Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community- dwelling older adults

a cross-sectional study

Authors

Keywords:

Aged, Dyspnea, Frailty

Abstract

CONTEXT: Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages. DESIGN AND SETTING: Cross-sectional study at community level, Brazil. OBJECTIVE: To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults. METHOD: Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 communit-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios. RESULTS: The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component. CONCLUSION: Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.

Downloads

Download data is not yet available.

Author Biographies

Giselle Layse Andrade Buarque, Universidade Estadual de Campinas and Universidade de São Paulo

PT, MSc. Physiotherapist and Doctoral Student, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

Flávia Silva Arbex Borim, Universidade Estadual de Campinas and Universidade de São Paulo

PT, PhD. Physiotherapist, Assistant Professor, Department of Collective Health, School of Health Sciences, Universidade de Brasília (UnB), Brasília (DF), Brazil; and Advisor, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

Anita Liberalesso Neri, Universidade Estadual de Campinas and Universidade de São Paulo

PhD. Psychologist and Collaborating Professor, Department of Medical Psychology and Psychiatry and Advisor, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

Mônica Sanches Yassuda, Universidade Estadual de Campinas and Universidade de São Paulo

PhD. Psychologist, Full Professor, School of Arts, Sciences and Humanities, and Advisor, Postgraduate Program on Gerontology, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), São Paulo (SP), Brazil; and Advisor, Postgraduate Program on Gerontology, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

Ruth Caldeira de Melo, Universidade Estadual de Campinas and Universidade de São Paulo

PT, PhD. Physiotherapist and Assistant Professor, School of Arts, Sciences and Humanities, and Advisor, Postgraduate Program on Gerontology, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), São Paulo (SP), Brazil.

References

Smith AK, Currow DC, Abernethy AP, et al. Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. J Am Geriatr Soc. 2016;64(10):2035-41. PMID: 27603500; https://doi.org/10.1111/jgs.14313.

van Mourik Y, Rutten FH, Moons KG, et al. Prevalence and underlying causes of dyspnoea in older people: a systematic review. Age Ageing. 2014;43(3):319-26. PMID: 24473156; https://doi.org/10.1093/ageing/afu001.

Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-52. PMID: 22336677; https://doi.org/10.1164/rccm.201111-2042ST.

Silva CFR, Pegorari MS, Matos AP, Ohara DG. Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study. Sao Paulo Med J. 2020;138(2):112-7. PMID: 32294715; https://doi.org/10.1590/1516-3180.2019.0428.R1.09122019.

Banzett RB, Schwartzstein RM. Dyspnea: Don’t Just Look, Ask! Am J Respir Crit Care Med. 2015;192(12):1404-6. PMID: 26669467; https://doi.org/10.1164/rccm.201508-1637ED.

MacDonald S, Yates J, Lance R, Giganti N, Chepurko D. Are you asking the right admission questions when assessing dyspnea? Heart Lung. 2005;34(4):260-9. PMID: 16027647; https://doi.org/10.1016/j.hrtlng.2004.12.002.

Yorke J, Savin C. Evaluating tools that can be used to measure and manage breathlessness in chronic disease. Nurs Times. 2010;106(17):10, 12-3. PMID: 20486630.

Crisafulli E, Clini EM. Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med. 2010;5(3):202-10. PMID: 22958431; https://doi.org/10.1186/2049-6958-5-3-202.

Banzett RB, O’Donnell CR, Guilfoyle TE, et al. Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research. Eur Respir J. 2015;45(6):1681-91. PMID: 25792641; https://doi.org/10.1183/09031936.00038914.

Miner B, Tinetti ME, Van Ness PH, et al. Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition. J Am Geriatr Soc. 2016;64(10):2042-50. PMID: 27549914; https://doi.org/10.1111/jgs.14290.

Mahler DA. Evaluation of Dyspnea in the Elderly. Clin Geriatr Med. 2017;33(4):503-21. PMID: 28991647; https://doi.org/10.1016/j.cger.2017.06.004.

