Multidimensional Frailty and its impact on Rehabilitation outcomes in older adults with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Abstract

Background: Frailty is a multidimensional syndrome that commonly affects older adults and can significantly influence rehabilitation outcomes. In patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD), frailty spans physical, cognitive, emotional, nutritional, and social domains. Understanding the impact of frailty on recovery is essential for optimizing care strategies in this vulnerable population. Objective: To find out the impact of frailty, assessed across physical, cognitive, emotional, nutritional, and social domains, on the rehabilitation outcomes of older patients with CHF and COPD. Methodology: A prospective observational study was conducted at Peshawar General Hospital, Peshawar, enrolled 60 clinically stable patients aged 65 years or older with CHF or COPD. Baseline and discharge frailty and associated domains were measured using validated instruments. Primary outcomes were physical function and independence improvements; secondary outcomes were mood, cognition, and frailty status. Results: Both CHF and COPD patients demonstrated large physical performance improvement (SPPB, TUG, 6MWT), mood (PHQ-9, GAD-7), executive function (FAB), and frailty score improvements. Frailty was reduced in 26.6% of patients after rehabilitation. There was slightly better cognitive performance at baseline among the COPD patients and good response among them in subdomains of attention and language. Baseline differences in disease profiles did not prevent benefit from rehabilitation in either group. Conclusion: Multidimensional rehabilitation significantly improves functional, cognitive, and emotional function in frail older persons with cardiorespiratory disease. Frailty is a reversible syndrome, incorporating vigorous frailty assessments can optimize rehabilitation interventions and facilitate enhanced recovery patterns.