Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes

Abstract

Rationale Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s) Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods This was an observational cohort study using Health and Retirement Study data (2006–2018) of community living individuals ages 50–64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results The study included 18,979 survey observations for age 50–64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50–64 (95% CI: 3.8–5.9% vs 0.7–1.3%) and age ≥65 (95% CI: 11.9–14.3% vs 5.6–6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50–64 years). These measures identify patients with increased risk of poor outcomes.

Prevalence and risk factors of frailty in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis

“…The characteristics of the included studies are presented in Table 1 . These studies were published between 2011 and 2022, and 24 of them were cross-sectional studies [ 6 , 7 , 19 , 21 – 41 ], 8 of which were longitudinal studies [ 17 , 42 – 48 ] and the remaining 6 cohort studies [ 12 , 49 – 53 ]. In total, 19,362 participants from 13 countries were included in the analysis, with the main geographic locations in the United States (eight studies) [ 28 , 38 , 40 , 44 – 46 , 49 , 50 ].…”

Pneumonia and subsequent risk of dementia: Evidence from the Japan Gerontological evaluation study

“…In addition, hormonal factors such as low blood androgens and estrogens may be involved in the development or progression of frailty 40 and increased risk of cognitive impairment in older men 41 . Furthermore, the prevalence of frailty is higher in people with chronic diseases such as chronic obstructive pulmonary disease (COPD) than those without COPD 42 . A meta‐analysis study showed that in people with Chronic obstructive pulmonary disease (COPD) or chronic heart failure, prone to contracted pneumonia, the prevalence of mild cognitive impairment (MCI) was higher than in the general population 43 .…”

“…41 Furthermore, the prevalence of frailty is higher in people with chronic diseases such as chronic obstructive pulmonary disease (COPD) than those without COPD. 42 A metaanalysis study showed that in people with Chronic obstructive pulmonary disease (COPD) or chronic heart failure, prone to contracted pneumonia, the prevalence of mild cognitive impairment (MCI) was higher than in the general population. 43 They assumed that hypoxemia, inflammation, and vascular disease might be involved in the development of MCI in those patients.…”

The Association of Pain with Incident Falls in People with Chronic Obstructive Pulmonary Disease: Evidence from the English Longitudinal Study of Ageing

“…COPD also has a systemic effect, and its comorbidities are common; between 51% to 90% of people with COPD are estimated to have more than one comorbid condition, and up to 97% in those with GOLD stage 4 COPD [ 2 , 3 , 4 , 5 ]. Furthermore, frailty is common, with 23% of people with COPD being classified as frail and 56% as prefrail [ 6 , 7 , 8 ]. Falling is a prominent feature of the frailty syndrome, and therefore, it is unsurprising that people with COPD are four times more likely to fall than healthy adults without COPD.…”