Alvi A. Rahman, from McGill University in Montreal, Quebec, and colleagues examined whether gabapentinoid use is associated with severe exacerbation in patients with COPD in a propensity score-matched, new-user cohort study. Within a base cohort of COPD patients, those initiating gabapentinoid therapy with an indication were matched with nonusers. The cohort included 356 gabapentinoid users with epilepsy, 9,411 with neuropathic pain, and 3,737 with other chronic pain who were matched to nonusers in a 1:1 ratio.

The researchers found that gabapentinoid use was associated with an increased risk for severe COPD exacerbations compared with nonuse overall (hazard ratio, 1.39) and across the indications of epilepsy, neuropathic pain, and other chronic pain (hazard ratios, 1.58, 1.35 and 1.49, respectively).

“These findings support the warnings from regulatory agencies and highlight the importance of considering this potential risk when prescribing gabapentin and pregabalin to patients with COPD,” the authors write.

The study was partially supported by a grant from Boehringer Ingelheim.

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David M. Levine, MD, MPH, from Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues report on the early national experience of the AHCaH waiver, issued in November 2020, creating a regulatory and payment pathway for hospitals to deliver AHCaH. A total of 5,132 patients with a medical diagnosis who received AHCaH between July 1, 2022, and June 30, 2023, were identified, representing 5,551 admissions.

The researchers found that patients receiving AHCaH were medically complex, with a mean hierarchical condition category score of 3.15; 42.5, 43.3, 22.1 and 16.1% had heart failure, chronic obstructive pulmonary disease, cancer and dementia, respectively. Heart failure, respiratory infection, sepsis, kidney or urinary tract infection, and cellulitis were the five most common discharge diagnoses. The mean length of stay was 6.3 days; the escalation rate was 6.2% and the mortality rate was 0.5% during hospitalization. At 30 days after discharge, the mortality, skilled nursing facility use, and readmission rates were 3.2, 2.6 and 15.6%, respectively.

“Our data provide preliminary evidence on national uptake and suggest that AHCaH is an important care model to manage acute illness, including among socially vulnerable and medically complex patients,” the authors write.

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I have spent most of my career focused on product development and design, most recently for Wellinks, a digital health company focused on cardiopulmonary conditions, which predominantly affect older adults. I know firsthand the dedication required to create solutions that are beneficial to all users. Engaging older adults isn’t impossible, but it isn’t a passive process. Companies must be willing to put in the time and energy.

Over the years, I have had valuable conversations with older adults and providers alike, constantly tweaking our approach and striving to find the perfect recipe for digital health tools that meaningfully engage older adult users outside of a brick-and-mortar physician’s office. For those interested in helping to make tech easier for older adults to adapt, in designing tech for older adults, or in taking a peek into the design process, here are four strategies I’ve found successful.

1. Demonstrate value up front.

For those who may not use technology regularly, it can be more difficult to see the big-picture effect of maintaining consistent engagement with digital solutions. Being asked constantly to input data without seeing any results can be frustrating, and it can make users question why they’re even engaging in the first place.

With this in mind, we should strive to create digital health tools that constantly demonstrate their value, making clear how each user action helps drive results and make a difference in the care journey. By helping users see both the short and long-term benefits — such as celebrating quick wins or establishing a baseline for daily readings — we can excite them about their results and empower them to continue adapting to new solutions.

2. Meet users where they are.

In many cases, people are fully excluded from digital health opportunities if they don’t have access to or feel comfortable using technologies such as smartphone apps. Rather than expecting older adults to learn completely new modes of technology, companies providing digital health services should be flexible with their offerings.

For example, if someone doesn’t own a smartphone or tablet, then there always should be options for them to engage with similar resources via email, text message or voice calls. Kicking off a user’s digital health journey with methods already familiar to them helps create a foundation of trust and comfort, making them open to being coached through incorporating new technologies down the road. If we commit to meeting users where they are, then we will open doors to quality care for a broader population.

3. Build technology as a window for personal connection.

It’s a common misconception that virtual care replaces human connections. Although it is true that digital health tools can offer alternatives to in-person physician visits, it’s best to think of those solutions as new windows for building human connections.

Fostering positive relationships with care providers helps users avoid the feeling of aimlessly inputting information into an app. Connecting with older residents and patients virtually builds trust and comfort in the process. Those relationships are the key to addressing the care gaps between in-person visits and improving continuity of care.

4. Prioritize accessibility.

When designing digital health solutions, it’s essential to make components user-friendly and accessible to encourage the consistent engagement necessary to be effective. Virtual care designers should prioritize things such as page scalability, screen reader compatibility, clear information hierarchies and a focus on making all elements as simple as possible. Keeping accessibility front and center in product development lets users know you are dedicated to their success.

Older adults managing chronic diseases have plenty to gain from accessing virtual care solutions, and the onus is on those of us offering those services to ensure that our tools work for those who need them most.

