Frailty assessment in older adults with chronic obstructive respiratory diseases

Abstract

The number of patients with chronic obstructive pulmonary disease (COPD) has been rising with continued exposure to environmental risk factors and aging of populations around the world. Frailty is a geriatric syndrome with a decline in physiological reserve and often coexists with chronic diseases such as COPD. Frailty is an independent risk factor for the development and progression of COPD, and COPD can lead to frailty; treating one might improve the other. Thus, there is an increasing interest in the assessment of frailty in patients with COPD. Furthermore, early identification and assessment of frailty in patients with COPD may affect the choice of intervention and improve its effectiveness. Based on the current literature, the intent of this review was to summarize and discuss frailty assessment tools used for COPD patients and the relevant clinical practices for predicting outcomes. We ascertain that using suitable frailty assessment tools could facilitate physicians to screen and stratify physically frail patients with COPD. Screening appropriately targeted population can achieve better intervention outcomes and pulmonary rehabilitation among frail COPD patients.

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

“…frailty, sarcopenia, multimorbidity) and respiratory disease, 1,19,65,66 plus appropriate interventions in this context. [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.…”

“…Once people felt supported to engage with exercise-based interventions, articles suggested experiencing subsequent improvements could also motivate participants going forwards. 58,65 Authors also signalled the need to take a more wholeperson approach, 1,19,48,55,56,60,61,63,64,[68][69][70]74 including having appropriate staffing and resources to do so. 55,56,64,69 Both service user and professional stakeholders perceived a holistic approach as essential.…”

“…This included choosing appropriate locations and timing to support engagement with exercise-based interventions, 19,45,47,48,60,63,75 and appropriate tailoring of services for individuals. 1,46,48,50,55,60,62,64,66,69,70,73 Stakeholders acknowledged that people with COPD and frailty may benefit from a modified or more flexible service structure. However, this was less often considered in existing practice.…”

“…In practice, authors commonly referred to a role for Comprehensive Geriatric Assessment, 61,64,70,75 and/or goalsetting activities 21,62,69 to achieve this. For example, Van Dam van Isselt et al 64 report case studies from an inpatient geriatric rehabilitation service.…”

What are the illnesses associated with frailty in community-dwelling older adults: the Korean Frailty and Aging Cohort Study

“…Insulin resistance or insulin depletion may be an important factor in the development of frailty in diabetes patients, since insulin is well-known as an anabol- ic hormone in muscle [37]. Frailty is an independent risk factor for the development of COPD, and COPD can lead to frailty [38]. Frailty is increased in the presence of chronic respiratory disease overall, ranging from 5% to 65%.…”