Frailty transitions in older persons with lung function impairment: a population-based study

Background: The aging population and its burden on health care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in participants with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or chronic obstructive pulmonary disease [COPD]). Methods: In participants from the population-based Rotterdam Study (mean age 69.1 ± 8.9 years), we examined whether PRISm (forced expiratory volume in 1 second [FEV ₁]/forced vital capacity [FVC] ≥ 70% and FEV ₁ < 80%) or COPD (FEV ₁/FVC < 70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty, and frailty], lost to follow-up, or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odds ratios (OR). Second, we assessed the diagnostic accuracy of frailty score for predicting mortality in participants with COPD using c-statistics. Results: Compared to participants with normal spirometry, participants with PRISm were more likely to transit from robust (OR 2.2 [1.2–4.2], p < .05) or prefrailty (OR 2.6 [1.3–5.5], p < .01) toward frailty. Participants with PRISm (OR 0.4 [0.2–0.8], p < .05) and COPD (OR 0.6 [0.4–1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state toward death (OR between 1.1 and 2.8, p < .01). Accuracy for predicting mortality in participants with COPD significantly improved when adding frailty score to age, sex, and smoking status (90.5 [82.3–89.8] vs 77.9 [67.2–88.6], p < .05). Conclusion: Participants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for participants with impaired spirometry for predicting increased life years.