Excluding older adults from technologic advancements based solely on their age and perceived unwillingness to learn is an overused excuse. So what if virtual care tools didn’t exist when our seniors were born? For many, neither did computers or microwaves, but this reality hasn’t stopped our grandparents from learning to comment on our social media posts or heat up their coffee. Why should it keep them from receiving quality healthcare?

Research conducted during the pandemic identified a 300% increase in the overall use of telemedicine services among older adults, indicating both willingness and ability to adopt those tools.

The senior living industry must resist the misconception that technology always is a barrier for older people and instead normalize adapting offerings to maximize value for all users, regardless of their age or level of familiarity with tech. Doing so creates meaningful opportunities for those users to gain more confidence in their self-management abilities, establish a better understanding of when intervention may be necessary, and check in more frequently with medical professionals invested in their well-being.

Especially in senior living communities, where older adults are more likely to experience mobility challenges and require assistance attending in-person doctor visits, we have a heightened responsibility to provide more accessible healthcare options that meet residents where they are. With more than 60% of adults aged more than 65 years owning smartphones as of 2021, the foundation for reaching residents already is there. Building it up and integrating digital health solutions is a natural next step.

Virtual care is here to stay, so it is time we start working harder to make those solutions an option for everyone.

Ellen Su is chief product officer for Wellinks, a digital health company focused on cardiopulmonary conditions.

The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.

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Ali M. Alasmari, from the National Heart and Lung Institute at Imperial College London, and colleagues conducted a randomized trial involving stable COPD patients with home SBP measurement ≥130 mm Hg. Participants were randomly assigned to 70 mL of nitrate-rich beetroot juice (400 mg NO₃) or an identical nitrate-depleted placebo juice once daily for 12 weeks (40 and 41 patients, respectively).

The researchers found that active treatment lowered SBP (Hodges-Lemman treatment effect mean difference, −4.5 mm Hg), improved 6-minute walk distance (+30.0 m), and improved measures of endothelial function (reactive hyperemia index [+0.34] and augmentation index [−7.61%]) compared with placebo.

“There is some evidence that beetroot juice as a source of nitrate supplementation could be used by athletes to improve their performance, as well as a few short-term studies looking at blood pressure. Higher levels of nitrate in the blood can increase the availability of nitric oxide, a chemical that helps blood vessels relax. It also increases the efficiency of muscles,” lead author Nicholas Hopkinson, PhD, also of Imperial College London, said in a statement. “This is one of the longest-duration studies in this area so far. The results are very promising, but will need to be confirmed in larger, longer-term studies.”

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Elroy Boers, PhD, from ResMed Science Center in Halifax, Nova Scotia, and colleagues conducted a modeling study to examine the global burden of COPD through 2050 considering COPD risk factors. Generalized additive models were developed, which included smoking prevalence, indoor and outdoor air pollution, and development indices as predictors to project global COPD prevalence.

The researchers estimate that from 2020 to 2050, the number of COPD cases will increase by 23% globally among those aged 25 years and older, approaching 600 million patients with COPD globally by 2050. The growth in COPD burden was projected to be largest among women and in low- and middle-income regions. By 2050, the number of cases in women was projected to increase by 47.1% compared with a 9.4% increase in men, and the number of cases in low- and middle-income regions was projected to be more than double that of high-income regions.

“Further research, prevention, and advocacy is needed to address these issues so that adequate preparation and resource allocation can take place,” the authors write.

Several authors disclosed ties to ResMed, which funded the study.

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Jos Lelieveld, PhD, from the Max Planck Institute for Chemistry in Mainz, Germany, and colleagues estimated all-cause and cause-specific deaths attributable to fossil fuel-related air pollution. The analysis included data from the Global Burden of Disease 2019 study and observational fine particulate matter and population data from the National Aeronautics and Space Administration.

The researchers estimated that globally, there are 8.34 million all-cause excess deaths per year due to fine particulate and ozone air pollution. Most of this mortality burden is tied to cardiometabolic conditions (52%), including ischemic heart disease (30%) and stroke and chronic obstructive pulmonary disease (16% for each). Globally, an estimated 5.13 million excess deaths annually are attributable to ambient air pollution from fossil fuel use and therefore could potentially be avoided by phasing out fossil fuels (~82% of the maximum number of air pollution deaths). Rather than a complete phase-out, smaller reductions indicate that responses are not strongly nonlinear. 

“Phasing out fossil fuels is deemed to be an effective intervention to improve health and save lives as part the United Nations’ goal of climate neutrality by 2050,” the authors write.

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Editorial

Wearables may be the most effective form of monitoring technology for assisting older adults with respiratory conditions, a new study shows.

Any remote monitoring capabilities, including passive systems within long-term care facilities, could critically assist with respiratory concerns. 

The need to track residents’ respiratory health has been highlighted by the many people who have had lung and breathing problems following COVID. 

Overall, almost a fourth of older adults end up developing long-COVID symptoms, the Centers for Disease Control and Prevention found.

