Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes

Abstract

Rationale: Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population.

Objectives: Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years.

Methods: This was an observational cohort study using Health and Retirement Study data (2006-2018) of community living individuals ages 50-64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions.

Results: The study included 18,979 survey observations for age 50-64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50-64 (95% CI: 3.8-5.9% vs 0.7-1.3%) and age ≥65 (95% CI: 11.9-14.3% vs 5.6-6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions.

Conclusion: Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50-64 years). These measures identify patients with increased risk of poor outcomes.

Keywords: cognition; disability; home health; peak air flow; survival.

Figure 1

Frailty and modified BODE prevalence (95% CI) by age group, survey years 2006–2016.

Figure 2

Prevalence of outcome event in next two years (95% CI), matched population by age group. Individuals surveyed in years 2006–2016, and outcome events identified at the next two-year survey (survey years 2008–2018).

Figure 3

Mortality next two years, matched population by age group, adjusted odds ratio (95% CI). Measure reference groups for ORs: Fried Phenotype = Robust, Enhanced FI-CGA = Relatively Fit, Modified BODE Score = 0–1 score. Regression models adjusted for demographics (all scales) and comorbidities (Fried, modified BODE).

Figure 4

Inpatient stay next two years, matched population by age group, adjusted odds ratio (95% CI). Measure reference groups for ORs: Fried Phenotype = Robust, Enhanced FI-CGA = Relatively Fit, Modified BODE Score = 0–1 score, Regression models adjusted for demographics (all scales) and comorbidities (Fried, modified BODE).

Figure 5

Nursing care, or home health next next two years, matched population by age group, adjusted odds ratio (95% CI). Measure reference groups for ORs: Fried Phenotype = Robust, Enhanced FI-CGA = Relatively Fit, Modified BODE Score = 0–1 score, Regression models adjusted for demographics (all scales) and comorbidities (Fried, modified BODE).