How to determine an impaired health status in COPD: Results from a population-based study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a significantly impaired health status and lost work productivity across all degrees of airflow limitation. The current study investigated whether an impaired health status is better represented by the recommended COPD Assessment Test (CAT) cut-point of 10 points, or the 95th percentile of the CAT score in a non-COPD population. Additionally, the impact of COPD on health status in a Dutch population, after stratification for work status, was measured. METHODS: Demographics, clinical characteristics, post-bronchodilator spirometry, and CAT were assessed in subjects from the Longitudinal Aging Study Amsterdam (LASA), a large Dutch population-based study. Normative values for the CAT score were described by percentiles using the mean, standard deviation, median and range. RESULTS: In total, 810 COPD and non-COPD subjects (50.4% male, mean age 60.5 ±; 2.9 years) were analysed. Significant differences were observed in CAT scores between non-COPD and COPD subjects (6.7 ±; 5.2 vs. 9.5 ±; 5.9, p < 0.001 respectively). The proportion of COPD subjects with an impaired health status differed between applying the CAT ≥ 10 cut-point (50.0%) and applying the 95th percentile of CAT in non-COPD subjects (> 18 cut-point; 7.6%). Higher CAT scores were seen in working COPD patients compared with working non-COPD subjects (9.3 ±; 5.2 vs. 6.0 ±; 4.6, p < 0.001). CONCLUSION: We suggest a CAT cut-point of > 18 points to indicate an impaired health status in COPD. This would imply an adaptation of the current GOLD classification of the disease.

[Lifestyle of Dutch people aged 55-64 years less healthy in 2002/'03 than in 1992/'93]. / Leefstijl van 55-64-jarige Nederlanders in 2002/'03 minder gezond dan in 1992/'93.

OBJECTIVE: To describe the lifestyle of men and women aged 55-64 years in The Netherlands in 2002/'03 and compare it with the lifestyle of people of the same age in 1992/'93. DESIGN: Descriptive. METHOD: Data were used from the Longitudinal Aging Study Amsterdam. The study comprised two randomly selected samples from local municipal registers in 1992/'93 (n = 966) and 2002/'03 (n = 1002), stratified according to sex, age and expected 5-year survival. Participants were from 11 municipalities in the west, northeast and south of The Netherlands. Data were collected from interviews, measurements and a written questionnaire. The response was 62% in 1992/'93 and 57% in 2002/'03. RESULTS: In 1992/'93, 9.5% of the men and 20.5% of the women were obese. Ten years later these percentages were 18.4 and 27.5. The percentage of current smokers was stable over time and included one-third of men and one-quarter of women. More people used alcohol in 2002/'03; excessive alcohol use was found in 15.7% of the men (11.7% in 1992/'93) and 19.5% of the women (11.1% in 1992/'93). The energy expended through walking, bicycling, household activities and sports was one-fifth less in 2002/'03. CONCLUSION: The lifestyle of people aged 55-64 years in The Netherlands was less healthy in 2002/'03 than in 1992/'93. Because positive changes in lifestyle can reduce the risk of chronic diseases, functional limitations and early death, more attention to healthy living is necessary in this age group.

Wishes to die in older people: a quantitative study of prevalence and associated factors.

BACKGROUND: Death thoughts and wishes occur frequently among older people. In different European countries estimates of 10%-20% have been found. AIMS: To determine the prevalence and associated factors of death thoughts and wishes among older people in The Netherlands. METHODS: In The Netherlands 1794 people (58-98 years) were interviewed in 2005/2006 (Longitudinal Aging Study Amsterdam). RESULTS: 81.3% reported never having death thoughts/wishes; 15.3% reported having had such thoughts/wishes; 3.4% reported currently having a wish to die and/or a weakened wish to continue living. Of those with a current wish to die, 67% had depressive symptoms (vs. 32% of people with death thoughts/wishes ever and 9% of people who never had had death thoughts/wishes), and 20% suffered from a depressive disorder (vs. 5% if death thoughts/wishes ever; 0.3% if never death thoughts/wishes). In a multivariate analysis, a current wish to die was associated with having depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment. CONCLUSIONS: Practical implications for health-care professionals are that they should be aware that in certain situations older people are more likely to develop a wish to die, and that a wish to die does not necessarily mean that someone has a depressive disorder. Nevertheless, it should serve as a trigger to investigate and to treat depression if present.