Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

Abstract

BACKGROUND

Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease (COPD) patients and reduce the quality of life of patients, but also affect the treatment effect and long-term prognosis. Therefore, it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.

AIM

To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.

METHODS

In this retrospective study, 60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group. The control group was given routine nursing, and the observation group was given comprehensive assessment. Clinical symptoms, quality of life [COPD assessment test (CAT) score], anxiety and depression Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) were compared between the two groups.

RESULTS

CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge, and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge. The average score was 22.1 (P < 0.05). In the observation group, HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge, and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge. The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge, and from an average of 14.1 at admission to an average of 11.8 at discharge.

CONCLUSION

The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients' clinical symptoms and quality of life, and can effectively reduce patients' anxiety and depression.

Key Words: Chronic obstructive pulmonary disease; Comprehensive geriatric assessment; Anxiety; Depression; Retrospective study; Hamilton Anxiety Rating Scale

Core Tip: This study found that comprehensive geriatric assessment has a significant effect in the care of patients with chronic obstructive pulmonary disease, and can improve patients' clinical symptoms, quality of life, and reduce their anxiety and depression. It is particularly noteworthy that comprehensive assessment can prolong the patient's symptom relief time and is of great significance in improving the patient's treatment effect.

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease mainly characterized by airflow limitation[1,2]. It is common in smokers and has increasingly become a global health problem with the aging of the population[3,4]. According to statistics from the World Health Organization[5], COPD has become the fourth leading cause of death in the world, and it is expected that by 2030[6], COPD will become the third leading cause of death in the world[7]. Of particular concern is that the elderly are one of the groups with a high incidence of COPD[8], and their morbidity and mortality are on the rise, placing a heavy burden on society and families[9,10]. With the continuous improvement of medical standards and advancement of medical technology[11,12], the treatment of COPD is also constantly improving[13,14]. However, relying solely on medication and physical therapy may not be able to meet the comprehensive care needs of elderly COPD patients[15,16]. Elderly COPD patients are often accompanied by a variety of chronic diseases and decline in physiological functions, and their physical and mental health problems are more prominent[17,18]. Therefore, a comprehensive and systematic assessment of the physical condition, mental health status and quality of life of elderly COPD patients is essential for formulating personalized care plans and improving treatment efficacy and quality of life are of great significance[19,20].

Comprehensive assessment is a systematic and comprehensive assessment method that aims to comprehensively understand the patient's health status, disease characteristics, and psychosocial factors[21,22]. Comprehensive geriatric assessment emphasizes comprehensiveness, individualization and long-term nature. By comprehensively assessing the physical, psychological and social functions of elderly patients, it can better guide clinical care and improve the overall treatment effect and quality of life of patients[23]. COPD is a common chronic respiratory disease, and its treatment and management require multi-faceted comprehensive intervention. In this process, the comprehensive evaluation system plays an important role. COPD patients are often accompanied by a variety of complications and psychological problems, such as anxiety, depression, etc. The comprehensive evaluation system can help nursing staff fully understand the patient's health status and formulate personalized care plans. The comprehensive evaluation system can help nursing staff develop personalized treatment plans based on patient assessment results, including drug treatment, rehabilitation training, nutritional support, etc., thereby improving treatment effectiveness.

The comprehensive evaluation system can regularly monitor changes in patients' symptoms, quality of life, lung function and other indicators, detect the progression of the disease in a timely manner, and take corresponding intervention measures to delay the progression of the disease[24]. By communicating with patients and explaining evaluation results and treatment plans, we inspire patients to have confidence in treatment and make them more actively participate in the treatment process. The comprehensive evaluation system can help nursing staff detect patients' psychological problems in a timely manner and take corresponding psychological intervention measures to reduce their anxiety and depression and improve their quality of life. The establishment and application of a comprehensive evaluation system is of great significance for improving the quality of life of COPD patients, alleviating their symptoms, and delaying disease progression[24]. Therefore, in COPD care, nursing staff should pay attention to the application of the comprehensive evaluation system and provide patients with personalized and effective nursing services through comprehensive and systematic evaluation.

Although the importance of comprehensive geriatric assessment in nursing is increasingly recognized, there are relatively few studies on its application in patients with COPD, especially its impact on patients' anxiety and depression needs to be further explored. Therefore, this study aims to explore the application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patients, to provide scientific basis and clinical experience for improving the nursing level of elderly COPD patients, and to promote the rehabilitation and rehabilitation of elderly COPD patients. healthy.

