A targeted intervention to support asthma self-management significantly improved outcomes and medication adherence among older adults, according to a new study published in JAMA Internal Medicine.
Asthma is a common condition in older adults, affecting about 7 percent of Americans older than 65 years. This population experiences more symptoms and hospitalizations related to the condition than younger groups, partly because of difficulties with self-management, such as the use of inhalers.
However, there has been a lack of interventions tailored specifically to older adults.
“The majority of interventions to promote asthma outcomes target young children and adolescents, despite older adults experiencing worse asthma outcomes compared with younger adults,” O’Conor said.
To address this need, a team of investigators and community partners created the Supporting Asthma Self-Management Behaviors in Older Adults (SAMBA) intervention. In the program, health coaches first met with patients to identify the specific behavioral, psychosocial and environmental factors that are barriers to asthma control. The coach then created a patient-led action plan using a selection of evidence-based interventions that target each identified barrier. The coach and patient also continued to meet over the following 12 months to reinforce the behavior change.
The investigators evaluated the effectiveness of the SAMBA intervention in a randomized clinical trial. The study included 406 adults 60 years and older with persistent, uncontrolled asthma who were randomized to one of three groups: a home-based intervention, clinic-based intervention or usual care.
Over a 12-month period, patients who received the SAMBA intervention reported greater asthma control, quality of life, inhaler technique and medication adherence than those in the control group.
“Most notably, the proportion of individuals with any visit to the emergency department in the previous 12 months was lower among those who received the SAMBA intervention,” O’Conor said.
There were no significant differences in outcomes between the patients who received the intervention at home and those who received it in the clinic.
Moving forward, the team is planning further dissemination of the SAMA program. They also recently received funding to adapt and pilot test the program in patients with chronic obstructive pulmonary disease (COPD).
Michael Wolf, PhD, ’02 MPH, associate vice chair for research in the Department of Medicine, was also a co-author of the JAMA Internal Medicine study.
Funding for the study, which was led by investigators at Mount Sinai in New York, was provided by the Patient-Centered Outcomes Research Institute (grant No. AS-1307-05584).
The SAMBA materials are available at no charge, in English and Spanish, at SAMBAforAsthma.org.