Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition - American Geriatric Society

Objectives

To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons.

Design

Cross-sectional.

Setting

Cardiovascular Health Study.

Participants

Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% <high school education, 54.7% ever-smokers).

Measurements

Dyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV₁)), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle–brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI).

Results

In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV₁ less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37–3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61–2.73), depressive symptoms (CES-D score ≥16; aOR = 2.02, 95% CI = 1.26–3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67–2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31–1.71).

Conclusion

In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.

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