Frailty Is a Predictor of Disability, Hospitalization and Mortality in Older Adults with COPD: A Longitudinal Study

Background/Objectives: Frailty is highly prevalent among individuals with chronic obstructive pulmonary disease (COPD) and further elevates the risk of disability, hospitalization, and mortality. However, longitudinal evidence examining the combined impact of COPD and frailty on adverse events remains limited. This study aims to examine the longitudinal association of COPD and frailty with adverse events. Methods: This longitudinal study analyzed data from the Toledo Study for Healthy Aging, including 1576 Spanish community-dwelling older adults (mean age 75 ± 6 years; 44% women). COPD was diagnosed according to GOLD criteria. Frailty was assessed using the Frailty Trait Scale-5 (FTS5), analyzed from both continuous and dichotomous perspectives. Multivariate proportional hazard regression models were used to assess mortality and hospitalization, and logistic regression was used for assessing worsening disability, adjusting for age, sex, and Charlson comorbidity index. Results: COPD was associated with an increased risk of hospitalization (HR: 1.43; 95%CI: 1.02-2.01; p = 0.04), but not mortality or disability. Frailty was independently associated with increased risk of mortality, hospitalization, and worsening disability (OR/HR ranging from 1.07 to 3.09; p < 0.001). Among individuals with COPD, frailty significantly increased the risk of mortality (HR: 5.51; 95%CI: 1.32-22.92; p = 0.019) and hospitalization (HR: 3.56; 95%CI: 1.42-8.92; p = 0.007). Compared with individuals without either frailty or COPD, the coexistence of COPD and frailty was associated with significantly higher risks of mortality and hospitalization, but not with worsening disability (p 0.069), whereas COPD alone (in non-frail individuals) was not associated with any adverse event. Conclusions: Frailty significantly increases the association of adverse outcomes, highlighting the importance of routinely assessing frailty in COPD population.