Frailty in Elderly with COPD is Related to Shortness of Breath and Frequent Flare-ups

Frailty in Elderly with COPD is Common (10%)   

Background: Those with COPD often have other medical conditions (called co-morbidities) that include heart disease, muscle weakness and wasting, weight loss, arthritis, and low red blood cells (anemia). Both COPD and these other conditions can contribute to a frail status – defined as a generalized loss of physical abilities. The five important features are nutritional status, physical activity, mobility, strength, and energy. Frailty is common in the general elderly population, but is unknown in the elderly with COPD. Study: Dr. Lahousse and colleagues working at the Ghent University Hospital examined residents living in Rotterdam, The Netherlands, who agreed to be tested every 3-5 years. Frailty was defined as someone meeting 3 or more of the following 5 conditions: weight loss of more 5% compared with previous visit; low physical activity (less than 383 kcal per week for men and less than 270 kcal per week for women); slow walking pace; reduced grip strength; and self-reported exhaustion “frequently” or “mostly.” The study results were published in the Journals of Gerontology, Series A, Biological Sciences and Medical Sciences, 2016, volume 71, pages 689-695. Results: There were 2,142 subjects 65 years of age or older. 100 of these were considered frail and was more common in those with COPD (10%) compared to those without COPD (3%). It was greatest in those who had severe obstruction on breathing tests, more shortness of breath, and frequent flare-ups (exacerbations). Subjects with COPD who were frail had worse survival.
Frailty in COPD

Results of Frailty and Non-frailty Based on Severity of COPD

Conclusions: COPD is associated with frailty even after adjusting for various risk factors. My Comments: Treatment of those who are frail requires a multidisciplinary approach to deal with many factors including possible associated anxiety and depression. Whenever possible, physical therapy and/or pulmonary rehabilitation should be offered to the individual.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.