“It is important to take a multidisciplinary and holistic approach to patient care, especially in complex diseases like COPD.”–Katherine Young, MD

Social frailty appears to lead to poorer health in patients with chronic obstructive pulmonary disease (COPD).

“In patients with COPD, social frailty is markedly prevalent and has a strong clinical impact. These individuals had reduced appetite, more severe dyspnea, and were at high risk of severe acute exacerbation and unexpected hospitalization,” lead study author Kuniaki Hirai, MD, PhD, of the Division of Respiratory Medicine and Allergology of Showa University School of Medicine in Tokyo, and colleagues write in International Journal of Chronic Obstructive Pulmonary Disease.

“The results of this study indicate the importance of investigating the long-term impact of social frailty and the need for intervention trials for social frailty in patients with COPD,” they add.

Social Frailty Is an Area of Growing Research Interest

Frailty, and its effects on social activity and the risks for physical disability and death, have recently begun to interest researchers. The authors explain that people with physical, psychological, or social frailty can lose homeostasis and become vulnerable. They also may be at increased risk of falls, disability, and death.

In a questionnaire-based observational study between January 2018 and February 2021 in patients treated at four medical facilities, Dr. Hirai and colleagues investigated the prevalence, characteristics, and impact of social frailty in patients with COPD (Figure).

The 405 randomly selected study participants were aged ≤40 years (mean 74.3 years) and had COPD with a history of smoking. Patients with recent acute COPD exacerbation, other accompanying respiratory disease, concurrent active malignancy, inability to read and understand the questionnaires, and those with missing data, were excluded from the study.

Participants underwent assessments including the modified Medical Research Council (mMRC) dyspnea scale, the COPD Assessment Test (CAT), the Simplified Nutritional Appetite Questionnaire (SNAQ), the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression), and a physical performance test of their ability to rise from a chair multiple times in sequence without assistance.

The mean CAT score was 14.1, and the mean forced expiratory volume in 1 second (FEV₁) was 65.1%. Participants’ objective findings were recorded, and they replied to a survey that asked whether they were: 1) going out less often than in the previous year, 2) not visiting friends sometimes, 3) not feeling helpful to family or friends, 4) living alone, and 5) not talking to someone every day.

The 122 (30.1%) participants who agreed with none of the statements were considered to be socially robust. The 134 (33.1%) who agreed with one issue were considered prefrail, and the 149 (36.8%) who agreed with two or more were deemed socially frail.

Social Frailty Linked With Various Health Issues

Participants who were older, and those who were more socially frail, tended to have worse CAT, mMRC, SNAQ, HADS-Anxiety, and HADS-Depression scores. Participants with worse FEV₁ had more difficulty rising from a chair (P<0.05 for all).

Socially frail participants had reduced appetite, with SNAQ score odds ratio (OR) of 0.81; 95% confidence interval (CI), 0.69-0.95; P<0.01. They also had more severe dyspnea, with an mMRC score OR of 1.42; 95% CI, 1.05-1.93; P=0.02, compared with patients without social frailty.

Participants were followed up for 1 year to determine whether they had exacerbations. Social frailty was not a risk factor for moderate acute COPD exacerbation, but it was a risk factor for severe acute exacerbation (standardized regression coefficient β, 0.13; 95% CI, 0.01-0.25; P=0.04) and for all-cause unexpected hospitalization (β, 0.10; 95% CI, 0.03-0.18; P=0.01).

“It is important to take a multidisciplinary and holistic approach to patient care, especially in complex diseases like COPD,” says Katherine Young, MD, assistant professor of medicine in the Department of Medicine at Duke University School of Medicine in Durham, North Carolina.

“While more research is needed, this study identifies ‘social frailty’ as having a significant impact on outcomes for COPD patients,” adds Dr. Young, who was not involved in the study. “Defining and studying factors like this and their impact is the first step to identifying solutions, treatment, and resources that will hopefully lead to better patient care in the future.”