200 Geriatric Nursing Volume 20, Number 4

Feature Article

Very old people make supportive health care promotion very challengingbecause of their high incidence of chronic problems, long exposure toenvironmental toxins, and physiological changes. The ChronicObstructive Pulmonary Disease (COPD) Wellness Program, a joint ven-ture of a community hospital and a rural subsidized housing facility in

western Pennsylvania, was developed to meet that challenge.An apartment building for senior citizens had an increasingly rapid turnover of

residents from independent living to skilled care situations. Such transfers have signif-icant economic implications, but of even greater concern is the loss of independence.The mission of the wellness program was to help the residents with this particularchronic problem maintain their independent status through knowledge and skillsaimed at improved self-management of their COPD.

BACKGROUNDAs a primary intervention, education can play a substantial role in directing

clients to become active participants in self-care.1 Dennis et al.2 found that even mini-mal educational follow-up, such as providing the client with a written list of disease ex-acerbation warning signs and scheduling a follow-up appointment with the primarycare physician, after acute episodes of chronic conditions can decrease hospital read-missions. Pulmonary rehabilitation, exercise training, and nutritional counseling pro-vide elders with the means to effectively self-manage chronic problems, maintain

Abstract: Health care providers can work toward the goal of maintainingquality, dignity, and independence in the elderly when they combine re-sources with the community to promote wellness and help manage chronicproblems. The Chronic Obstructive Pulmonary Disease (COPD) WellnessProgram was undertaken for this purpose. The target participants were el-derly individuals and their care partners who met the program qualifications:a diagnosis or symptoms of COPD and residency in a certain independenthousing facility. The program was designed to help the participants maxi-mize their independence through knowledge and improved management oftheir disease process.

(Geriatr Nurs 1999;20:200-2)

A Joint Effort to Affect Lives

The COPD Wellness ProgramKatherine Monahan, RN, MSN

Geriatric Nursing Volume 20, Number 4 201

independence, and combat the depres-sion so often associated with COPD.

PROGRAM DESCRIPTIONParticipation in the wellness pro-

gram was completely voluntary andprovided as a free service. Invitationswere extended to the residents in a par-ticular housing facility with a docu-mented diagnosis of COPD, thoseexhibiting COPD symptoms, and inter-ested care partners. The participantswere mostly women (only one manjoined the group), two of whom usedcontinuous oxygen therapy.

A multidisciplinary team withmembers from the community hospitaland the housing facility worked to-gether to plan and implement the pro-gram. Each participant’s primary carephysician was provided with informa-tion related to the program objectives(Table 1), and planned activities.

The first phase of the program con-sisted of a six-part educational seriesshown in Table 2. The participants werescheduled to meet once a week for 2hours. Each participant was providedwith the 6-week course schedule at theintroductory meeting. As an added in-centive to participate, attendees’ nameswere placed in a drawing for prizes thatwere awarded after the final session.

In the second phase of the pro-gram, the participants were offered indi-vidual assessments/counseling by anoccupational therapist, registered dietit-ian, and pharmacist; Table 3 discussesthese activities. These assessments wereconducted in the participants’ ownapartment, allowing for confidentialityand individualized problem-solving.Some practical outcomes of this phaseincluded adapting shower tubing forone resident and suggesting assistivedevices for other residents, such as araised commode seat, sock aid, andreacher.

The third program phase consistedof weekly informal support group meet-ings. The goal of these sessions was toreinforce the teaching and help partici-pants incorporate some of the learnedbehaviors into their daily schedules.Each of these eight weekly meetingsfollowed a similar format: practicing

I. Apply learned principles to maintain/improve activities of daily living

II. Increase adherence to physician recommendations

III. Use appropriate measures to maximizeindependent functioning

IV. Decrease COPD-related hospital ad-missions and exacerbations

Table 1. Program Objectives

Schedule Personnel Content

Week 1 • Education specialist, I. IntroductionHome Health Service, II. Normal anatomy and physiologyWashington Hospital

• Pulmonary clinical nurse specialist, Washington Hospital

Week 2 • Education specialist, I. Common lung diseasesHome Health Service, a. AsthmaWashington Hospital b. Chronic bronchitis

• Pulmonary clinical nurse c. Emphysemaspecialist, Washington Hospital II. Lung infections

a. Contributing factorsb. Signs and symptomsc. Preventive measuresd. When to call the physician

