Co-morbidity in older patients with COPD--its impact on health service utilisation and quality of life, a community study.

BACKGROUND co-morbidity has been shown to be an important consideration in COPD with an estimated prevalence of 84%. In the Netherlands, a weak association between health-related quality of life and lung function has been found, with a closer link to co-morbidity. OBJECTIVE to determine the influence of co-morbidity on quality of life and health service utilisation in older patients with COPD in the community. DESIGN observational cohort study. SETTING general practice in the North East of England that has a list size of 8300. PARTICIPANTS 27 patients aged 70 years or above on the practice COPD register. MEASUREMENTS data on age and sex, spirometry to confirm the diagnosis of COPD, questionnaires to assess quality of life, activities of daily living (ADLs) and co-morbidity. Health service utilisation was recorded by the number of primary and secondary care attendances in the previous year. RESULTS 10 had mild, 12 had moderate, and 5 had severe disease. Mean age was 76 years. Quality of life (QOL), co-morbidity and health service utilisation measurements were not significantly different between COPD severity groups. There was a significant positive correlation between increasing co-morbidity and poor QOL (r = 0.45, P < 0.05), and significant negative correlation between co-morbidity and ADL scores (scored inversely), r = -0.54, P < 0.05. Significant negative correlation was found between co-morbidity and primary care attendances (r = -0.41, P < 0.05) and significant positive correlation between worsening QOL and secondary care attendances (r = 0.46, P < 0.05). CONCLUSIONS co-morbidity has an important part to play in COPD assessment, more accurately reflecting QOL in our population. Health service utilisation did not correlate to forced expiratory volume (FEV1)-defined COPD severity.