Nursing Assignment: Asthma Management in Older Adults

This report presents a systematic literature review focusing on the challenges of asthma management in elderly patients. The study investigates the impact of comorbidities, medication adherence, and under-diagnosis on the treatment of asthma in older adults. The methodology includes a comprehensive search across multiple databases such as CINAHL, PubMed, Google Scholar, Medline, and EMBASE, using specific search terms and Boolean operations to identify relevant articles published after 2009. The review analyzes 106 articles initially, narrowing down to 35 for a second screening, and ultimately including articles that met specific inclusion and exclusion criteria. The findings highlight the complex interplay of factors such as aging pathophysiology, under-diagnosis, and co-morbidities that contribute to poor asthma management in the elderly population. The report aims to identify interventions that can improve asthma symptoms and enhance the quality of life for older patients. The conclusion emphasizes the need for improved diagnostic strategies, tailored treatment plans, and a better understanding of the challenges faced by elderly patients with asthma. This report is contributed by a student and is available on Desklib.

Running head: NURSING ASSIGNMENT
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Name of the student:
Name of the university:
Author note:

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Abstract:
Asthma is an incurable health condition of the respiratory system which causes
respiratory suffering in patients. The disease roots irritation and narrowing inside of the lung,
limiting air supply. This respiratory condition has a major influence on aged population. It
has been observed that elderly patients suffering from asthma remain at high risk of
witnessing ill health due to asthma and the death rate is also found to be high. And the main
reason behind the issue is the ageing pathophysiology. In older patients, the under-diagnoses
of asthma are quite common hence the under-treatment occurs. And it has been observed that
management of aged asthma patient is challenging. In this systemic literature review, the
research problem considered will focus on the poor management of elderly asthma patient
and the research question “what interventions can provide better progress in asthma
symptoms for elderly asthma patients?”. The purpose of conducting this systematic review is
to develop a proper understanding about the interventions which can be helpful for aged
asthma patients and highlighting the factors that are creating challenges for these patients.
The review was performed in a planned and thorough way using proper database. The results
and conclusion has been provided in the paper.

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Table of Contents
Introduction:...........................................................................................................................3
Aim:........................................................................................................................................5
Objective:...............................................................................................................................5
Methodology:.........................................................................................................................6
Standards for including the studies:.......................................................................................6
Identification of studies:.........................................................................................................7
Study selection:......................................................................................................................8
Data extraction:......................................................................................................................9
Quality Assessment:...............................................................................................................9
Data Analysis:......................................................................................................................10
PRISMA Flow chart:........................................................................................................11
Results:.................................................................................................................................12
The impact of comorbidity on the treatment challenges in elderly people with asthma
disease..............................................................................................................................13
Challenges in the medication management and the adherence in elderly population
suffering with asthma.......................................................................................................14
Challenges due to the under-diagnosis of asthma in elderly people................................17
Appendix:.............................................................................................................................21
Discussion:...........................................................................................................................31
Conclusion:..........................................................................................................................38

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References:...........................................................................................................................41

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Introduction:
Asthma is a medical condition where the airways of the respiratory system starts becoming
narrow and swollen and excessive amount of mucus production is observed, causing
difficulty in breathing and induces, wheeziness, coughing and rapidity of breath (Ozturk &
Iliaz, 2016). According to th study conducted by the World Health Organization in the year
2016, it was reported that around 383000 death occurred throughout the world because of
asthma (World Health Organization, 2017). These death cases have become a major concern
for public health care in high revenue as well as low and mid revenue countries. And the most
of the cases of asthma related deaths are from low and mid income countries (D’amato et al.,
2015). Asthma is recognised as a disease of earlier adults but the death rate has been seen to
be higher in adults beyond 55 years of age. The disease is common in adults beyond the age
of 65 years and the risk is related to those of the younger asthma suffering patients (Gillman
& Douglass, 2012). The diagnosis of the disease can decrease the psychological and physical
value of life of older individuals. It is also being observed that the burden of disease has
increased with age and people in the age group of 75-79 witness the utmost effect
(globalasthmareport.org, 2014). The health management of asthma in older individuals gains
more attention because of the uneven burden of the disease in older and various risk factors in
the older group.
With the increasing aged people, the burden of the health care system should be
reduced focusing on the diseases that are common is elder population. The risk of asthma in
older people increases as their pulmonary tract changes because of ageing, challenges while
diagnosing and sever effects of treatment because of co-morbidities. These factors induce
challenges and complications for healthcare facilities while treating an elderly patient with
asthma. A review literature proposes under-diagnosis can be one of the management
experiments in asthmatic elder population. Pandya et al. (2016) stated that diagnosis is

