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

King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK. King's College London, Department of Psychology, London, UK. Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK. University of East Anglia, School of Health Sciences, Norwich, UK. King's College London, Clinical Trials Unit, London, UK. King's College London, Cicely Saunders Institute Public Involvement Group, London, UK. Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK. Brunel University London, College of Health, Medicine and Life Sciences, London, UK. King's College Hospital NHS Foundation Trust, Pulmonary Rehabilitation, London, UK. King's College Hospital NHS Foundation Trust, Department of Clinical Gerontology, London, UK. Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas' NHS Foundation Trust, London, UK. Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK. King's College London, Department of Twin Research and Genetic Epidemiology, London, UK. Guys and St. Thomas' NHS Foundation Trust, Department of Ageing and Health, London, UK. Imperial College, National Heart and Lung Institute, London, UK. King's College London, Faculty of Life Sciences and Medicine, London, UK.

ERJ open research. 2024;(4)
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Abstract

INTRODUCTION Many 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. METHODS A 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. RESULTS Recruitment stopped at 31 participants (mean±sd age 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. CONCLUSION Integrating 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.