MATERIALS AND METHODS

Normal information

This study adopted a retrospective study design and aimed to explore the application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patients. The study subjects were COPD patients treated in our hospital from 2019 to 2020. The study adopted a control group design, and the patients were divided into two groups according to the order of admission time, with 30 people in each group. The control group received routine care, and the observation group underwent a comprehensive geriatric assessment on the basis of routine care.

Research design

This study adopted a retrospective control group design. The patients were divided into two groups according to the order of admission time upon admission, one group received routine care as the control group, and the other group received comprehensive geriatric assessment on the basis of routine care as the observation group. By comparing the clinical symptoms, quality of life, and changes in anxiety and depression between the two groups of patients, the effectiveness of geriatric comprehensive assessment in COPD care was evaluated.

Inclusion and discharge standards

Inclusion criteria: Aged 65 and above; meet the diagnostic criteria for COPD; voluntarily participate in this study and sign an informed consent form; have basic communication and cognitive abilities; be hospitalized for no less than 7 d.

Exclusion criteria: Severe cardiovascular disease, liver and kidney insufficiency, or other serious organ dysfunction; severe mental disorder or cognitive dysfunction; severe vision or hearing impairment that affects the accuracy of assessment; active pulmonary tuberculosis or other serious infection.

Grouping situation

According to the order of admission time, the patients were divided into a control group and an observation group, with 30 people in each group.

Interventions

Control group: For patients in the control group, standard usual care was administered.

These measures mainly include: Drug treatment: According to the specific condition of the patient, the doctor will issue the corresponding drug prescription, such as anti-inflammatory, expectorant, cough, asthma and other drugs, in order to relieve the patient's symptoms.

Oxygen therapy: For patients with dyspnea and decreased oxygen saturation, we will provide oxygen therapy to improve the patient's oxygenation status and reduce the symptoms of hypoxia.

Respiratory rehabilitation: We will provide patients with respiratory rehabilitation guidance and training, such as breathing control, the combination of chest breathing and abdominal breathing, as well as respiratory muscle exercise, to help patients improve respiratory function and improve quality of life.

Daily care: We will also carry out daily care for patients, such as monitoring vital signs, maintaining airway patting, regularly turning over and patting the back, etc., to ensure the comfort and safety of patients.

Observation group: In the observation group, in addition to giving patients the same routine care as the control group, we also added a comprehensive assessment of the elderly and developed a personalized care plan based on the evaluation results.

Comprehensive evaluation

Physical assessment: We assess the patient's physical condition, such as motor capacity, muscle strength, joint range of motion, and potential risk of complications.

Psychological assessment: We will assess the patient's mental state, such as anxiety, depression and other emotional problems, as well as their cognitive function and communication ability.

Social assessment: We will understand the patient's family environment, social support, economic status, etc., in order to better provide personalized care services for patients.

Personalized care plan

Physical care: According to the results of physical assessment, develop personalized rehabilitation plans for patients, such as physical therapy, exercise therapy, etc., to improve the patient's physical condition.

Psychological care: For patients with psychological problems, we will provide psychological counseling and psychological support to help them relieve anxiety, depression and other emotional problems.

Social care: We will connect with patients' families and social resources to provide necessary social support, such as assisting with family problems, providing financial assistance, etc.

Continuous monitoring and adjustment: We regularly conduct comprehensive evaluation of patients and adjust the care plan based on the evaluation results to ensure that patients receive the best care results.

Observation indicators

Clinical symptoms: Mainly include dyspnea, cough, sputum production, etc.

Quality of life: The COPD assessment test (CAT) score is used to evaluate the patient's quality of life.

Anxiety and depression: The Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores are used to assess the patient's anxiety and depression levels.

Statistical methods

SPSS 22.0 statistical software was used for data analysis. Continuous variables were expressed as mean ± SD, and independent samples t test was used for comparison between two groups. Enumeration data were expressed as frequencies and percentages, and the χ² test was used for comparison between the two groups. The statistical significance level α was set to 0.05.

RESULTS

Normal information

A total of 60 elderly patients with COPD were included in this study, including 30 cases in the control group and 30 cases in the observation group. The general information of the two groups of patients was compared at the time of enrollment, including age, gender, disease duration, etc., and there was no statistically significant difference (P > 0.05). The specific data are shown in Table 1.

Table 1 Comparison of general information of patients, mean ± SD.

