Frailty assessment in older adults with chronic obstructive respiratory diseases

Figures & data

Table 1 Summary of the selected studies on frailty and COPD in different populations

First author, year (reference no)	n	Country	Design	Frailty tool	% frail with COPD	Main results
Based on community dwelling
Vaz Fragoso, 2012^Citation31	3,578 participants, 13.8% airflow limitation and 9.3% restrictive pattern	USA	Cross-sectional and longitudinal analysis	FFP	No COPD frail data Pre-frail 48.3% and frail 5.8% in CHS data	Frailty and respiratory impairment were strongly associated with one another. When frailty and respiratory impairment were both present, it will increase the risk of death
Lahousse, 2016^Citation29	2,142 participants, 402 with COPD and 1,740 without COPD	The Netherlands	Prospective population-based cohort study	FFP	Pre-frail 51.2% and frail 10.2%	Frailty identified those COPD participants at high risk of mortality
Park, 2013^Citation6	20,470 participants, 211 with COPD	USA	Cross-sectional study	TFI	Pre-frail 21.8% and frail 57.8%	Individuals with COPD who had self-reported shortness of breath and comorbid diabetes were more likely to be frail than those who did not. Frail people tended to have a greater number of disabilities
Galizia, 2011^Citation102	1,288 (489 with COPD and 799 without COPD)	Italy	Cross-sectional study, 12-year follow-up	FSS	Frailty 48.9% with COPD and 36.8% without COPD	Clinical frailty COPD had a high risk of mortality
Akgün, 2016^Citation81	3,538 HIV-infected participants and 3,606 HIV-uninfected participants, 4% and 5% had COPD	USA	Cross-sectional	aFRP	No COPD frail data Pre-frail 32.2% and frail 3.0% in HIV infected; pre-frail 33.0% and frail 2.6% in HIV uninfected	COPD was strongly associated with frailty and physical limitations. The association was stronger among those with both HIV infection and physical limitation than among those without HIV infection
Stable COPD outpatients in clinic or rehabilitation center
Gale, 2018^Citation92	520 diagnosed with COPD and 150 comparator group	UK	Cross-sectional analysis Community- based patients with COPD	FI-CGA	Frail 28%	Patients with COPD were more likely to be frail than comparators. Frailty could be predicted by the number of comorbidities and the number of exacerbations per year as well as physical function
Limpawattana, 2017^Citation86	121 COPD patients	Thailand	Cross-sectional study of COPD in clinic	FRAIL	Frail 6.6% and pre-frail 41.3%	Fatigue was the major component of frailty in these populations
Kusunose, 2017^Citation96	79 COPD patients	Japan	Prospective, consecutive COPD outpatients	KCL	Pre-frail 30.4% and frail 21.5%	Frailty was significantly related with SGRQ. Frailty assessment should be included in the multidimensional assessment of COPD and separated from lung function assessment
Mittal, 2016^Citation28	120 participants with chronic lung disease, 56% with COPD	USA	Prospective	FFP	Pre-frail 64% and frail 18%	Frailty was common in patients with chronic lung diseases. Exhaustion and slow gait speed were the two most common markers of frailty
Maddocks, 2016^Citation32	816	UK	Prospective	FFP	Pre-frail 64.3% and frail 25.6%	Frail patients responded favorably to rehabilitation, and their frailty can be reversed in the short term
Clinically advanced COPD in hospital
Baldwin, 2017^Citation79	618 with advanced lung disease, 130 older ICU survivors	USA	Prospective, multicenter cohort	FFP- MLTA and FFP- DASI	Advanced frail 42%–1% and ICU 49%–12%	MLTA had a substantially greater floor effect than the DASI. The DASI improved the construct and predictive validity of frailty assessment
Uchmanowicz, 2016^Citation4	102	Poland	Prospective, hospitalized due to exacerbation	TFI	75.5%	Elderly patients with severe COPD may be more prone to frailty and decreased acceptance of their disease in comparison to patients suffering from other chronic diseases
Bernabeu-Mora, 2017^Citation99	103	Spain	Prospective, hospitalized	REFS	Mild frailty 25%, moderate frailty 27.8%, and severe frailty 66.7%	Identifying patients with frailty for targeted interventions may reduce early readmission rates
Valenza, 2016^Citation121	212 (104 stable and 108 exacerbation)	Spain	Cross-sectional study	Modified FFP Modified Baecke physical activity	Stable 64.8% and exacerbation 62.6%	Physical activity level can predict the absence or presence of frailty in subjects with stable and exacerbated COPD

Abbreviations: aFRP, adapted frailty-related phenotype; COPD, chronic obstructive pulmonary disease; FFP, Fried frailty phenotype; CHS, Cardiovascular Health Study; TFI, Tilburg Frailty Indicator; FSS, Frailty Staging System; FI, Frailty Index; CGA, Comprehensive Geriatric Assessment; KCL, Kihon Checklist; SGRQ, St George’s Respiratory Questionnaire; MLTA, Minnesota Leisure Time Physical Activity Questionnaire; DASI, Duke Activity Scale Index; REFS, Reported Edmonton Frail Scale.

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LahousseLZiereGVerlindenVJARisk of frailty in elderly with COPD: a population-based studyJ Gerontol A Biol Sci Med Sci201671568969526355016

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ParkSKRichardsonCRHollemanRGLarsonJLFrailty in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003–2006)Heart & Lung: The Journal of Acute and Critical Care201342316317023535142

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GaliziaGCacciatoreFTestaGRole of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary diseaseAging Clin Exp Res201123211812521743290

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AkgünKMTateJPOurslerKKAssociation of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected VeteransAIDS201630142185219327191979

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GaleNSAlbarratiAMMunneryMMFrailty: A global measure of the multisystem impact of COPDChron Respir Dis2018 147997231775276

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LimpawattanaPPutraveephongSInthasuwanPBoonsawatWTheerakulpisutDChindaprasirtJFrailty syndrome in ambulatory patients with COPDInt J Chron Obstruct Pulmon Dis2017121193119828458530

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KusunoseMOgaTNakamuraSHasegawaYNishimuraKFrailty and patient-reported outcomes in subjects with chronic obstructive pulmonary disease: are they independent entities?BMJ Open Respir Res201741e000196

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MittalNRajRIslamEANugentKThe frequency of frailty in ambulatory patients with chronic lung diseasesJ Prim Care Community Health201671101526333537

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MaddocksMKonSSCCanavanJLPhysical frailty and pulmonary rehabilitation in COPD: a prospective cohort studyThorax2016711198899527293209

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BaldwinMRSingerJPHuangDRefining low physical activity measurement improves frailty assessment in advanced lung disease and survivors of critical illnessAnn Am Thorac Soc20171481270127928398076

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UchmanowiczIJankowska-PolańskaBChabowskiMUchmanowiczBFalAMThe influence of frailty syndrome on acceptance of illness in elderly patients with chronic obstructive pulmonary diseaseInt J Chron Obstruct Pulmon Dis2016112401240727729781

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Bernabeu-MoraRGarcía-GuillamónGValera-NovellaEGiménez-GiménezLMEscolar-ReinaPMedina-MirapeixFFrailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal studyTher Adv Respir Dis2017111038339228849736

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ValenzaMCTorres-SánchezICabrera-MartosIRodríguez-TorresJGonzález-JiménezEMuñoz-CasaubonTPhysical activity as a predictor of absence of frailty in subjects with stable COPD and COPD exacerbationRespir Care201661221221926535000

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