Frailty Transitions in Older Persons With Lung Function Impairment: A Population-Based Study

Abstract

Background The ageing population and its burden on health-care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in subjects with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or Chronic Obstructive Pulmonary Disease [COPD]). Methods In participants from the population-based Rotterdam Study (mean age 69.1±8.9 years), we examined whether PRISm (Forced Expiratory Volume in 1 second [FEV1]/Forced Vital Capacity [FVC]≥70% and FEV1<80%) or COPD (FEV1/FVC<70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty and frailty], lost to follow-up or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odd’s ratios (OR). Second, we assessed diagnostic accuracy of frailty score for predicting mortality in subjects with COPD using c-statistics. Results Compared to subjects with normal spirometry, subjects with PRISm were more likely to transit from robust (OR 2.2[1.2-4.2], p<0.05) or prefrailty (OR 2.6[1.3-5.5], p<0.01) towards frailty. Subjects with PRISm (OR 0.4[0.2-0.8], p<0.05) and COPD (OR 0.6[0.4-1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state towards death (OR between 1.1 and 2.8, p<0.01). Accuracy for predicting mortality in subjects with COPD significantly improved when adding frailty score to age, sex and smoking status (90.5[82.3-89.8] vs 77.9[67.2-88.6], p<0.05). Conclusion Participants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for subjects with impaired spirometry for predicting increased life years.

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease

“…As the age of the patients increased, their level of frailty also showed an increasing trend. This suggests that with age, patients with COPD are more likely to show signs of frailty, such as physical weakness, decreased immune function, and unstable psychological status ( 27 ), which may be related to decreased physical function, cognitive impairment, and greater dysfunction in socialization and multiple chronic diseases. In addition, our study identified an association between frailty in patients with COPD and other factors such as gender and smoking history ( 28 ), which might have interacted with the patient’s age to further influence the occurrence of frailty.…”

Lung function and the risk of frailty in the European population: a mendelian randomization study

“…Frailty is a geriatric syndrome characterized by sarcopenia, a reduction in endurance and stress tolerance, as well as an increase in vulnerability and dependence [ 27 ]. Increasing studies have showed that lung diseases, such as COPD [ 5 , 28 ], interstitial lung disease (ILD), and idiopathic pulmonary fibrosis (IPF), were associated with the risk of frailty [ 29 – 31 ]. For instance, it was reported that the prevalence of frailty in COPD patients was two-fold higher than non-COPD patients [ 12 ].…”

“…Increasing evidence suggests that patients with chronic pulmonary disorders have an increased susceptibility to frailty [ 4 , 5 ]. For instance, previous studies showed that frail individuals often encountered a decline in lung function earlier in comparison to their healthy controls in the community [ 4 , 6 ].…”

ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly

“…W ijnant et al . [ 39 ] (Rotterdam, the Netherlands) reported the outcomes of a Dutch population-based study (n=5442) assessing frailty transitions and their accuracy for mortality prediction in subjects with impaired spirometry. Patients with either a decreased ratio of forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity (FVC) <0.7, or FEV 1 <80% of mean predicted value, were less likely to recover from frailty, and more likely to progress from any frailty state towards death, compared to individuals with normal spirometry.…”

“…Wijnant et al (Rotterdam) reported the outcomes of a Dutch population-based study (n=5,442) assessing frailty transitions and their accuracy for mortality prediction in subjects with impaired spirometry. Patients with either a decreased ratio of forced expiratory volume in one second related to forced vital capacity (FEV1/FVC) <0.7, or FEV1 <80% of mean predicted value, were less likely to recover from frailty, and more likely to progress from any frailty state towards death, compared to individuals with normal spirometry.The accuracy of a statistical model (including age, sex, and smoking status) to predict mortality in patients with FEV1/FVC <0.7 was significantly improved when incorporating frailty score (area under ROC curves: 90.5[82.3-89.8] vs 77.9 [67.2-88.6])[39].Finally, Doe et al (Leicester) presented a feasibility study investigating the impact of a structured diagnostic pathway designed to confirm or exclude the five most common causes of chronic breathlessness over 40 years old: COPD, anxiety, anaemia, hearth failure, and obesity/deconditioning…”