Dr. Shih-Yi Lin, Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan 407219. Fax: +886-4-23759378, Tel: +886-4-23592525-3208, E-mail address:
J Nutr Health Aging. 2023;27(11):987-995. doi: 10.1007/s12603-023-2017-7.
We aimed to evaluate the effect of frailty on lung function and disease outcomes in older adults with chronic obstructive pulmonary disease (COPD).
Retrospective observational cohort.
At baseline, comprehensive geriatric assessment and pulmonary function tests were extracted from the case management care system of the geriatric department of a tertiary medical center.
Frailty was assessed by the modified Rockwood frailty index. Kaplan-Meier survival and Cox proportional hazard analyses were used to analyze the primary outcome. Both the Friedman test and generalized estimating equations were used to evaluate the rate of decline in lung function.
Among 151 enrolled older patients, comprising 69 non-COPD and 82 COPD subjects, the mean age was 80.9±8.3 years. After a median follow-up of 2.87 years, the serial forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), and forced expiratory flow at 25-75% of FVC (FEF25-75%) showed significantly different slope changes between older COPD patients with and without frailty. The mortality hazard ratio (HR) was 2.53 for COPD without frailty and 3.62 for COPD with frailty, versus those without COPD. Among COPD patients, the factors most strongly associated with mortality were timed up-and-go, activities of daily living (ADLs), instrumental ADLs, FEV1/FVC, and serum HCO3-. After adjustment for potential confounders, ADLs and FEV1/FVC remained independent mortality predictors.
Among older patients with COPD, frailty was common and associated with pulmonary function decline, and mortality risk was higher in frail than in non-frail subjects.
评估衰弱对老年慢性阻塞性肺疾病（COPD）患者肺功能和疾病结局的影响。
回顾性观察性队列研究。
在基线时，从老年医学科病例管理护理系统中提取全面老年评估和肺功能测试数据。
采用改良 Rockwood 衰弱指数评估衰弱。使用 Kaplan-Meier 生存分析和 Cox 比例风险分析来分析主要结局。使用 Friedman 检验和广义估计方程来评估肺功能下降率。
在纳入的 151 名老年患者中，包括 69 名非 COPD 患者和 82 名 COPD 患者，平均年龄为 80.9±8.3 岁。中位随访 2.87 年后，COPD 患者的用力肺活量与用力呼气量之比（FEV1/FVC）和 25%~75%肺活量时的呼气流速（FEF25-75%）的系列值呈明显不同的斜率变化，衰弱患者与非衰弱患者之间存在差异。COPD 无衰弱患者的死亡率风险比（HR）为 2.53，COPD 衰弱患者为 3.62，而无 COPD 患者为 1.00。在 COPD 患者中，与死亡率最密切相关的因素是计时起立行走测试、日常生活活动（ADL）、工具性日常生活活动、FEV1/FVC 和血清 HCO3-。在调整潜在混杂因素后，ADL 和 FEV1/FVC 仍然是独立的死亡率预测因素。
在老年 COPD 患者中，衰弱较为常见，与肺功能下降相关，衰弱患者的死亡风险高于非衰弱患者。
