Aging Clinical and Experimental Research

, Volume 23, Issue 2, pp 118–125 | Cite as

Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease

  • Gianluigi Galizia
  • Francesco Cacciatore
  • Gianluca Testa
  • David Della-Morte
  • Francesca Mazzella
  • Assunta Langellotto
  • Carolina Raucci
  • Gaetano Gargiulo
  • Nicola Ferrara
  • Franco Rengo
  • Pasquale AbeteEmail author
Original Article


Background and aims: Elderly subjects are characterized by a high prevalence of chronic obstructive pulmonary disease (COPD) and frailty. This study examined the predictive role of frailty on long-term mortality in elderly subjects with and without COPD. Methods: The study assessed mortality after a 12-year follow-up in 489 subjects with COPD and 799 subjects without COPD, selected in 1992. Frailty was assessed according to the Frailty Staging System scores ranging from 1 to 7. Results: After 12 years’ follow-up, mortality was 48.1% in subjects without and 60.7% in subjects with COPD (p>0.001). With increasing frailty, mortality increased from 41.7% to 75.1% (p for trend >0.01) in subjects without and from 54.3% to 97.0% in subjects with COPD (p for trend >0.001). Multivariate analysis showed that both COPD [hazard ratio (HR)=1.34; 95% confidence interval (95% CI)=1.02–1.81; p=0.042] and frailty score (HR=1.69 for each unit of increase; 95% CI=1.42–2.00; p>0.001) were predictive of long-term mortality. The frailty score also increased the risk of long-term mortality by 34% in the absence of COPD (HR=1.34 for each unit of increase; 95% CI=1.02-1.81; p>0.05) and by 80% in its presence (HR=1.80 for each unit of increase; 95% CI=1.28-2.53; p>0.001). Conclusions: Long-term mortality was higher in elderly subjects with than in those without COPD. The clinical frailty score also significantly predicted mortality in subjects without and, even more, in those with COPD. Thus, clinical frailty may be considered a new prognostic factor to identify COPD subjects at high risk of mortality.