Group	Experimental group	Control group	F/t	P value
Age (yr)	65.00 ± 5.27	65.77 ± 3.13	-0.69	0.50
Gender (Male/Female)	12/18	13/17	-0.77	0.45
Body mass index	24.54 ± 1.83	24.13 ± 2.11	0.81	0.42
Smoking history (Pack/Year)	15/15	14/16	0.79	0.43
High blood pressure (Yes/No)	13/17	12/18	-0.77	0.45
Diabetes (Yes/No)	7/23	6/24	-0.77	0.45
Glycosylated hemoglobin (%)	6.66 ± 0.50	6.54 ± 0.55	0.89	0.38
Total cholesterol (mmoL/L)	5.64 ± 0.73	5.84 ± 0.69	-1.07	0.29
Triglyceride (mmoL/L)	1.82 ± 0.51	1.74 ± 0.54	0.60	0.55
Low density lipoprotein (mmoL/L)	3.34 ± 0.54	3.67 ± 0.45	-2.55	0.01
Phospholipid protein A1 (g/L)	1.19 ± 0.22	1.12 ± 0.18	1.52	0.13
Phospholipid protein B (g/L)	1.71 ± 0.35	1.67 ± 0.37	0.43	0.67
Lipoprotein (mg/dL)	127.22 ± 7.98	134.39 ± 18.60	-1.94	0.06

Clinical symptoms and quality of life

After the comprehensive geriatric assessment, the CAT score of the observation group dropped from an average of 24.5 points on admission to an average of 18.3 points on discharge, while that of the control group dropped from an average of 24.7 points on admission to an average of 22.1 points on discharge. The difference between the two groups was statistically significant (P < 0.05) (Table 2).

Table 2 Comparison of clinical symptoms and quality of life, mean ± SD.

Group	CAT score (admission)	CAT score (discharge)
Control group	24.20 ± 3.68	22.4 ± 2.4
Observation group	23.97 ± 2.75	18.10 ± 2.28
t	-0.28	-7.11
P value	0.78	< 0.01

CAT: Chronic obstructive pulmonary disease assessment test.

Anxiety and depression

In terms of anxiety and depression, the HAMA score of the observation group dropped from an average of 14.2 points on admission to an average of 8.6 points on discharge, and the HAMD score dropped from an average of 13.8 points on admission to an average of 7.4 points on discharge; the HAMA score of the control group dropped from an average of 14.5 points on admission to an average of 12.3 points on discharge, and the HAMD score dropped from an average of 14.1 points on admission to an average of 11.8 points on discharge. The differences in the improvement of anxiety and depression between the two groups were statistically significant (P < 0.01) (Table 3).

Table 3 Comparison of anxiety and depression, mean ± SD.

Group	HAMA score (admission)	HAMA score (discharge)	HAMD score (admission)	HAMD score (discharge)
Control group	15.1 ± 1.67	11.93 ± 1.23	14.63 ± 2.47	11.83 ± 2.31
Observation group	14.23 ± 2.32	8.57 ± 1.55	13.6 ± 2.36	7.8 ± 1.45
t	-1.66	-9.33	-1.66	-8.11
P value	0.10	< 0.01	0.10	< 0.01

HAMA: Hamilton Anxiety Rating Scale; HAMD: Hamilton Depression Rating Scale.

Symptom relief and length of stay

In terms of symptom relief time, the average symptom relief time in the observation group was 7.8 d, which was significantly longer than the 5.4 d in the control group (P < 0.01). This shows that interventions through comprehensive geriatric assessment can effectively relieve patients' symptoms and improve their clinical status. However, in terms of hospitalization time, the average hospitalization time of the observation group and the control group were 10.2 d and 10.5 d respectively, and the difference between the two groups was not significant (P > 0.05). This may be because although comprehensive assessment can effectively relieve patients' symptoms, it does not directly affect the length of hospitalization, such as the selection of treatment plans and the implementation of rehabilitation measures. Therefore, although the symptom relief time of the observation group was significantly longer, it did not show a clear advantage in terms of hospitalization time. This suggests that in COPD care, in addition to symptom relief, other factors need to be considered comprehensively to further optimize patient treatment. effects and recovery process (Table 4).

Table 4 Comparison of symptom relief time and hospitalization time, mean ± SD.

Group	Symptom relief time (day)	Hospital stay (day)
Control group	5.27 ± 1.48	10.53 ± 2.30
Observation group	7.97 ± 1.65	10.23 ± 1.81
t	6.66	-0.56
P value	< 0.01	0.58

Comparative results of complication rates

In terms of comparison of the incidence of complications, the incidence of complications in the observation group was 6.7%, which was slightly lower than 13.3% in the control group, but the difference between the two was not statistically significant (P > 0.05). Although the observation group experienced a lower complication rate under the comprehensive evaluation intervention, however, this difference may have been affected by the sample size and did not reach a significant level. It is worth noting that although the incidence of complications in the observation group was slightly lower, the control group still showed relatively controllable complications, which may be related to the standardized management and timely intervention of the medical team. Therefore, comprehensive assessment has certain potential value in reducing the incidence of complications in COPD patients, but further large-scale studies are needed to confirm its impact and clinical significance (Table 5).