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complicated because most of the cardiovascular diseases mimic symptoms of asthma mostly
found in older population compared to the younger once. Chronic airflow hindrance and
symptoms of asthma may also get misdiagnosed as chronic bronchitis. Unpredictable
outcome in spirometry also induces challenges in elderly population (Gillman & Douglass,
2012). This research was not a population based and as it was conducted in a particular
hospital, only a narrow information was provided regarding the elderly asthma patient
diagnosis challenges. Benfante and Scichilone (2016) examined management challenges in
older individuals surfing from asthma and the research disclosed that less number of studies
have assessed the effect of various co-morbidities for controlling symptoms of asthma in the
elderly population. The research generally highlights the fact that there are various areas for
additional research for asthma management in older population.
The gaps in the research data remains concerning suitable mediations to overcome
some management challenges in asthma patients, performing a systematic review of
literature, focusing on the identification of the challenges in the asthma disease management
is essential. The systematic review and analysis of the research article focusing on the
involvements for asthma management and the connected issues can help in understanding the
barriers in the recovery process and refining the standard of life for the elderly asthma
patients. The main issue identified in the paper is the occurrence of the disease in elderly
patients and the growing health burden because of bad management in health care services.
The question in the research that would help in guiding the systematic review is as follows:
what interventions can provide better progress in asthma symptoms for elderly asthma
patients?

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Aim:
The aim of the research is to progress on an understanding of all the variety of
interventions for older people suffering from asthma and the factors that are increasing the
challenges in the elder population, using systematic review.
Objective:
The key objectives of the systematic review are:
 To achieve understanding about the management of the elderly asthma patients
 To know the properties of the interventions for the older asthma population
 To assess interventions executed for the management process for aged people.
Methodology:
For the aim of alignment of the result of the research at the end of the study with the
objective defined at the primary stage, it was found to be beneficial to perform the systematic
review. According to LoBiondo-Wood and Haber (2014), systematic review of a literature is
inclusive yet informative which focuses on empathy and following synthesis of current
studies. The main purpose of such studies is to précis the key findings of the present studies.
The systematic review of literature intended to associate important and significant research
outcomes on the management of the asthma disease in the elderly population so that the
participants remain informed about the exercise changes in the healthcare services in relation
to the management of asthma illness. In the systematic literature appraisals, the integrative
valuation of important data is organized from a chunk of information so that suitable
assumptions can be strained from it. As stated by Alligood (2017), a systematic review of
literature is to be taken as a process determined and inclusive review that centres on a specific
question. A refined methodology is to be followed for permitting a better result of the review.

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Standards for including the studies:
The inclusion and exclusion standard that is considered in a systematic review are the
reason behind setting limitations of the study. The two groups of standards expressed after
the question of the research is agreed, and before performing the research the search of the
essential articles are accompanied. Diverse factors can be considered as the inclusion and
exclusion standard (LoBiondo-Wood & Haber, 2014). These inclusion standards are the set
of features that the study selected should possess and the exclusion standard are the set of
features that prohibits the article from being incorporated in the systematic review. And for
this systematic review literature these standards of inclusion and exclusion was set early. The
inclusion standard comprised peer-reviewed research journals that has being recovered from
various sources and only those articles were selected, whose full excess was available. The
other criteria for the inclusion was the year of publication, which was after the year of 2009
and those who were available in English language. At last, the articles which had human
participant in them were important for the review purpose. Articles of last ten years were
taken in to account for developing main inferences from updated and current studies in
contrast to developing healthcare facilities in relation with asthma (Alligood, 2017).
Exclusion standards therefore were partial copy articles, those which were not published in
English and were before the year of 2009, and absenteeism of human volunteers in the
research. Articles from throughout the world were measured for growing the generalisability
of the research findings.
Identification of studies:
Databases- Electrical databases are influential and consistent tools that can be used by the
researchers throughout the world to engage in the secondary research which includes
systematic literature review. Suitable electrical databases need to be recognized and used for
performing the systematic examination successfully (LoBiondo-Wood & Haber, 2014). There

