Frailty, Depression Can Affect Social Support, Self-Management in Older Patients With COPD

Self-management (SM) among older patients with chronic obstructive pulmonary disease (COPD) was considered moderate to low, with frailty and depression playing a partially mediating role in the relationship between SM and social support, according to a study published in BMC Pulmonary Medicine.

The researchers explained that there is currently no effective cure for COPD, so treatment primarily focuses on stabilizing the condition and alleviating symptoms. Consequently, SM in patients with COPD is key to enhancing their quality of life and health outcomes, as affirmed by both the 2023 Global Initiative for COPD (GOLD) guidelines and the Cochrane review.

Despite these confirmations of SM’s benefits, a research gap exists in understanding the relationships between social support, frailty, depression, and SM among older patients with COPD. This is because previous studies reported that most patients with COPD later presented with frailty and mental illnesses, namely depression, which affect SM. Consequently, the researchers conducted a study to explore the underlying mechanisms and strengths of the effects of depression and frailty on social support and SM pathways in older patients with COPD.

“It is expected that, based on the findings, researchers can formulate more targeted care plans and interventions to enhance the biopsychosocial health of elderly COPD patients and improve their SM abilities,” the authors wrote.

Depressed elderly patient | Image Credit: Rido - stock.adobe.com

They created their study population using convenience sampling, selecting older patients with COPD seen at 5 public hospitals in the Ningxia region of northwest China between November 2020 and July 2021. Consequently, their analysis included 627 older patients with COPD, 379 of whom were male and 248 were female. The mean (SD) age of the participants was 72.87 (7.03) years, and most (63.64%) lived in a rural area. Also, most patients (46.57%) had not received education beyond elementary school, and 69.38% used inhalers for treatment.

To conduct the study, the researchers made a questionnaire that used the COPD SM Scale (COPD-SMS), Frail Scale (FS), 15-Item Geriatric Depression Scale (GDS-15), and Social Support Rating Scale (SSRS) to assess SM, frailty, depression, and social support, respectively. They distributed on-site questionnaires at the hospitals, obtaining informed consent from participants. Upon completion, the questionnaires underwent checks for completeness. After, 2 researchers conducted data coding and inputting, with a third person conducting spot checks; in cases of individual missing values, the mean of the variable was used as a replacement.

Out of 255, the mean (SD) total score of the COPD-SMS was 156.99 (25.15), indicating relatively moderate to low SM among the study population. Additionally, the SSRS, FS, and GDS-15 scores were significantly correlated with COPD-SMS (P < .05).

Overall, the mediation effect analysis demonstrated that social support has a direct predictive effect on SM (β, 1.687; 95% CI, 1.359-2.318). The researchers also found that social support can indirectly predict patients' SM through the mediation of depression (β, 0.290; 95% CI, 0.161-0.436) and frailty-depression (β, 0.040; 95% CI, 0.010-0.081). However, they did not find the mediation effect of frailty alone to be statistically significant (β, –0.010; 95% CI, –0.061 to 0.036).

The researchers acknowledged their study’s limitations, one being its design; since it was a cross-sectional survey, some items in the questionnaire had recall bias. Also, the study population was created through convenience sampling of patients at 5 public hospitals in China, so the findings may not be generalizable to broader populations. Based on these limitations, the researchers made suggestions for future research.

“In the future, longitudinal research is needed to explore the SM level, influencing factors, and their change trajectory of elderly COPD patients, and to study the internal mechanisms that affect the patients’ self-management from different perspectives,” the authors concluded.

Reference

Zhao J, Zhang X, Li,X, et al. Unraveling the mediation role of frailty and depression in the relationship between social support and self-management among Chinese elderly COPD patients: a cross-sectional study. BMC Pulm Med. 2024;24:66. doi:10.1186/s12890-024-02889-y