Elsevier

Archives of Gerontology and Geriatrics

Volume 85, November–December 2019, 103913
Archives of Gerontology and Geriatrics

Relationship between peak expiratory flow and incidence of frailty, deaths and falls among nursing home residents: Results of the SENIOR cohort

https://doi.org/10.1016/j.archger.2019.103913Get rights and content

Highlights

  • Subjects with low peak expiratory flow have low physical and muscular capacity.

  • Peak expiratory flow is not an independent predictor of adverse health outcomes.

  • Peak expiratory flow has limited added value compared to the SPPB test.

Abstract

Objective

To correlate peak expiratory flow (PEF) with the incidence of frailty, deaths and falls among nursing home residents.

Methods

This is a 1-year longitudinal analysis performed on the clinical data of the SENIOR cohort. PEF, measured by peak flow meter, was considered as “low” when the observed value was ≤80% of the theoretical value. Physical capacity was evaluated using Short Physical Performance Battery, balance and gait using Tinetti test and muscle strength using a dynamometer. The incidence of frailty was defined as the transition from a “robust” or “prefrail” status to a “frail” status following Fried’s criteria. Deaths and falls were also collected.

Results

Among 646 subjects included at baseline (83.2 ± 9 years and 72.1% women), 297 (45.7%) displayed a low PEF. In this subgroup, physical capacity (p-values from 0.01 to <0.001), muscle strength (p < 0.001), balance and gait score (p < 0.001) were significantly lower compared to subjects displaying normal PEF. Subjects who became frail after one year displayed a lower % of the theoretical PEF value compared to those that did not (88.52 ± 45.06 vs 102.78 ± 50.29, respectively, p = 0.03). After adjustment for potential confounding variables (calf circumference, Tinetti test, SPPB test and handgrip strength), PEF was no longer associated with the occurrence of frailty. There was no association between PEF and mortality and falls.

Conclusion

In a nursing home setting, PEF is not an independent factor associated with the incidence of frailty, deaths and falls.

Introduction

Frailty is a major public health issue in older people (Buckinx, Rolland et al., 2015). This geriatric syndrome is defined as a state of increased vulnerability to stressors accompanied by a loss of reserves of different physiological systems (Fried et al., 2001; Rockwood, 2016). Screening and diagnosing frailty in the older population is important to prevent its related negative consequences, such as mortality, falls and loss of autonomy (Leng, Chen, & Mao, 2014). Practical indicators are then used to identify frail people or subjects at risk of becoming frail. Because frailty is associated with a decrease in muscle strength and physical capacity (Tabue-Teguo et al., 2018), their assessment seems to be highly relevant in clinical practice (Furtado, Patrício, Loureiro, Teixeira, & Ferreira, 2017; Xie et al., 2017). For some muscle and physical capacity assessments, different tools are needed, limiting their use in particular settings, such as nursing homes.

Lung function and respiratory muscle strength are known to decrease with age and are associated with reduced physical capacity, occurrence of death and health status (Vaz Fragoso, Gahbauer, Van Ness, Concato, & Gill, 2008) and consequently could be interesting markers of frailty and its consequences (Marengoni et al., 2018). The gold standard technique to evaluate lung function is spirometry (Miller et al., 2005), but it is not applicable in the specific setting of nursing homes since it necessitates complex training and specific equipment (Bellia et al., 2000). Peak expiratory flow (PEF), defined as the maximum instantaneous flow achieved during a forced expiration maneuver from maximal lung inflation (Quanjer, Lebowitz, Gregg, Miller, & Pedersen, 1997), is very easy to obtain from non-trained individuals and can be a practical lung function measurement to obtain from older people in large studies.