Key words

Chronic obstructive pulmonary disease elderly frailty mortality 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chapman KR, Mannino DM, Soriano JB et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006; 27: 188–207.PubMedCrossRefGoogle Scholar
  2. 2.
    Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932–46.PubMedCrossRefGoogle Scholar
  3. 3.
    Celli BR, Cote CG, Marin JM et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Zielinski J, Bednarek M, Górecka D et al. Increasing COPD awareness. Eur Respir J 2006; 27: 833–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: Role of comorbidities. Eur Respir J 2006; 28: 1245–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Fried LP, Tangen CM, Walston J et al., for Cardiovascular Health Study Collaborative Research Group.Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.PubMedCrossRefGoogle Scholar
  7. 7.
    Strandberg TE, Pitkälä KH. Frailty in elderly people. Lancet 2007; 369: 1328–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Cacciatore F, Abete P, Mazzella F et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest 2005; 35: 723–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008; 56: 898–903.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Cacciatore F, Gallo C, Ferrara N et al. Morbidity patterns in aged population in southern Italy. A survey sampling. Arch Gerontol Geriatr 2008; 26: 201–13.CrossRefGoogle Scholar
  11. 11.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Measso G, Cavarzeran F, Zappalà G. The Mini-Mental State Examination: normative study of an Italian random sample. Developmental Neuropsycol 1993; 9: 77–85.CrossRefGoogle Scholar
  13. 13.
    Yesavage JA, Brink TL, Rose TL et al. Development and validation for geriatric depression screening scale: a preliminary report. J Psychiatric Res 1983; 17: 37–49.CrossRefGoogle Scholar
  14. 14.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of BADL; a standardized measure of biological and psychological functions. JAMA 1963; 185: 94–9.CrossRefGoogle Scholar
  15. 15.
    Cacciatore F, Abete P, Maggi S et al. Disability and 6-year mortality in elderly population. Role of visual impairment. Aging Clin Exp Res 2004; 16: 382–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Cacciatore F, Napoli C, Abete P, Marciano E, Triassi M, Rengo F. Quality of life determinants and hearing function in an elderly population: Osservatorio Geriatrico Campano Study Group. Gerontology 1999; 45: 323–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Offermans MP, Du Moulin MF, Hamers JP, Dassen T, Halfens RJ. Prevalence of urinary incontinence and associated risk factors in nursing home residents: a systematic review. Neurourol Urodyn 2009; 28: 288–94.PubMedCrossRefGoogle Scholar
  18. 18.
    Mazzella F, Cacciatore F, Galizia G et al. Social support and longterm mortality in the elderly: Role of comorbidity. Arch Gerontol Geriatr 2010; 51: 323–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lachs MS, Feinstein AR, Cooney LM Jr et al. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med 1990; 112: 699–706.PubMedCrossRefGoogle Scholar
  20. 20.
    Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, for Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med 2005; 142: 233–39.PubMedCrossRefGoogle Scholar
  21. 21.
    Calverley PM, Anderson JA, Celli B et al., for TORCH Investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–89.PubMedCrossRefGoogle Scholar
  22. 22.
    McGarvey LP, John M, Anderson JA, Zvarich M, Wise RA, for TORCH Clinical Endpoint Committee. Ascertainment of causespecific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax 2007; 62: 411–15.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Bale G, Martínez-Camblor P, Burge PS, Soriano JB. Long-term mortality follow-up of the ISOLDE participants: causes of death during 13 years after trial completion. Respir Med 2008; 102: 1468–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Antonelli-Incalzi R, Pedone C, Scarlata S et al. Correlates of mortality in elderly COPD patients: focus on health-related quality of life. Respirology 2009; 14: 98–104.PubMedCrossRefGoogle Scholar
  25. 25.
    Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28: 523–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Chin APM, Dekker JM, Feskens EJ, Schouten EG, Kromhout D. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999; 52: 1015–21.CrossRefGoogle Scholar
  27. 27.
    Klein BE, Klein R, Knudtson MD, Lee KE. Frailty, morbidity and survival. Arch Gerontol Geriatr 2005; 41: 141–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Woods NF, LaCroix AZ, Gray SL et al., for Women’s Health Initiative. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005; 53: 1321–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006; 54: 1674–81.PubMedCrossRefGoogle Scholar
  30. 30.
    Newman AB, Simonsick EM, Naydeck BL et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 2006; 295: 2018–26.PubMedCrossRefGoogle Scholar
  31. 31.
    Berger JS, Sanborn TA, Sherman W, Brown DL. Effect of chronic obstructive pulmonary disease on survival of patients with coronary heart disease having percutaneous coronary intervention. Am J Cardiol 2004; 94: 649–51.PubMedCrossRefGoogle Scholar
  32. 32.
    Curkendall SM, DeLuise C, Jones JK et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 2006; 16: 63–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Wedzicha JA, Seemungal TA, MacCallum PK et al. Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels. Thromb Haemost 2000; 84: 210–5.PubMedGoogle Scholar
  34. 34.
    Schunemann HJ, Dorn J, Grant BJ, Winkelstein WJ, Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest 2000; 118: 656–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Stavem K, Aaser E, Sandvik L et al. Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males. Eur Respir J 2005; 25: 618–25.PubMedCrossRefGoogle Scholar
  36. 36.
    Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population based study and a systematic review of the literature. Chest 2005; 127: 1952–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2011

Authors and Affiliations

  • Gianluigi Galizia
    • 1
    • 6
  • Francesco Cacciatore
    • 2
  • Gianluca Testa
    • 1
    • 3
  • David Della-Morte
    • 1
    • 4
  • Francesca Mazzella
    • 1
    • 2
  • Assunta Langellotto
    • 1
  • Carolina Raucci
    • 1
  • Gaetano Gargiulo
    • 1
  • Nicola Ferrara
    • 2
    • 5
  • Franco Rengo
    • 1
    • 2
  • Pasquale Abete
    • 1
    Email author
  1. 1.Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Cattedra di GeriatriaUniversità degli Studi di Napoli “Federico II”NapoliItaly
  2. 2.Istituto Scientifico di Campoli/Telese, Fondazione Salvatore MaugeriIRCCSBeneventoItaly
  3. 3.Facoltà di Scienze del BenessereUniversità del MoliseCampobassoItaly
  4. 4.Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiUSA
  5. 5.Cattedra di Medicina Interna, Dipartimento di Scienze animali, vegetali ed ambientaliUniversità del MoliseCampobassoItaly
  6. 6.Istituto Scientifico di Veruno (No), Divisione di Recupero e Rieducazione Funzionale, Fondazione Salvatore MaugeriIRCCSVeruno (No)Italy

Personalised recommendations