare-ups and hospitalizations
• A higher risk of death.

When you are depressed, you may:

• Have less ability to exercise or participate in pulmonary rehabilitation programs
• Spend more time in the hospital or clinic
• Have more trouble taking your medicines correctly and following doctor’s advice
• Tend to smoke more and have more trouble quitting
• Suffer worse symptoms
• Feel worse about your own health, well-being and general quality of life.

A very high number of COPD patients do become sad, angry and depressed.  Remember that this is a natural reaction to the new limitations in your life.  But many people, especially older people who feel that they should handle emotional difficulties on their own, avoid telling their doctors that they are having trouble coping.   Depression is a major medical problem, not a weakness or a normal part of aging.  Most people feel better with treatment. 
You owe it to yourself to get the best help you can, so that your COPD does not prevent you from living your life to the fullest.  Therefore it is important to tell your healthcare professional if you are having any of the symptoms listed below. Having at least one of the first two symptoms and at least five of the others may mean that you are developing a depression.

• Sadness or emptiness most days for several weeks
• No pleasure in activities that you used to enjoy
• Poor sleep that is restless or disrupted, such as early waking and difficulty falling asleep
• Less energy and lack of motivation
• Difficulty concentrating, making decisions, remembering things
• Sleeping a lot more or a lot less than you used to
• Eating a lot more or a lot less than you used to; gaining or losing weight
• Loss of self-esteem or feeling useless
• Frequent crying; feelings of hopelessness and pessimism
• Increased irritability and restlessness
• Physical symptoms (stomach aches, various pains) that your doctor cannot diagnose or relieve
• Excess sensitivity (being more “thin-skinned”) or reacting more strongly to criticism
• Thoughts about ending your life, or even making an attempt.

You do not have to accept these feelings. Depression can be treated very effectively, with both medicines and talk therapy (psychotherapy). You will find that the support provided by individual, family, or group therapy—especially when combined with an anti-depressant medication—can let you cope much more effectively to the challenges of COPD.

Anxiety and COPD

COPD is a challenging illness that requires care and discipline to keep well-controlled. But you may find yourself worrying too much about your condition. If this feeling becomes too strong or constant, you may develop an anxiety disorder.
Anxiety is the feeling of being constantly worried or tense, often far more than the situation calls for. You may even experience strong anxiety episodes called panic attacks. Researchers have found that up to half of all patients with COPD are suffering from an anxiety disorder, which often goes unnoticed. This rate is far higher than the number of people suffering from anxiety in the general population.
When you have a hard time breathing, you may feel that you are suffocating. This feeling triggers an alarm in your brain to warn you to get more air. You may experience this alarm as anxiety or panic. Your muscles will tense up and you may have even more trouble catching your breath. As your COPD progresses, you may feel this alarm more frequently until the feeling becomes a kind of habit.
Having excessive anxiety can make your COPD worse. For example, flare-ups can go on for a longer time in people with COPD who have an anxiety disorder. Even the simple feeling of worry can make you breathless. But researchers have also found that getting help for your anxiety also helps your COPD symptoms improve. For this reason, as well as to improve your outlook and quality of life, tell your healthcare professional if you think you are anxious too much of the time. Signs that you may have with an anxiety disorder include:

• Trouble getting to sleep because you are worrying so much
• Being suddenly breathless, even without physical activity
• Worrying constantly about your next breathless episode
• Being so afraid of germs, pollution, or other stresses that you stop going out
• Developing fears about airplane travel, elevators, bridges, tunnels or similar situations
• Worrying constantly about an impending catastrophe, for no reason.

If your healthcare professional thinks that you are suffering from an anxiety disorder, he or she will suggest several approaches, all of which are known to help:

• An antidepressant or anti-anxiety pill
• Pulmonary rehabilitation (breathing training) to help you breathe more easily
• Pursed lip breathing, which may keep airways more open
• Programs that will teach you techniques for staying calm and relaxed, such as reducing bright lights and noise, using soothing music, doing yoga or meditating, or taking up a hobby
• Visualization exercises, in which you imagine yourself in a relaxed state
• Counseling (psychotherapy) – either individual, family, or group counseling. 

Cardiovascular disease and COPD

People with COPD tend to develop cardiovascular diseases at a higher rate than those without COPD. This is related to increased inflammation in your blood vessels that develops when your blood is low in oxygen for extended periods of time. Your blood vessels may also have a tendency to become less elastic after many years of COPD. In addition, the extra effort exerted by your heart to pump blood when you have COPD may increase the risk of heart failure. In fact, cardiovascular diseases are the main causes of death for COPD patients. Compared to people who do not have COPD, researchers have found that COPD patients:

• are twice as likely to be hospitalized for cardiovascular disease
•  have more irregular heartbeats, heart attacks, heart failure, stroke, high blood pressure in the blood vessels feeding the lungs (pulmonary hypertension), blood clots (embolism), and angina (pain in the chest)
• Are more likely to die of a cardiovascular-related illness.

Be sure to tell your doctor if you ever have symptoms like pain or tightness in your chest, a feeling that your heart is racing or missing beats, or swelling in your legs, hands or feet.

Follow your healthcare professional's instructions about diet, exercise, and medications. This is especially important if you are taking medicines for high blood pressure, blood thinners, water pills (diuretics), or other cardiovascular medications (beta blockers, ACE inhibitors). Make sure that you are taking your COPD medicines correctly as well.

Mobility problems in COPD

Your healthcare professional will routinely measure you arterial blood gases to see how much oxygen is circulating through your body. At some stage in your COPD, the damage to your lungs will start to limit the amount of air you breathe in. Your oxygen level will start to decline and your doctor will prescribe extra (supplemental) oxygen.
In years past, this stage of the disease meant that patients were restricted to a sedentary life indoors—either at home or in a clinic or hospital—because of the patient’s dependence on a heavy oxygen tank. Now, however, oxygen can be supplied from various devices that are much lighter and easier to move. Modern delivery systems have been designed to make sure that you are able to get around inside and outside your home as easily as possible.
The three types of portable oxygen delivery systems are:

• Compressed oxygen: The old heavy tanks have been replaced by light-weight aluminum cylinders that are easy to carry in a wheeled trolley or back-pack carrier but need to be refilled.
• Liquid oxygen: The cylinders last longer than compressed oxygen cylinders and have similar carrier options, but also need refilling periodically.
• Oxygen concentrators: These devices use oxygen from the air and therefore do not require a refillable cylinder. They plug in to a standard wall socket or your car’s accessory outlet.  They can also be battery operated so you can get out and about.

The oxygen from these devices is delivered to your lungs through hoses that run from the machine to a face mask or to nasal cannula (small tubes that fit comfortably into the nostrils). A newer delivery system brings the oxygen directly into your windpipe (trachea) and is appropriate and advantageous for some patients.
Supplemental oxygen devices can be taken in cars, buses, trains, and sometimes on airplanes. Check with the transportation company for rules about traveling with your oxygen device and how to carry and secure it. Having COPD no longer means that travel is a pleasure of the past.
You may find that it is easier to get around with the help of a mobility aid which will also carry your oxygen cylinder. These include:

• Walkers
• Wheelchairs
• Mobility scooters.

Using supplemental oxygen as much as possible during the day will ease your symptoms and slow the progress of the disease. It will make it much easier to get around and to exercise. It will also reduce possible damage to other parts of your body, such as your cardiovascular system.

Never smoke near an oxygen tank or supply system, and keep away from open flames and fireplaces. Follow your oxygen supplier’s instructions carefully.

Updated: March 2012
Posted:  March 2012