Comprehensive geriatric assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial

Author:

Brighton Lisa JaneORCID,Evans Catherine J.,Farquhar Morag,Bristowe Katherine,Kata Aleksandra,Higman Jade,Ogden Margaret,Nolan ClaireORCID,Yi Deokhee,Gao Wei,Koulopoulou Maria,Hasan Sharmeen,Ingram Karen,Clarke Stuart,Parmar Kishan R.,Baldwin Eleni,Steves Claire J.,Man William D-C.ORCID,Maddocks Matthew

Abstract

IntroductionMany people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.MethodsA multicentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”;ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.ResultsRecruitment stopped at 31 participants (mean±sdage 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4–5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.ConclusionIntegrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.

Funder

National Institute for Health and Care Research

National Institute for Health Research Applied Research Collaboration South London

Publisher

European Respiratory Society (ERS)

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