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are an extensive range of electrical databases that are useful in healthcare research. For the
systematic review, the databases that were kept in account were CINAHL, PubMed, Goggle
scholar, Medline and EMBASE. All these databases are the most commonly used databases
for retrieving a varied series of research articles in the field of research topic. It is very simple
to get access to the full-text articles from all these databases and getting access to diverse
research journals is potential, and as peer reviewed articles are used, these databases
comprise of a huge assortment of the most current information and lessons.
Search Terms-Search terms are a very critical part in any kind of systematic review of
literature. These are the short phrases, terms or words that are used in searching the
applicable articles in an electrical database. The terms mostly relay to the objectives of the
research. The use of these suitable terms sorts the research method in a faster and convenient
manner (Peters et al., 2015). For this systematic review, the search terms that is used were
“elderly”, “aged”, “senior”, “asthma”, “respiratory illness”, “respiratory disorder”, “asthma
attack”, “respiratory disease”, “older”, “adult”, “grownup”, “elder”, “senior”, “management”,
“administration”, “supervision”, “difficulty”, “exertion”, “challenge” “trail”, “cure” and
“treatment”.
Boolean Operation- The usage of proper search terms is not the only sufficient aspect for
constructing the search an easy method. The use of Boolean operations comes into account in
this respect. These operations are reasonable terms that the researchers use along with the
recognized search terms for constructing the research process more advanced. One of the
more precise and efficient search is hence allowed. The usefulness of the operation is that the
unsuitable search can be more certainly removed, making the end result to be more useful
(LoBiondo-Wood & Haber, 2014). Boolean operations that was considered for the use in the
current review were OR and AND, focusing on the condition of the respective database used.

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Study selection:
A particular search is essential for suitable study outcomes. To confirm that the implications
drawn from the research paper bring into line the research objectives, the assignment is to
choice the articles over suitable screening (Parahoo, 2014). In situation of the systematic
review of literature, thorough actions are required in order to assess an enormous pool of
research studies to categorize only those which meet the appropriateness of the criteria. A
bird’s eye vision is required for making a full review paper, to enable the readers to achieve
depth information of the articles that is to be presented (Gibson & McDonald, 2017). An
investment in respected resources was required in this systematic review to spot the
challenges in managing the asthma in elderly population. Each and every database were
examined individually for the related articles. The total number of articles that were retrieved
was 106. Thirty-five articles were then selected for the second round of the screening process.
The label of the articles and the abstracts were then scrutinised in order to understand their
strength. Twenty-eight articles subsequently were send forward for the next step. The
appropriateness of the articles was decided after understanding the full articles. From thirteen
articles were lastly incorporated in the systematic review.
Data extraction:
The next stage of the systematic review after recovering articles is to go through the
full text of the articles that is to be involved in the systematic review in demand to obtain
relevant data. The extraction of data in a systematic review should be précised in account to
enhance the outcome of the research. This is also found to help in decreasing the amount of
time to be taken for concluding the review. Systematic reviews help in the documentation,
production and understanding of an available pool of data on the focused topic for refining
decision making for the participants such as clinicians and policy makers (Jonnalagadda et
al., 2015). For this research on interventions that provides the best development in symptoms

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of asthma in the aged population, some key perceptions from the research articles were
witnessed. For this systematic review, a tabular format was used to summarise the important
sets of information from the adequate studies. The information that was included in the
summary table was country, author details, and study aim, study setting, year of publication,
study design, research sample and results. The table delivers a summary of the research
papers and the key findings.
Quality Assessment:
The quality assessment of the quantitative research articles was completed
with the assistance of the PRISMA checklist. Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) is an evidence cantered set of substances that are
discussed for writing on reviews. The checklist suggests accurate outlines on what needs to
be incorporated in the systematic review of literature. It covers several features stretching
from the methodology to results. It is considered as an exceptional template for reporting on
the systematic reviews.
Data Analysis:
The content of the research articles that was selected for the systematic review are
analysed in a suitable way and offered in a clear form. Systematic review targets to evaluate
the value of the study and efforts given in to the research. In this systematic review, a
thematic study was chosen as a process of data analysis instead of meta-analysis. Meta-
analysis is conceded when the purpose of the research is being identification of reliability in
the research studies and a definite treatment outcome is needed (Parahoo, 2014). The
thematic method was agreed for the analysis of articles and to categorise them below diverse
domains. Thematic analysis is defined as a process of recognizing themes in qualitative data.
A process of analysing, identifying and recording themes in data. Hence, this method will be
used to gain knowledge and insight from the collected data. As stated by LoBiondo-Wood

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and Haber (2014), the thematic analysis is recognized to be an operative and proficient
approach for connecting designated studies with the study objective, thus illustrating
conclusions. The categorisation into various subjects has been found to be helping the
researchers to practice writing after calming key findings.
PRISMA Flow chart: