Symptom Perception
Symptom Perception
Older asthmatics have considerably worse outcomes than younger patients with asthma. In this
 study, the investigators will evaluate the role of symptom perception as a key determinant of
 poorer outcomes and lower adherence to asthma self-management behaviors among older
 asthmatics. The proposed study is significant for its potential to greatly advance
 understanding of the mechanisms related to worse outcomes in older adults, and it will
 provide actionable data for new interventions to improve self-management.
Asthma is a common condition in the older population and associated with worse morbidity and
 mortality compared to younger individuals. Various self-management behaviors (SMB),
 medication adherence in particular, are key for achieving good asthma control. Unfortunately,
 less than half of older asthmatics regularly adhere to their controller medications and to
 other SMB. Several observations suggest that symptom perception may be a major determinant of
 asthma SMB and outcomes in older adults. First, experimental studies consistently demonstrate
 that many older adults are substantially less aware of their level of airway obstruction.
 Second, under-perception of asthma symptoms is linked to elevated risk of near-fatal and
 fatal asthma attacks and increased morbidity among younger adults. Third, cognitive
 impairment, commonly associated with aging, has been identified as a key determinant of
 under-perception of symptoms in younger asthmatics. Fourth, interventions to correct symptom
 under-perception in children have been shown to improve asthma medication adherence. Despite
 the greater vulnerability of older asthmatics to poor asthma outcomes and their diminished
 ability to perceive the severity of their airway obstruction, the association of symptom
 perception with asthma SMB and outcomes has not been studied in this population. The goal of
 this project is to determine how symptom perception influences the management and outcomes of
 older asthmatics and to pilot test an intervention to correct under-perception. The Specific
 Aims are: 1) Prospectively assess the association between symptom perception and asthma
 morbidity among older adults; 2) Examine the association between symptom perception and
 asthma SMB among older adults and identify the pathways (via illness and medication beliefs)
 linking them; 3) Determine the influence of cognition on symptom perception among older
 adults with asthma; 4) Pilot test an intervention to correct under-perceptions of asthma
 symptoms in older adults. The investigators will conduct a prospective cohort study of 400
 asthmatics ≥60 years of age recruited from East Harlem and the Bronx in New York City. The
 investigators will measure symptom perception in naturalistic settings using an innovative
 and validated methodology and repeatedly collect data on illness and medication beliefs,
 cognitive functioning, SMB (including objective measures of medication adherence), and asthma
 morbidity over 12 months. At the end of the observation period, the investigators will pilot
 test an intervention to improve symptom perception on a random sample of 80 participants. The
 proposed study is significant for its potential to greatly advance understanding of the
 mechanisms related to low adherence to SMB and worse outcomes in older asthmatics, a
 vulnerable and understudied population.
Inclusion Criteria:

 -  Age ≥60 years

 -  English or Spanish speaking

 -  Asthma diagnosis made by a health care provider

 Exclusion Criteria:

 -  Diagnosis of dementia

 -  Diagnosis of chronic obstructive pulmonary disease (COPD) or other chronic respiratory
 illness

 -  Smoking history of ≥15 pack-years owing to possible undiagnosed COPD

 -  Moderate or severe cardiac disease (including New York Heart Association stages 4 or 5
 congestive heart failure, because dyspnea among patients with severe heart failure is
 more likely to be attributable to their heart condition than their asthma)

 -  Dependence on assistance for medication administration

 -  Uncorrectable visual impairment