Asthma in older adults has been overlooked, understudied, and inadequately treated. While asthma programs targeting the unique needs of children, teenagers, women, minorities, and other populations have been successfully developed, there are currently none for older adults. This is particularly distressing as the asthma hospitalization rates, mortality rates, quality of life, and control are significantly worsein the elderly as compared to other age groups. It is clear that novel approaches are needed to improve the care in this population. Our group has been active in the research of asthma in the elderly. We have analyzed national asthma data sets to look for disparities in older adults, have conducted qualitative research to determine factors associated with poor control in the elderly, and have performed a pilot study of a self- regulation intervention which was able to improve outcomes. We also have over 20 years of experience in asthma self-regulation interventions and physician communication enhancement for multiple populations of asthma patients. We will combine these strengths into our current protocol. The intervention program will be based on the self-regulation theory of behavior, which will enhance the participants' ability to self-manage this chronic condition, actively involve the participant in their own health care management, and produce sustained results. In this application, we will evaluate a self-regulation asthma intervention in a diverse population of older adults. The intervention will be personalized to the challenges and goals each individual faces, which will enhance its applicability in different populations. This intervention will incorporate standard asthma education, complementary techniques for which older adults have expressed a strong interest, and enhanced communication with each participant's physician. Asthma specific outcomes will be assessed at one, six, and 12 months. The primary goal of this intervention is to decrease health care utilization (emergency department, urgent care, hospital, and unscheduled visits) for older adults with asthma. We will also assess the ability to improve quality of life, asthma symptoms, asthma control, lung function parameters, self-efficacy, and cost effectiveness.
The proposed research is relevant to public health because adverse asthma outcomes disproportionally affect older adults, yet very little research has been directed towards this population. The proposed intervention directly addresses the National Institute on Aging's mission of extending and improving the healthy, active years of life.
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