III. Environmental triggersa. Cigarettesb. Pollutionc. Weather

Week 3 Registered psychiatric nurse, I. Dealing with anxiety and depressionWashington Hospital a. Definition of anxiety vs. depression

b. Contributing factorsc. Signs and symptomsd. Management and treatment

Week 4 Pharmacist, Presbyterian I. Medication managementSenior Care a. Drug categories

b. Purposec. Inhaled vs. oral route d. Special guidelines

II. Preventive measuresa. Immunizationsb. Smoking cessation

Week 5 Registered dietitian, I. Nutrition/dietary managementPresbyterian Senior Care a. Food pyramid

b. Fluidsc. Sodiumd. Food labels

Week 6 • Pulmonary clinical nurse I. Breathing exercisesspecialist, Washington Hospital a. Pursed lip

• Respiratory therapist, b. DiaphragmaticWashington Hospital c. Controlled coughing

• Occupational therapist, d. Relaxation techniquesWashington Hospital II. Energy conservation

a. Principles of work efficiencyb. Benefitsc. Application to daily activities

Table 2. Course Schedule

202 Geriatric Nursing Volume 20, Number 4

breathing techniques, doing range of motion (ROM) ex-ercises, and practicing relaxation using deep breathingand imagery. Each participant was given a relaxationtherapy tape to use at home. At the conclusion of 8weeks, three of the six support group members reportedparticipation in these activities at home 2 to 3 timesweekly and generally were “feeling better.” Table 4 givessome of their comments.

EVALUATION AND FOLLOW-UPMost of the participants (70%) found the informa-

tion helpful in managing their lung disease and activitiesof daily living. The program also was instrumental inhelping some elders resume previously enjoyed socialactivities. For example, after the program, one partici-pant felt more confident in venturing out because of in-creased endurance and a feeling of greater stabilitywhen walking.

At the 2-month follow-up point, some significantlifestyle changes were reported by the group: four of thesix individuals continued the breathing exercises, ROMexercises, and relaxation techniques at least once ortwice per week. One individual reported no participa-tion in any of the activities, one was unavailable for thefollow-up survey, and one was hospitalized twice—oncerelated to COPD exacerbation and once because of afall injury.

CONCLUSIONIn planning and implementing the COPD program,

the importance of having participant input was rein-forced dramatically. The program initially was scheduledfor the summer. After the first 2 weeks, attendancedropped to a point necessitating cancellation becausethese independent elders maintained a very activeschedule. The team interviewed participants regarding abetter time frame for the program, and they said early inthe afternoon on Tuesdays during the fall would bettersuit them. The program was very well received whenrescheduled according to the participants’ input.

Chronic, debilitating diseases, such as COPD, affectevery aspect of an individual’s mental, physical, and so-cial well-being. Because no cure has been found, thefocus of care needs to be disease management throughlifestyle modifications. Wellness promotion specificallydesigned to increase knowledge of COPD managementstrategies can help emphasize abilities, lessen limita-tions, promote continued activity rather than dysfunc-tion or activity intolerance, and maintain independencerather than allow a slow progression toward depen-dency. The continuity afforded by the COPD wellnessprogram was vital. Following the individuals over timeby reinforcing, reminding, and cueing toward health pro-motion yielded a positive result that education alonecould not accomplish.

REFERENCES

1. Chapman KR. Therapeutic approaches to chronic obstructive pulmonary dis-ease: an emerging consensus. Am J Med 1996;100:5S-10S.

2. Dennis LI, Blue CL, Stahl SM, Benge ME, Shaw CJ.The relationship betweenhospital readmissions of Medicare beneficiaries with chronic illnesses andhome care nursing interventions. Home Healthcare Nurse 1996;14:303-9.

KATHERINE MONAHAN, RN, MSN, is a geriatric clinical nurse spe-cialist for the Washington Hospital Home Health Service inWashington, Pa.

Copyright © 1999 by Mosby, Inc.

0197-4572/99/$8.00 + 0 34/1/1099

Personnel Activity

Occupational therapist, I. Assessment of activities ofWashington Hospital daily living

II. Home management

III. Adaptive equipment needs

Registered dietitian, I. Nutrition assessmentPresbyterian Senior Care II. Diet history

III. Appropriate nutritional care plan

Pharmacist, Presbyterian I. Assessment of current medicationSenior Care regimen

II. Recommend medical follow-up asappropriate

Table 3. Individual Activities

Satisfaction with the program/outcomes

“I never thought this would work, but I’m glad I stayed with it,it really works.”

“I love this. I feel so much safer now, especially when I get outof bed at night.”

“I can walk to my car with no problem now.”

“My arms feel better; they’re easier to use.”

“I only need two breathing treatments now; I did need four.”

Camaraderie/sharing of ideas

“Here’s how I season my chicken.”

“Try the (relaxation) tape, it really works.”

Lifestyle changes

“I do the (ROM) exercises 2 to 3 times every week.”

“The relaxation tape helps me rest better.”

Table 4. Comments from Participants