Multimorbidity, frailty and chronic obstructive pulmonary disease

Abstract

The overwhelming majority of people with chronic obstructive pulmonary disease (COPD) have at least one coexisting medical condition often conceptualized as 'comorbidities'. These coexisting conditions vary in severity and impact; it is likely that for some patients, COPD is not their most important or severe condition. The concepts of multimorbidity and frailty may be useful to understand the broader needs of people with COPD undergoing pulmonary rehabilitation. Multimorbidity describes the coexistence of two or more chronic conditions, without reference to a primary condition. Best care for people with multimorbidity has been described as a shift from providing disease-focused to patient-centred care. Pulmonary rehabilitation is well placed to deliver such care as it focuses on optimizing function, encourages integration across care settings, values input from multidisciplinary teams and measures patient-important outcomes. When designing optimal pulmonary rehabilitation services for people with multimorbidity, the concept of frailty may be useful. Frailty focuses on impairments rather than medical conditions including impairments in mobility, strength, balance, cognition, nutrition, endurance, mood and physical activity. Emerging data suggest that frailty may be modifiable with pulmonary rehabilitation. The challenge for pulmonary rehabilitation clinicians is to broaden our perspective on the role and outcomes of pulmonary rehabilitation for people with multimorbidity.

<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.…”

“…60,63 Our service user and professional stakeholders also felt social isolation was important, acting as both a barrier to, and facilitator of, participation. Altogether, these factors influenced individuals' perceptions of exercise-based interventions in relation to their priorities, [60][61][62][63]69 as well as their physical ability to engage.…”

“…Authors recommended actively involving people within exercise-based interventions to help them feel more worthy and in control. 60,62,64,69,75 Incorporating better communication and relationships with staff 47,[60][61][62] also suggested to influence how people view services in relation to themselves. 60,61,63,65 Service users acknowledged the importance of relationships with intervention staff as a facilitator of attendance.…”

“…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.…”