Frailty and Respiratory Impairment in Older Persons

Abstract

Background Among older persons, the association between frailty and spirometry-confirmed respiratory impairment has not yet been evaluated. Methods Using data on white participants aged 65–80 years (Cardiovascular Health Study, N=3,578), we evaluated cross-sectional and longitudinal associations between frailty and respiratory impairment, including their combined effect on mortality. Baseline assessments included frailty status (Fried-phenotype; non-frail, pre-frail, and frail) and spirometry. Outcomes included development of frailty features (pre-frail or frail) at Year-3 and respiratory impairment (airflow limitation or restrictive-pattern) at Year-4, and death (median follow-up, 13.2 years). Results At baseline, 48.3% were pre-frail, 5.8% were frail, 13.8% had airflow limitation, and 9.3% had restrictive-pattern; 46.1% subsequently died. At baseline, pre-frail and frail were cross-sectionally associated with airflow limitation—adjusted odds ratio (OR) (95% confidence interval): 1.62 (1.29, 2.04) and 1.88 (1.15, 3.09), and restrictive-pattern—adjusted OR: 1.80 (1.37, 2.36) and 3.05 (1.91, 4.88), respectively. Longitudinally, participants with baseline frailty features had an increased likelihood of developing respiratory impairment―adjusted OR: 1.42 (1.11, 1.82). Conversely, participants with baseline respiratory impairment had an increased likelihood of developing frailty features—adjusted OR: 1.58 (1.17, 2.13). Mortality was highest among participants who were frail and had respiratory impairment—adjusted hazard ratio: 3.91 (2.93, 5.22), relative to those who were non-frail and had no respiratory impairment. Conclusion Frailty and respiratory impairment are strongly associated with one another and substantially increase the risk of death when both are present. Establishing these associations may inform interventions designed to reverse or prevent the progression of either condition and to reduce adverse outcomes.

Relationship between frailty and respiratory function in the community-dwelling elderly

“…In the study conducted by Vaz Fragoso et al 6 , it was found that reduced gait speed (RGS) and low physical activity level were associated with airflow limitation in a cross-sectional analysis, while RGS, low physical activity level and reduced hand grip strength were associate with the restrictive lung function pattern.…”

“…Vaz Fragoso et al 6 demonstrated cross-sectional and longitudinal associations between frailty and respiratory dysfunction in a sample of 3.578 white elderly, aged between 65 and 80 years. In the cross-sectional analysis, pre-frail and frail elderly presented 62% and 88% of probability of having airflow limitation and 80% and 205% of a restrictive lung function pattern, respectively.…”

“…Compromise of the spirometric variables was not observed in this study, being the results within the normative values 24 . Future studies with larger samples are needed, since the frailty syndrome and respiratory dysfunction seem to have a strong association with increased risk of death 6 .…”

“…Weiss et al 18 and Vaz Fragoso et al 6 emphasized in their studies the need to use other measurements to investigate pulmonary function in frail elderly, such as the evaluation of maximal respiratory pressures. Therefore, the aim of this study was to evaluate the impact of frailty on respiratory function in community-dwelling elderly.…”

“…Therefore, the main components of this syndrome are: chronic malnutrition, sarcopenia, decreased muscle strength, declining exercise tolerance, decreased levels of physical activity, decreased energy expenditure and imobility 4,5 . Another study has established a strong association between frailty and respiratory dysfunction evaluated by spirometry in the community-dwelling elderly and the presence of both characteristics may increase substantially the risk of death 6 .…”