Marchetti N, Kaplan A. Dyspnea and Hyperinflation in Chronic Obstructive Pulmonary Disease: Impact on Physical Activity. Cleve Clin J Med. 2018;85(2 Suppl 1):S3-S10. PMID: 29494327; https://doi.org/10.3949/ccjm.85.s1.02.

Lahousse L, Ziere G, Verlinden VJ, et al. Risk of Frailty in Elderly With COPD: A Population-Based Study. J Gerontol A Biol Sci Med Sci. 2016;71(5):689-95. PMID: 26355016; https://doi.org/10.1093/gerona/glv154.

Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7. PMID: 23764209; https://doi.org/10.1016/j.jamda.2013.03.022.

Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. PMID: 11253156; https://doi.org/10.1093/gerona/56.3.m146.

Vaz Fragoso CA, Enright PL, McAvay G, Van Ness PH, Gill TM. Frailty and respiratory impairment in older persons. Am J Med. 2012;125(1):79-86. PMID: 22195532; https://doi.org/10.1016/j.amjmed.2011.06.024.

Vaz Fragoso CA, Araujo K, Leo-Summers L, Van Ness PH. Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons. J Am Geriatr Soc. 2015;63(8):1628-33. PMID: 26200804; https://doi.org/10.1111/jgs.13529.

Neri AL, Yassuda MS, de Araújo LF, et al. Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA. Cad Saude Publica. 2013;29(4):778-92. https://doi.org/10.1590/S0102-311X2013000400015.

Nunes BP, Batista SRR, Andrade FB, et al. Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saude Publica. 2018;52Suppl 2(Suppl 2):10s. PMID: 30379288; https://doi.org/10.11606/S1518-8787.2018052000637.

División de Promoción y Protección de la Salud, Organización Panamericana de la Salud. Encuesta multicentrica salud bienestar y envejecimiento (SABE) en América Latina: informe preliminar. In: XXXVI Reunión del Comité Asesor de Investigaciónes en Salud. Washington DC: Organización Panamericana de la Salud; 2001. p. 1-19.

Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. 1997;12(2):277-87. PMID: 9189988; https://doi.org/10.1037//0882-7974.12.2.277.

Batistoni SST, Néri AL, Cupertino AP. Validade e confiabilidade da versão Brasileira da Center for Epidemiological Scale - Depression (CES-D) em idosos Brasileiros. Psico-USF. 2010;15(1):13-22. https://doi.org/10.1590/S1413-82712010000100003.

Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-61. PMID: 7838189; https://doi.org/10.1056/NEJM199503023320902.

Taylor HL, Jacobs DR Jr, Schucker B, et al. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31(12):741-55. PMID: 748370; https://doi.org/10.1016/0021-9681(78)90058-9.

Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498-504. PMID: 10993420; https://doi.org/10.1097/00005768-200009001-00009.

Huijnen B, van der Horst F, van Amelsvoort L, et al. Dyspnea in elderly family practice patients. Occurrence, severity, quality of life and mortality over an 8-year period. Fam Pract. 2006;23(1):34-9. PMID: 16115834; https://doi.org/10.1093/fampra/cmi064.

Ho SF, O’Mahony MS, Steward JA, et al. Dyspnoea and quality of life in older people at home. Age Ageing. 2001;30(2):155-9. PMID: 11395346; https://doi.org/10.1093/ageing/30.2.155.

Akgün KM, Krishnan S, Feder SL, et al. Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. Am J Hosp Palliat Care. 2020;37(4):278-85. PMID: 31550901; https://doi.org/10.1177/1049909119877512.

Petersen S, von Leupoldt A, Van den Bergh O. Geriatric dyspnea: doing worse, feeling better. Ageing Res Rev. 2014;15:94-9. PMID: 24675044; https://doi.org/10.1016/j.arr.2014.03.001.