The high number of older adults with some compromised lung function following even mild COVID cases could turn into a broader “wave” of chronic lung disease, the McKnight’s Clinical Daily reported last year.

“Patients with chronic respiratory diseases and those in the post-discharge period following hospitalization because of COVID-19 are particularly vulnerable,” the study authors warn, “and little is known about the changes in their symptoms and physiological parameters.”

The study on respiration involved 60 hospital patients diagnosed with lung disease. It evaluated a handful of commercially available monitoring options, including wearables, passive sensor systems, smartphone apps and finger pulse oximeters.

Overall, both passive systems and “lowest-burden” methods were used more frequently by the study participants, who wore monitoring devices for the majority of the day, or approximately 19 hours, the researchers found. 

The participants were significantly less likely to report symptoms via a questionnaire or breathing test. But even with the latter, a majority of study participants (60%) used a breathing test when requested by a clinician, and 90% of such tests were completed correctly, the study indicated. 

Future research on respiratory illness and technology could focus on how care teams can most effectively collect data and coordinate with seniors to make sure they are reporting symptoms effectively, the study authors suggested.

In addition to COVID, insomnia is another condition that commonly puts seniors at risk for respiratory infection and complications, studies have shown.

Yong Liu, MD, from the U.S. Centers for Disease Control and Prevention, and colleagues assessed trends and differences in self-reported physician-diagnosed COPD prevalence among US adults using data from the 2011 to 2021 Behavioral Risk Factor Surveillance System.

The researchers observed no significant change in age-standardized prevalence of COPD from 2011 to 2021 (6.1 to 6.0%). For most states and subgroups, prevalence was stable; however, among adults aged 18 to 44 years, prevalence decreased significantly (average annual percentage change [AAPC], −2.0%), and it increased significantly among those aged ≥75 years, those living in micropolitan counties, and among current or former smokers (AAPCs, 1.3, 0.8, 1.5 and 1.2%, respectively). Among women, adults aged ≥65 years, those with a lower education level, those unable to work, those living in rural areas, and ever smokers, the prevalence of COPD remained elevated.

“Strategies can be tailored to address the prevention of COPD-related risk factors and the needs of adults disproportionately affected by COPD, including persons aged ≥75 years, those who ever smoked, and residents of rural areas,” the authors write.

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Loes Oostrik, from Utrecht University in the Netherlands, and colleagues evaluated the relationship between symptom burden and MVPA in individuals from a population-based sample mirroring the general population. The analysis included 406 participants with mild COPD, 287 participants with moderate COPD, 347 healthy individuals, and 474 individuals at risk for developing COPD.

The researchers found significant associations between high symptom burden and lower MVPA levels in the overall COPD sample (β = −717.09) and in the moderate COPD subgroup (β = −694.1). COPD was previously undiagnosed in 72% of the participants with COPD. Compared with individuals with physician-diagnosed COPD, the undiagnosed participants had significantly higher MVPA (β = −592.41). 

“It can be difficult and scary to exercise while experiencing symptoms like breathlessness,” Stephanie Williams, RRT, the COPD Foundation vice president of education and engagement, said in a statement. “However, regular exercise like gentle yoga and walking — under the supervision of a doctor — can improve COPD symptoms and quality of life for those living with the disease.”

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Artificial intelligence is being used to screen for several conditions that commonly afflict older adults, and a recent AI-enabled analysis has gleaned new insights into chronic coughing, which disproportionately afflicts elderly women, researchers said.

Although coughing itself is mostly an uncomfortable nuisance, chronic cases can be caused by more serious underlying conditions, such as an illness or hazardous air quality, exports note. 

Perhaps most ominously, chronic coughing can be a symptom of long-COVID; approximately one-fourth of older adults who contracted COVID have at least one long-term symptom, such as coughing, according to the National Institute on Aging.

The new coughing study comes from data collected by Hyfe, a company that has developed an AI-enabled app that specifically tracks respiratory conditions.

Almost three-fourths of those with chronic cough are aged more than 55 years, and 70% of the older cohort are women, according to Hyfe’s findings, which were announced in late October. The majority of chronic coughers in the 4,000-person sample cough more than 450 times a day, Hyfe reported. 

In addition, 20% of respondents said that their chronic coughing has been an issue for 10 years or more, the research showed. 

Although the AI study linked somewhat benign comorbidities such as asthma and allergy to the coughing, a more concerning linkage was coughing and chronic obstructive pulmonary disease.

The latter can be improved by technology such as air purifiers and other methods to remove indoor air pollutants, the McKnight’s Clinical Daily reported last year.

Even among older adults who never have smoked or had respiratory issues before, episodes of coughing could signal greater mortality risk, studies have suggested.

On the flipside, just because an older adult is coughing doesn’t mean his or her life is in danger. There are different kinds of coughs, including wet, dry and spasmodic. 

The most common cause of chronic coughing is postnasal drip, which often is a harmless — albeit annoying — condition caused by normal temperature and weather fluctuations, as one senior living operator has noted.