Vaz Fragoso et al. found that PEF was a risk assessment tool for frailty, especially for exhaustion and inactivity (Vaz Fragoso, Gahbauer, Van Hess, Gill, & Yu, 2009). Other studies established cross-sectional and longitudinal associations between respiratory function and frailty in community-dwelling older people using spirometry parameters such as FEV1 (forced expiratory volume) but not taking into account the PEF (Pegorari, Ruas, & Patrizzi, 2013; Vaz Fragoso, Enright, McAvay, Van Ness, & Gill, 2012; Weiss, Hoenig, Varadhan, Simonsick, & Fried, 2010). Low PEF in older people can predict health outcomes such as mortality and cognitive decline (Albert et al., 1995). Little is known about the relationship between PEF and falls (Gale, Cooper, Westbury, & Dennison, 2016). However, no studies were performed in nursing homes.

Moreover, studies of peak flow meter reproducibility in older people or nursing home populations are lacking in the literature. There are also no reference values ​​for very old populations in nursing homes. Studies of the specific population of nursing home residents are scarce, and data are lacking about PEF. The objectives of the present study were to evaluate the reproducibility of the PEF, to calculate normative values of PEF and to investigate, for the very first time, the relationship between low PEF and the incidence of frailty, deaths and falls among nursing home residents.

Section snippets

Population and study design

The present study was performed using the first year of follow-up of the SENIOR (Sample of Elderly Nursing home Individuals: an Observational Research) cohort. The SENIOR cohort is a longitudinal ongoing study conducted in 28 nursing homes in the Liege area (Belgium). This cohort of 662 subjects started in 2013, and all participants were invited every year to participate in the follow-up examination. Anamnestic, sociodemographic and clinical data were collected through individual face-to-face

Study population

At baseline, complete data for PEF were available for 646 subjects of the SENIOR cohort (Fig. 1). There were 662 subjects at baseline in the SENIOR cohort, but 16 subjects had missing data for PEF assessment. Longitudinal analyses could be performed on 332 subjects who had both frailty assessments after 1 year of follow-up and PEF assessment at baseline. Mortality and refusals to participate reduced our sample after 1 year of follow-up. The analyses of 1-year mortality and falls were carried

Discussion

The main findings of this study suggest that the percentage of theoretical PEF measured by a peak flow meter is not associated with the incidence of frailty, mortality or falls after 1 year of follow-up after adjustment for confounding variables. These results indicate that this measurement adds no more information as compared to the SPPB test. In the meantime, PEF is a very easy measurement with no need for extensive training. Peak flow meter is a portable device that is noninvasive,

Conclusion

In conclusion, in a sample of nursing home residents, the percentage of the theoretical PEF value, calculated as a function of a predictive equation, is not associated with the incidence of frailty, deaths or falls. However, PEF could be an interesting and practical alternative to collect in the absence of physical tests such as the SPPB test.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (43)

  • V. Bellia et al.

    Quality control of spirometry in the elderly

    American Journal of Respiratory and Critical Care Medicine

    (2000)
  • V. Bellia et al.

    Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients

    The European Respiratory Journal

    (2003)
  • A.E. Bone et al.

    Sarcopenia and frailty in chronic respiratory disease: Lessons from gerontology

    Chronic Respiratory Disease

    (2017)
  • F. Buckinx et al.

    Burden of frailty in the elderly population: Perspectives for a public health challenge

    Archives of Public Health

    (2015)
  • F. Buckinx et al.

    Relationship between isometric strength of six lower limb muscle groups and motor skills among nursing home residents

    The Journal of Frailty & Aging

    (2015)
  • F. Buckinx et al.

    Relationship between frailty, physical performance and quality of life among nursing home residents: The SENIOR cohort

    Aging Clinical and Experimental Research

    (2016)
  • A.J. Cruz-Jentofs et al.

    Sarcopenia : Revised European consensus on definition and diagnosis

    Age and Ageing

    (2019)
  • L.P. Fried et al.

    Frailty in older adults: Evidence for a phenotype

    Journal of Gerontology

    (2001)
  • G. Furtado et al.

    Physical fitness and frailty syndrome in institutionalized older women

    Perceptual and Motor Skills

    (2017)
  • C.R.G. Gale et al.

    Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing

    Age and Ageing

    (2016)
  • J. Gawel et al.

    The short physical performance battery as a predictor for long term disability or institutionalization in the community dwelling population aged 65 years old or older

    The Physical Therapy Review

    (2012)
  • Cited by (0)

    View full text