Evidence of early frailty in chronic respiratory diseases: A biopsychosocial approach

BACKGROUND: Frailty is increasingly recognised in chronic diseases, including chronic respiratory diseases (CRD), which often represent progressive functional impairment. Frailty is multifactorial and may be a result of a complex interaction between biological, psychological, and social factors. Understanding the biopsychosocial interaction in the aetiology of frailty among CRD patients is necessary to optimise public health policies. OBJECTIVES: To estimate prevalence of frailty in Chronic Respiratory Diseases (CRD) and to understand the mediating effect of biopsychosocial factors. METHOD: This cross-sectional study included 66,434 community-dwelling adults (age ≥45 years, 52.9% females) with and without physician-reported diagnosis of CRD from an ongoing population-based cohort. Frailty was assessed using Fried criteria. RESULT: CRD showed a significantly higher frailty compared to controls [37.7% vs 25.7% (p < 0.001)]. Frailty was significantly higher in CRD between 45 and 75 years (p < 0.001) compared to controls, but no difference was noted after 75 years (p > 0.05). Adjusted for covariates, CRD remained significantly associated with increased frailty [AOR: 1.49 (95% CI: 1.05, 2.12)]. Next to direct effect, structural equation modelling revealed an indirect association of age (estimate = 0.159, p < 0.001) comorbidities (estimate = 0.031, p < 0.001), cognition (estimate = 0.006, p < 0.001), education (estimate = 0.012, p < 0.01) and economic status (estimate = -0.004, p < 0.01) as frailty mediators. CONCLUSION: Frailty is abundantly present in CRD. Frailty in CRD appeared to be influenced by direct and indirect factors beyond chronological age. The results indicate an early and multifactorial trajectory of vulnerability to become frail in CRD individuals. Therefore, frailty screening is necessary in CRD from early onset to facilitate timely intervention.