Population group
An at-risk population’ refers to a group more susceptible to experiencing adverse health outcomes or contracting certain diseases than the general population (Merrill, 2024). One such population in Canada is comprised of older adults. Sherrington et al. (2020) define an older adult as 65 or older. Older adults form a significant part of Canada’s population, standing at 19% in the census of 2021 (Statistics Canada, 2023).
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the lungs and the airway, comprising chronic bronchitis and emphysema. COPD is the second most common obstructive lung disease in Canada after asthma, as reported by (Canada et al., 2019). COPD typically affects people aged 35 years or older. Hence, it is a significant public health concern among the elderly in Canada (Farooqi et al., 2022).
Older adults are at higher risk of contracting COPD due to a myriad of reasons. Advancements in age are associated with decreased immunity levels, which can predispose the elderly to respiratory infections. Tan et al. (2020) report that respiratory infections are the most common culprits of COPD exacerbation. Moreover, long-term exposure to smoking and other lung irritants with age damages the airways, increasing the risk of COPD. Finally, the existence of medical comorbidities in older adults coupled with reduced physical activity contributes to a higher risk of COPD. For instance, cardiovascular disease, diabetes and obesity can increase the risk and severity of COPD.
Failure to treat COPD among the elderly would cause disease progression with worsening symptoms. This would lead to increased shortness of breath, chronic cough and wheezing. Hurst et al. (2020) note that the effects of untreated COPD include reduced quality of life, increased hospitalizations due to acute exacerbations of COPD coupled with respiratory complications and higher mortality rates among the elderly. Overall, there would be increased healthcare costs and strain on the healthcare system.
Risk factors
Older adults in Canada are predisposed to COPD due to various risk factors. According to Singh and Bharti (2021), risk factors for COPD are categorized into modifiable and non-modifiable risk factors. Modifiable risk factors are related to behaviour and can be altered via lifestyle modification. One of the modifiable risk factors for COPD is environmental exposure to irritants such as smoke that predispose the elderly to COPD. Occupational exposure is another modifiable risk factor. Long-term exposure to inhaled chemicals at the workplace necessitates the respiratory system, increasing COPD risk among the elderly in Canada ((Bălă et al., 2021). Poor indoor air quality coupled with household chemicals and fuel smoke contribute to acute exacerbation of COPD among the elderly. This can be changed by applying indoor air filters and increased air ventilation in the house.
Behaviours such as reduced physical activity among the elderly contribute to increased risks of COPD. According to (Osei et al., 2020), tobacco smoking is one of the major behavioural risk factors leading to COPD among the elderly in Canada. Tobacco smoke contains chemicals that cause prolonged inflammation of the airways, leading to reduced elasticity of the lungs associated with reduced respiratory function. Tashkin (2021) reports that smoking cessation is an essential factor in controlling COPD exacerbations. Moreover, poor diet among the elderly may increase the risk of COPD. Kim, Choi, and Kim (2020) categorize people aged 65 and over as immunocompromised, suggesting that their immunity largely relies on diet. A diet low in vegetables and fruits increases the risk and the severity of COPD symptoms among the elderly (van Iersel et al., 2022). A balanced diet coupled with increased fruit and fluid intake is essential for maintaining respiratory health and decreasing the risk of COPD among the elderly (Wallace et al., 2020).
Non-modifiable risk factors are the risk factors that cannot be changed. They can only do so if intervention is at an early stage and the health workers put prevention measures in place for the at-risk population. According to (Zinnatullina, & Khamitov, 2021), advanced age is a non-modifiable risk factor for COPD. Advancement in age is directly proportional to the incidence of COPD in Canada (Canada et al., 2019). Research has suggested that COPD has a genetic basis. Moll et al., 2020) reported that family studies have shown an increased risk for COPD among individuals with a positive family history of COPD. The risk of COPD is significantly higher if a first-degree relative has COPD. Studies have consistently found higher concordance rates among monozygotic twins, suggesting that genetics contribute to susceptibility to COPD among all age groups, including the elderly.
Finally, research has shown that COPD is more prevalent among older men compared to women of the same age, with a ratio of 2:1 (Levin, K, Anderson & Crighton, 2020). However, it is thought that modifiable risk factors that are more prevalent in men (such as smoking patterns) affect the differences in the prevalence of gender.
Nursing role
The nurse plays a crucial role in supporting health changes and mitigating the risk of COPD among the elderly in Canadian communities. In line with the population health model, the nurse has a role in the prevention, health promotion, protection, diagnosis and treatment care for COPD (Canada et al. A, 2013). Firstly, the nurse has a role in raising awareness of risk factors for COPD and necessary prevention modalities. The nurse should educate the elderly on the detrimental effects of smoking on the respiratory system, for instance, and the importance of smoking cessation in controlling COPD and its exacerbations. Additionally, the nurse should educate the elderly on the role of regular physical activity, balanced nutrition and avoiding indoor air pollutants.
Moreover, the nurse will regularly screen for COPD risk factors among the elderly. Spirometry and respiratory assessments are essential tests to identify people at risk for COPD at an early stage (Laucho-Contreras et al., 2020). Early detection will allow for preventive measures to be done. For already affected populations, early treatment can be initiated to prevent disease progress and exacerbations of COPD.
Nurses can connect elderly individuals to community resources and support networks to enhance their social support and coping mechanisms. Groups such as Tobacco Anonymous can help elderly clients to cease tobacco smoking. Good social support can encourage perseverance in implementing required lifestyle changes to reduce the risk of COPD (Andreou et al., 2022).
Finally, the nurse should advocate policies and initiatives encouraging COPD prevention. Collaborating with local leadership and policymakers to promote early detection, screening, health promotion education and access to quality healthcare on COPD for the elderly as a public health concern could help reduce the risk of COPD among the elderly (Canada et al. A, 2013).
In conclusion, nurses play multiple roles in caring for the elderly in Canada to mitigate COPD risk and foster positive health and lifestyle changes within society. Nurses, with the help of education, screening, care plans tailored for individuals, medication management, development of self-management skills, linking to community resources and advocacy, contribute to improved respiratory health and enhanced quality of life among the elderly, reducing the risk of contracting COPD.
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