CHARACTERISTICS PREDICTING INCORRECT METERED-DOSE INHALER TECHNIQUE IN OLDER SUBJECTS

Objective: To determine whether cognitive status, hand strength, and d emographic variables are predictive of correct use of metered-dose inh alers by older subjects. Methods: Clinic patients (n=29) and healthy v olunteers (n=42) older than 50 years with no previous or limited meter ed-dose inhaler use were enrolled. After cognitive (Mini-Mental State Examination) and hand strength assessments, subjects received extensiv e instruction in proper metered-dose inhaler technique. Technique was independently assessed by two evaluators immediately after instruction and 1 week later. Correct technique was defined as (1) activating the canister in the first half of inhalation, (2) continuing to inhale sl owly and deeply, and (3) holding breath at full inspiration (5 seconds ). Data for the two subject groups were pooled for analyses. Results: The mean age of the subjects was 69.7 years. Forty subjects (56%) demo nstrated correct metered-dose inhaler technique at 1 week. Logistic re gression showed that hand strength measurement (odds ratio, 0.68; 95% confidence interval, 0.55 to 0.84),Mini-Mental State Examination score less than 24 (odds ratio, 3.66; 95% confidence interval, 1.07 to 12.4 ), and male gender (odds ratio, 5.01; 95% confidence interval, 1.07 to 23.5) were significant predictors of incorrect inhaler use. Correct u se of the metered-dose inhaler was unrelated to age, education, or sub ject status. Conclusions: Clinicians should consider cognitive status and hand strength when metered-dose inhaler therapy is initiated for a n older adult. Patients with cognitive impairment and hand strength de ficits may require more extensive training, frequent follow-up, or alt ernative dosage forms.