Pivetta NRS, Marincolo JCS, Neri AL, et al. Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship. Arch Gerontol Geriatr. 2020;86:103931. https://doi.org/10.1016/j.archger.2019.103931

Ibarra-Castillo C, Guisado-Clavero M, Violan-Fors C, et al. Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010-2014): a longitudinal study based on electronic health records. J Epidemiol Community Health. 2018;72(3):185-92. PMID: 29330165; https://doi.org/10.1136/jech-2017-209984.

Wang XX, Lin WQ, Chen XJ, et al. Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China. Health Qual Life Outcomes. 2017;15(1):73. PMID: 28412945; https://doi.org/10.1186/s12955-017-0635-7.

Yarnall AJ, Sayer AA, Clegg A, et al. New horizons in multimorbidity in older adults. Age Ageing. 2017;46(6):882-8. PMID: 28985248; https://doi.org/10.1093/ageing/afx150.

Rizzuto D, Melis RJF, Angleman S, Qiu C, Marengoni A. Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults. J Am Geriatr Soc. 2017;65(5):1056-60. PMID: 28306158; https://doi.org/10.1111/jgs.14868.

Marshall A, Nazroo J, Tampubolon G, Vanhoutte B. Cohort differences in the levels and trajectories of frailty among older people in England. J Epidemiol Community Health. 2015;69(4):316-21. PMID: 25646207; https://doi.org/10.1136/jech-2014-204655.

Johnson MJ, Bland JM, Gahbauer EA, et al. Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors. J Am Geriatr Soc. 2016;64(1):73-80. PMID: 26782854; https://doi.org/10.1111/jgs.13865.

Bekić S, Babič F, Filipčić I, Trtica Majnarić L. Clustering of Mental and Physical Comorbidity and the Risk of Frailty in Patients Aged 60 Years or More in Primary Care. Med Sci Monit. 2019;25:6820-35. PMID: 31507272; https://doi.org/10.12659/MSM.915063.

Schöttker B, Saum KU, Muhlack DC, et al. Polypharmacy and mortality: new insights from a large cohort of older adults by detection of effect modification by multi-morbidity and comprehensive correction of confounding by indication. Eur J Clin Pharmacol. 2017;73(8):1041-8. PMID: 28540438; https://doi.org/10.1007/s00228-017-2266-7.

Marengoni A, Vetrano DL, Manes-Gravina E, et al. The Relationship Between COPD and Frailty: A Systematic Review and Meta-Analysis of Observational Studies. Chest. 2018;154(1):21-40. PMID: 29477493; https://doi.org/10.1016/j.chest.2018.02.014.

Medina-Mirapeix F, Bernabeu-Mora R, Giménez-Giménez LM, et al. Physical frailty characteristics have a differential impact on symptoms as measured by the CAT score: an observational study. Health Qual Life Outcomes. 2018;16(1):140. PMID: 30012169; https://doi.org/10.1186/s12955-018-0969-9.

Ramon MA, Ter Riet G, Carsin AE, et al. The dyspnoea-inactivity vicious circle in COPD: development and external validation of a conceptual model. Eur Respir J. 2018;52(3):1800079. PMID: 30072504; https://doi.org/10.1183/13993003.00079-2018.

Egerton T, Chastin SF, Stensvold D, Helbostad JL. Fatigue May Contribute to Reduced Physical Activity Among Older People: An Observational Study. J Gerontol A Biol Sci Med Sci. 2016;71(5):670-6. PMID: 26347508; https://doi.org/10.1093/gerona/glv150.

Downloads

Published

2022-05-05

How to Cite

1.
Buarque GLA, Borim FSA, Neri AL, Yassuda MS, Melo RC de. Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community- dwelling older adults: a cross-sectional study. Sao Paulo Med J [Internet]. 2022 May 5 [cited 2025 Mar. 9];140(3):356-65. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/952

Issue

Section

Original Article