This project is a direct outgrowth of the R01 """"""""Assessing the Occupational Burden of COPD,"""""""" and is the resubmission of a competitive renewal of that R01. Although COPD is common and costly, prevalence statistics and economic estimates alone cannot capture its impact on individuals. COPD leads to a host of physical and cognitive limitations and is strongly linked to work disability and limitations in activities of daily living. COPD may also cause difficulty in a wide array of other life activities, such as socializing with friends, traveling, or participating in hobbies, although this is less studied. The wide range of activities that individuals find meaningful or pleasurable, above and beyond activities necessary for survival or self-sufficiency, is what we term """"""""valued life activities"""""""" (VLAs). Performance of VLAs appears to be strongly linked to psychological well-being and satisfaction with function. Disability in VLAs has been shown to be a stronger predictor of the subsequent onset of new depressive symptoms than decline in general function. This study will delineate the pathways linking airways disease, and COPD specifically, to physical and cognitive functioning, and, in turn, linking functioning to disability, and disability to psychological distress;and identify factors that may modify those pathways, building on the Verbrugge and Jette model of disablement. Data will be collected in four annual telephone interviews and two home visits. Items to assess VLA disability and psychological outcomes, as well as questions about potential risk and protective factors for VLA disability and psychological distress, will be included in the interview. Lung function, biometric, and performance data will be collected in home visits. Analyses based on the study model (Figure 1) will focus on 3 major areas: (1) delineating the pathways leading to disability and distress among individuals with COPD over a 4-year period, (2) identification of factors associated with maintenance of VLAs after development of functional limitations, and (3) identification of factors associated with maintenance of psychological well-being after VLA disability. Statistical models will be developed to describe these relationships in the context of the study model, using both cross-sectional and longitudinal analyses. The findings from this study will provide information that may help minimize VLA disability and the psychological distress that might result from VLA disability, thereby improving quality of life of persons with COPD.
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