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

BACKGROUND: The ageing 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 subjects 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 [FEV1]/Forced Vital Capacity [FVC]≥70% and FEV1<80%) or COPD (FEV1/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 odd's ratios (OR). Second, we assessed diagnostic accuracy of frailty score for predicting mortality in subjects with COPD using c-statistics.; RESULTS: Compared to subjects with normal spirometry, subjects with PRISm were more likely to transit from robust (OR 2.2[1.2-4.2], p<0.05) or prefrailty (OR 2.6[1.3-5.5], p<0.01) towards frailty. Subjects with PRISm (OR 0.4[0.2-0.8], p<0.05) 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 towards death (OR between 1.1 and 2.8, p<0.01). Accuracy for predicting mortality in subjects 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