Short-term prognostic value of forced expiratory volume in 1 second divided by height cubed in a prospective cohort of people 80 years and older

Abstract

BackgroundSpirometry-based parameters of pulmonary function such as forced expiratory volume in 1 second (FEV1) have prognostic value beyond respiratory morbidity and mortality. FEV1 divided by height cubed (FEV1/Ht3) has been found to be better at predicting all-cause mortality than the usual standardization as percentage of predicted "normal values" (FEV1%) and its use is independent of reference equations. Yet, limited data are available on the very old adults (80 years and older) and in association to other adverse health outcomes relevant for this age group. This study aims to investigate the short-term prognostic value of FEV1/Ht3 for all-cause mortality, hospitalization, physical and mental decline in a cohort of very old adults.MethodsIn a population-based prospective cohort study of 501 very old adults in Belgium, comprehensive geriatric assessment and spirometry were performed at baseline and after 1.7 ± 0.21 years. Kaplan-Meier curves for 3-year all-cause mortality and hospitalization rates and multivariable analysis adjusted for age, sex, smoking status, co-morbidities, anemia, high C reactive protein and creatinine levels examined the association of FEV1/Ht3 with all-cause mortality, unplanned hospitalization and decline in mental and physical functioning. Physical functioning was assessed by activities of daily living, a battery of physical performance tests and grip strength. Mental functioning was assessed with mini mental state examination and 15 items geriatric depression scale.ResultsIndividuals in the lowest quartile of FEV1/Ht3 had a statistically significant increased adjusted risk for all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.10-2.60) and unplanned hospitalization (HR 1.65, 95% CI 1.21-2.25), as well as decline in physical (odds ratio [OR] 1.89, 95% CI 1.05-3.39) and mental functioning (OR 2.39, 95% CI 1.30-4.40) compared to the rest of the study population.ConclusionsIn a cohort of very old adults, low FEV1 expressed as FEV1/Ht3 was found to be a short-term predictor of all-cause mortality, hospitalization and decline in physical and mental functioning independently of age, smoking status, chronic lung disease and other co-morbidities. Further research is needed on FEV1/Ht3 as a potential risk marker for frailty and adverse health outcomes in this age group.

Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study

“… 18 , 34 In addition, FEV 1 as a potential risk marker for adverse health outcomes in older adults can be assessed in spirograms in which plateau of >6 s has not been reached (spirometry quality levels ATS 1–3 are usable for this purpose and were achieved by 96% of participants in the BELFRAIL and 80% of participants in the CRYSTAL study). 4–8 …”

“…2 , 3 Besides this, spirometry parameters such as forced expiratory volume in 1 s (FEV 1 ) have been found to be predictors of adverse health outcomes such as all-cause mortality, disability and frailty in the older adults. 4–8 Yet, there is still underuse of spirometry for diagnosing respiratory problems, especially in older adults, even though it has become widely available in primary care and hand-held office spirometry is reliable. 9–12 …”

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

“…Thus, it can be reasonably expected that chronic respiratory diseases compromising pulmonary function will trigger or accelerate the development of frailty and/or disability. In very old adults (80 years and older) a poor pulmonary function predicts decline in physical and mental functioning and mortality (Turkeshi et al, 2015). Moreover, exposure to second hand tobacco smoke in non-smoking older adults increases the frequency of frailty (García-Esquinas et al, 2015b).…”

Derivation of a frailty index from the resident assessment instrument – home care adapted for Switzerland: a study based on retrospective data analysis

“…An FI can be derived from various types of databases as long as its derivation follows the proposed guideline [ 15 ]. Recent studies convincingly demonstrated that an FI can be derived from data collected with unified instruments from the interRAI suite either with the interRAI Acute Care [ 17 ], interRAI Nursing Homes [ 18 ], or interRAI Home Care [ 19 ]. Aside from FI derivations, scales assessing frailty have also been proposed; among them, the Frailty Scale [ 20 ] built from the interRAI Home Care and the FRAIL-NH scale [ 21 , 22 ] elaborated on the interRAI Nursing Home.…”