Dyspnoea a potential marker of frailty, adverse outcomes in older adults
Dyspnoea commonly occurs in adults aged 80 years and older, and is an independent predictor of mortality, hospitalization and disability, a study has found. Moreover, dyspnoea correlates with cardiopulmonary and physical performance impairments.
The study included 565 community-dwelling older adults (mean age 84.72 years; 62.8 percent female) from the BELFRAIL prospective cohort. Assessments included Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data.
Kaplan–Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analyses were performed to examine the association of dyspnoea (MRC 3 to 5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates.
Results revealed that older adults with dyspnoea (29.9 percent) were at increased risk of cardiovascular mortality (hazard ratio [HR], 2.85; 95 percent CI, 1.93 to 4.20), all-cause mortality (HR, 2.04; 1.58 to 2.64) and first hospitalisation (HR, 1.72; 1.35 to 2.19), as well as a higher likelihood of new/worsened disability (odds ratio, 2.49; 1.54 to 4.04) compared with those who had mild or no dyspnoea. These associations were independent of age, sex and smoking status.
Furthermore, dyspnoea was independently correlated with low FEV1, high NT-proBNP, low physical performance and high BMI.
The finding that dyspnoea is common among older adults, independently associated with a higher risk of adverse outcomes, and is correlated with cardiopulmonary and physical performance impairments underscore the need for active monitoring and management of dyspnoea in older adults, researchers said.
Dyspnoea on exertion is a common and distressing symptom, although in older adults the symptom is nonspecific and complex given the presence of comorbidities. A previous report has suggested that dyspnoea overlaps between lung disease, heart disease, obesity and deconditioning in older adults. It is important that dyspnoea in older adults is studied as the symptom is disabling, as well as limits basic and instrumental activities of daily living. It also affects mobility and is associated with functional decline and frailty. [Age Ageing 2014;43:319–26; Am J Respir Crit Care Med 2012;185:435–521; Ageing Res Rev 2014;15:94–9; Int J Clin Pract 2007;61:1481–91]