ED Use in COPD Linked to Depression, Loneliness

September 30, 2019

Findings: COPD patients who are lonely and depressed are at increased risk for ED use and hospital admission. Even mild depression is a risk factor.

Results of 2 recent studies, published in Mayo Clinic Proceedings in Innovation and Quality Outcomes and the International Journal of Chronic Obstructive Pulmonary Disease, now suggest that depression and loneliness in COPD may increase ED utilization. The studies have implications for potentially improving care, quality of life, and healthcare utilization in patients with COPD. Click through highlights of both above.

Does Depression in COPD Affect ED Use? 12-month prospective study of depression in COPD and ED use among 355 patients with COPD in the UK. Primary outcomes: ED attendance during one-year follow-up; hospital admission from ED during one-year follow-up.

Moderate-Severe Depression Symptoms Reported by Half of Patients with COPD. Characteristics linked to ED visits/admissions: Older age, comorbidities, severity of COPD, past emergency care, and depression. Importantly, even mild depression linked to increased ED visits and emergency admissions.

COPD, Depression, and Use of Urgent Care.

Clinical Implications: Depression in COPD:

May be underdiagnosed in patients with COPD seen in primary are

Even subthreshold depression in COPD increases use of urgent care

Depression may increase ED utilization independent of COPD severity, other comorbidities

Treating depression in COPD patients seen in primary care may decrease hospital admissions

Loneliness in COPD: What Impact on Use of ED? Participants: patients with moderate-severe COPD s/p lung-volume reduction surgery; N=1218 (mean age 65 yrs, 47% women); quetionnaires assesed: Loneliness, social isolation in past 3 days. Follow-up: Loneliness, 5 yrs; ED use, 24 mo.

Loneliness Ups ED Use, Worsens Health Perception. Loneliness independently linked to 57% increased odds of visiting the ED (OR 1.57 (95% CI, 1.005-2.466, p=0.04)* and independently linked to 10 times increased odds of low general health ratings and four times increased odds of dyspnea (OR 4.05, p<.001; OR 9.92, p<.001, respectively).**

* Adjusted for age, gender, lung function, dyspnea, 6-minute walk test, treatment
** Adjusted for age, lung function, treatment, marital status, dyspnea

Clinical Implications: Loneliness in COPD:

Assessment for loneliness in routine clinical care for patients with COPD, other chronic conditions may improve quality of life, reduce ED visits

Interventions that increase activities outside the home may improve well-being

CBT or health coaching could help target loneliness

More support for health-related decisions may decrease stress

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Many individuals with COPD also suffer from depression and anxiety, which can interfere with self-care and adherence to medication regimens. That, in turn, may worsen outcomes including more frequent exacerbations, increased hospital admissions, and increased mortality. Symptoms of COPD, like fatigue and breathlessness, can also limit mobility and contribute to social isolation and loneliness.