Frailty, Comorbidity, and COPD

Charbek, Edward; Espiritu, Joseph; Nayak, Ravi; Morley, John E.

doi:10.1007/s12603-018-1068-7

Cited by 15 publications

(12 citation statements)

References 99 publications

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“…In the National Health and Nutrition Examination Survey (NHANES), 56.6% of individuals with COPD were frail, and this association has received significant attention [30]. It was observed that individuals with COPD had more than double the number of medical comorbidities than those without [30]. In our cohort individuals with COPD had significantly more medical illnesses than those without (4.4 vs. 2.4, P < 0.01).…”

Section: Discussionmentioning

confidence: 62%

“…With regard to the diverse medical disorders encountered in our population, diabetes mellitus and COPD were independently associated with frailty. In the National Health and Nutrition Examination Survey (NHANES), 56.6% of individuals with COPD were frail, and this association has received significant attention [30]. It was observed that individuals with COPD had more than double the number of medical comorbidities than those without [30].…”

Section: Discussionmentioning

confidence: 99%

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Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

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Sueiras i , for the NNTC Objectives: Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. Design: Analysis of a prospective, observational, longitudinal cohort. Methods: Three hundred and thirty-two participants in the medically advanced NNTC were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. Results: The mean number of medical comorbidities per participant was 2.7, mean CD4 þ T-cell count was 530 cells/ml, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. Conclusion: Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIVassociated morbidity in aging populations.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

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“…[67][68][69] Other reviews focused on frailty assessment 70 and optimising physical activity and pulmonary rehabilitation interventions. 21,71,72 We also included a letter about pulmonary rehabilitation in severe COPD, 73 an editorial on frailty, comorbidity and COPD, 74 and a commentary on a geriatric policy document from a lung health task force. 75…”

Section: Focus Of Included Studiesmentioning

confidence: 99%

“…Authors noted how this population frequently present with lower levels of function and health, and higher levels of dyspnoea, distress relating to dyspnoea, disability, and comorbidities, 10,19,21,48,[59][60][61][62][63][64][65][66][67][68]73,74 including comorbid psychiatric illness and cognitive dysfunction. 56,61 This was further complicated by their risk of significant health events or deterioration during exercise-based interventions.…”

Section: Scoping the Literature The Context Of Living With Frailtymentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

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“…Besides its effects on bone, vitamin D has been considered to be integral in the cause of immune dysfunction, falls, muscle weakness, cancer, cardiovascular disease, cognitive dysfunction, lung disease, stroke, paraplegia, benign paroxysmal positional vertigo; multiple sclerosis and depression (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Frailty is a major cause of poor outcomes in older individuals (15)(16)(17)(18)(19)(20)(21)(22) and has been associated with low levels of 25 (OH) Vitamin D (23)(24)(25)(26). These claims are based predominantly on epidemiological studies.…”

mentioning

confidence: 99%