Frailty and Respiratory Impairment in Older Persons

doi:10.1016/j.amjmed.2011.06.024

The American Journal of Medicine

Volume 125, Issue 1, January 2012, Pages 79-86

https://doi.org/10.1016/j.amjmed.2011.06.024 Get rights and content

Abstract

Background

Among older persons, the association between frailty and spirometry-confirmed respiratory impairment has not been evaluated yet.

Methods

By using data on white participants aged 65 to 80 years (Cardiovascular Health Study, N = 3578), 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% of participants were pre-frail, 5.8% of participants were frail, 13.8% of participants had airflow limitation, and 9.3% of participants had restrictive pattern; 46.1% of participants subsequently died. At baseline, pre-frail and frail were cross-sectionally associated with airflow limitation (adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.29-2.04 and adjusted OR 1.88; 95% CI, 1.15-3.09) and restrictive pattern (adjusted OR, 1.80; 95% CI, 1.37-2.36 and adjusted OR, 3.05; 95% CI, 1.91-4.88), respectively. Longitudinally, participants with baseline frailty features had an increased likelihood of developing respiratory impairment (adjusted OR, 1.42; 95% CI, 1.11-1.82). Conversely, participants with baseline respiratory impairment had an increased likelihood of developing frailty features (adjusted OR, 1.58; 95% CI, 1.17-2.13). Mortality was highest among participants who were frail and had respiratory impairment (adjusted hazard ratio, 3.91; 95% CI, 2.93-5.22), compared with 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.

Section snippets

Study Population

We used de-identified, publicly available data from the Cardiovascular Health Study, a longitudinal study of older persons, assembled from 1989 to 1990, with follow-up to 2002.²² For the present study, eligibility criteria included age 65 to 80 years, white race, no self-reported asthma, and completion of at least 2 American Thoracic Society (ATS) acceptable spirometric maneuvers and a frailty evaluation. Of the 4047 participants who were eligible on the basis of age, race, and no self-reported

Results

Among all 3578 study participants, the mean age was 71.5 years; 2063 (57.7%) were female, 1641 (45.9%) were non-frail, 1728 (48.3%) were pre-frail, and 209 (5.8%) were frail.

As shown in Table 1, there were statistically significant increases across the 3-level frailty status (from non-frail to frail) in age and BMI, as well as in the frequency of female sex, lower education, current smokers, fair-to-poor health status, chronic conditions, respiratory symptoms, and spirometric respiratory

Discussion

In a large sample of community-living white older persons, we found that frailty and respiratory impairment were strongly associated with one another, cross-sectionally and longitudinally, and substantially increased the risk of death when both were present, independently of potential confounders. These results suggest that the association between frailty and respiratory impairment is bidirectional and that their combined effects are particularly deleterious.

In cross-sectional analysis, we

Conclusions

Among community-living white older persons, frailty and respiratory impairment are strongly associated with one another and substantially increase the risk of death when both are present. Because frailty and respiratory impairment are potentially modifiable, establishing these associations could help to inform interventions designed to reverse or prevent the progression of either condition and to reduce adverse outcomes.1, 4, 5, 6, 7, 15, 16, 17, 18, 19, 20, 21

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: Funding: Dr Vaz Fragoso is currently a recipient of career development awards from the Department of Veterans Affairs and the Yale Pepper Center. Dr Gill is the recipient of an National Institute on Aging Midcareer Investigator Award in Patient-Oriented Research (K24AG021507). Dr Van Ness received support from the Claude D. Pepper Older Americans Independence Center at Yale (2P30AG021342). The work for this report was funded in part by a grant from the National Institute on Aging (R03AG037051).

: Conflict of Interest: None.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

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Clinical research studyFrailty and Respiratory Impairment in Older Persons

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Population

Results

Discussion

Conclusions

Am J Med

Chest

Ann Epidemiol

Chest

J Clin Epidemiol

Chest

Chest

J Nutrition Health Aging

Chest

Frailty in older adults: evidence for a phenotype

J Gerontol Med Sci

Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging

J Gerontol Med Sci

Sex hormones and frailty in older men: the osteoporotic fractures in men (MrOS) study

J Clin Endocrinol Metab

Second National Report on Human Exposure to Environmental Chemicals: Tobacco Smoke

Morb Mortal Wkly Rep

Long-term inhalable particles and other air pollutants related to mortality in nonsmokers

Am J Respir Crit Care Med

GOLD executive summaryGlobal strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Interpretative strategies for lung function tests

Eur Respir J

The ratio of the forced expiratory volume in 1-second to forced vital capacity in establishing chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Reductions in functional balance, coordination, and mobility measures among patients with chronic obstructive pulmonary disease

J Cardiopulm Rehabil

Home assessment of activities of daily living in patients with severe chronic obstructive pulmonary disease on long-term oxygen therapy

Eur Respir J

Impaired lung function and mortality risk in men and women: findings from the renfrew and paisley prospective population study

BMJ

Reduced lung function and risk of atrial fibrillation in the Copenhagen city heart study

Eur Respir J

Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective

Eur Respir J

Elevated plasma fibrinogen associated with reduced pulmonary function and increased risk of chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Clinical research study
Frailty and Respiratory Impairment in Older Persons