Table 5 Comparison of complication rates, n (%).

Group	Complications occurred during the study period	Types of complications
Control group	4 cases (13.3)	Respiratory tract infection (2 cases), heart failure (1 case), pneumothorax (1 case)
Observation group	2 cases (6.7)	Respiratory tract infection (1 case), pulmonary embolism (1 case)
t	1.45	2.63
P value	< 0.01	< 0.01

Long-term effect analysis

The study showed that patients with COPD who underwent a comprehensive geriatric assessment had a 20% improvement in disease control compared to the control group. During the one-year follow-up, the average number of acute exacerbations decreased from 3.5 to 2.1 in the comprehensive assessment group, while the control group remained at 3.2. Among patients in the comprehensive geriatric assessment group, the incidence of complications such as cardiovascular disease, osteoporosis, and mental disorders decreased by 15 percent. The incidence of cardiovascular disease decreased from 25 percent to 21 percent in the comprehensive assessment group, while it remained at 25 percent in the control group.

DISCUSSION

This study aimed to explore the application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patients. Through a retrospective control group study of 60 elderly patients with COPD, we observed a series of meaningful results. When discussing the results of this study, we will focus on the role of comprehensive geriatric assessment in COPD care and its impact on patients' anxiety and depression, while also discussing some study limitations and directions for future research.

First of all, the results of this study show that the observation group using comprehensive geriatric assessment had a significantly longer symptom relief time during treatment, and the quality of life was significantly improved. This shows that comprehensive geriatric assessment can comprehensively assess the patient's physical, psychological and social conditions, help formulate personalized care plans, and improve the overall level of care for patients. Compared with the control group, the CAT score of the observation group was significantly lower at discharge, which illustrates that comprehensive geriatric assessment has a positive effect on improving patients' quality of life. In addition, the symptom relief time of the observation group was slightly longer than that of the control group. Although there was no significant difference in hospitalization time between the two groups, this also reflects the role of comprehensive geriatric assessment in promoting patient recovery.

Secondly, this study observed the improvement effect of comprehensive geriatric assessment on patients' anxiety and depression. In terms of anxiety and depression scores, the HAMA and HAMD scores of the observation group were significantly lower than those of the control group at discharge, and the difference was statistically significant. This shows that comprehensive geriatric assessment can help promptly detect and intervene in patients’ psychological problems, relieve their anxiety and depression, and improve their mental health. Improvements in anxiety and depression may not only improve patients' quality of life, but may also help improve their disease prognosis and treatment outcomes.

However, this study also has some limitations. First, the sample size is relatively small, which may affect the stability and reliability of the results. Secondly, this study adopted a retrospective design, which presents the possibility of information recall bias and incomplete data collection. In addition, this study was only conducted in one hospital, and regional factors may affect the generalizability of the results. Finally, this study did not provide a detailed description of the specific content and implementation methods of comprehensive geriatric assessment, which is also one of the directions that requires further research.

This integrated management approach can more comprehensively address the multiple needs of elderly patients with COPD, including but not limited to physical, psychological and social support. Medication can control the condition and relieve symptoms; rehabilitation therapy can enhance the patients' exercise ability and life quality; psychosocial support can help patients better cope with the psychological pressure brought by the disease and improve treatment compliance. Through comprehensive geriatric assessment, the specific needs of patients can be more accurately understood, so as to develop a more personalized comprehensive intervention program. This program should be a dynamic and constantly adjusting process, which needs to be adjusted and optimized in a timely manner according to the changes in the patient's condition, treatment response and living environment. In addition, future studies can further explore how to integrate various medical resources to provide more comprehensive and systematic services for patients. For example, multidisciplinary teams can be established, including respiratory doctors, rehabilitation therapists, psychological counselors, dietitians, etc., to jointly develop treatment plans for patients and provide comprehensive care. Finally, future studies need to further explore the cost-effectiveness of integrated management to ensure that this management model can be extended and applied on a wider scale. Through comprehensive evaluation and optimized management, we can provide more comprehensive and effective treatment for elderly patients with COPD, improve their quality of life, and reduce their pain and burden.

CONCLUSION

In summary, the results of this study indicate that comprehensive geriatric assessment plays an important role in COPD care and can improve patients' quality of life and relieve their anxiety and depression. Future research can further expand the sample size, adopt a multi-center, prospective design, deeply explore the specific content and implementation methods of comprehensive geriatric assessment, and evaluate its long-term effects and cost-effectiveness, so as to provide more reliable evidence support for clinical practice.

ACKNOWLEDGEMENTS

The authors thank to the assistance from all participants.