Depressive Symptoms, Low Adherence, and Poor Asthma Outcomes in the Elderly

Abstract

Objective. To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma. Methods. Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patient Health Questionnaire (PHQ-9). Outcomes included asthma control (Asthma Control Questionnaire, ACQ), asthma-related quality of life (Asthma Quality of Life Questionnaire, AQLQ), and acute resource utilization (inpatient and outpatient visits). Asthma medication adherence was evaluated using the Medication Adherence Reporting Scale (MARS). Results. Three hundred and seventeen participants ≥60 years were included in the study (83% women, 30% Hispanic, and 31% Black). In unadjusted analyses, participants with depressive symptoms were more likely to report poor asthma control (p < .001), worse AQLQ scores (p < .001), and higher rates of inpatient asthma-related visits (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.04–3.99). Those with depressive symptoms also reported lower medication adherence (OR: 0.23, 95%CI: 0.10–0.54). Similar results were obtained in analyses adjusting for age, sex, race/ethnicity, income, asthma medication prescription, years with asthma, intubation history, comorbidities, and health literacy. Conclusion. In this cohort of elderly inner-city participants, depressive symptoms were associated with poorer asthma control and quality of life, as well as with lower rates of adherence to controller medications. Future work exploring possible mediators, including adherence, might elucidate the relationship between depression and poorer asthma outcomes in this population.

• asthma
• depression
• elderly
• outcomes
• self-management

Acknowledgments

We thank Liliana Aguayo, Fernando Caday, Diego Chiluisa, Annie Boyd, Nicole Fortuna, Jennifer Lenahan, Rachel O’Conor, and Rina Sobel for their efforts recruiting participants, performing study interviews, and with data collection.

Notes on Contributor

Juan P. Wisnivesky is a member of the research board of EHE International, has received lecture honorarium fromNovartis Pharmaceutical and consulting fees from UBSand IMS Health, and was awarded a research grant fromGlaxoSmithKline to conduct a COPD study.