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.

Keywords:

• disability
• survival
• home health
• peak air flow
• cognition

Abbreviations

ADL, activities of daily living; AUC, area under the receiver operating characteristic curve; BMI, body mass index; CES-D8, Center for Epidemiologic Studies Depression Scale, 8 items; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FI-CGA, frailty index based on a comprehensive geriatric assessment; IADL, instrumental activities of daily living; HRS, Health and Retirement Study; MI, myocardial infarction; MMRC, modified Medical Research Council; NIA, National Institutes on Aging; OR, odds ratio; PEF, peak expiratory flow.

Disclosure

The authors report the following disclosures outside of the submitted work. Dr. Roberts reports grants from Sunovion Pharmaceuticals, receipt of research support from GlaxoSmithKline and manuscript writing support from Boehringer Ingelheim. Dr. Mapel reports grants from Sunovion Pharmaceuticals, personal fees from Genentech, receipt of research support from GlaxoSmithKline, and manuscript writing support from Boehringer Ingelheim and Genentech. Dr Melissa H Roberts reports grants from Sunovion Pharmaceuticals, during the conduct of the study; grants from GlaxoSmithKline, non-financial support from Boehringer Ingelheim, outside the submitted work; Dr Melanie A Dodd reports grants from Sunovion Pharmaceuticals, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

The study summarized in this article was partially funded by an investigator-initiated research grant from Sunovion Pharmaceuticals. Data used in this study is from the Health and Retirement Study, a longitudinal study sponsored by the National Institute on Aging (National Institutes of Health, Bethesda, MD; grant number NIA U01AG009740) and conducted by the University of Michigan (Ann Arbor, MI). The views expressed in this article do not communicate an official position of The University of New Mexico, or Sunovion Pharmaceuticals.