Posted: 5/23/2001
A Johns Hopkins study of elderly persons found that many have either moderate or severe asthma that has been underdiagnosed or undertreated.
Asthma also can lead to a decreased quality of life for elderly people, concludes Karen Huss, DNSc, RN, a nurse researcher and associate professor at The Johns Hopkins University School of Nursing.
In her study of 80 senior citizens over age 65, published in the May issue of Annals of Allergy, Asthma and Immunology, Huss found that two thirds had either moderate or severe persistent asthma caused primarily by elements in the home such as dust mites, mold, and allergens from cockroaches, cats and dogs. Asthma medication was either not being used or used improperly.
“Asthma is a significant, chronic problem in the elderly,” says Huss. “Despite the high prevalence, major allergens in the homes have not been identified. We conducted home visits to collect dust samples and evidence of other allergens. That is the first step in alleviating the problem.”
Almost 75 percent of senior citizens in the study tested positive to an airborne allergen, and 53 percent were skin test positive to at least one indoor allergen. Although the elderly with asthma were primarily sensitive to indoor allergens, the second most prevalent allergen was Bermuda grass. Allergen levels in the homes were often high enough to place the elderly at risk for asthma complications.
“Our data suggest that high allergen levels found in the homes of older adults with asthma are from carpeting, older furnishings, high indoor relative humidities and non-encased mattresses,” says Huss. “Cockroach exposure is also a significant cause of asthma in these older adults, and exposures to furred pets are important triggers for asthma, as well.”
The study indicates that asthma in the elderly also contributes to a decreased quality of life. Those with more severe asthma reported more negative feelings about life in general, described their health as being poor, and had a greater degree of impairment during daily activities. This finding implies that senior citizens with severe asthma are less likely to engage in domestic activities such as dusting and vacuuming, leading to higher allergen levels and ultimately exacerbating severe asthma.
Despite the high levels of allergy Huss found among the elderly, few were taking proper medication to treat it. One third of the elderly in the study were not taking inhaled steroids, the preferred method of treating asthma. Many were using short-acting inhalant medications on a regular basis rather than the recommended way, which is as-needed only.
“It is critical that we first identify and control allergens in an elderly person’s environment in order to avoid asthma attacks,” says Huss. “Skin tests need to be done on elderly patients with asthma so they will know what to avoid. Once allergens in the home are reduced and medications that combat inflammation in the airways are introduced, then asthma severity in the elderly should decrease and the quality of life should improve.”
The study was supported by the Fund for Geriatric Medicine and Nursing of The Johns Hopkins University and by Greer Laboratories, Inc. Other authors were P.L. Naumann, MSN; P.J. Mason, MSN; P.P. Nanda, MPH; R.W. Huss, M.D., C.M. Smith, BS; and R.G. Hamilton, PhD.