ArticleFrontiers in public health2026
Heterogeneous frailty trajectories and their differential impact on social integration in older adults with COPD: a prospective longitudinal study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To explore the heterogeneous development trajectories of frailty in older adults with chronic obstructive pulmonary disease (COPD) and to examine the associations between different trajectory classes and levels of social integration at 12 months. Methods: A prospective longitudinal study was conducted. Eligible older adults with COPD were consecutively recruited from the Sixth People's Hospital of Nantong City between May 2024 and January 2025. Assessments were performed at five time points: baseline (T0), 3 months (T1), 6 months (T2), 9 months (T3), and 12 months (T4). Frailty was assessed using the Fried frailty phenotype. Social integration was evaluated across three dimensions: functional, structural, and subjective experience, using the Instrumental Activities of Daily Living scale, the 6-item Lubben Social Network Scale, and the UCLA Loneliness Scale (Version 3), respectively. Data analysis involved identifying potential frailty development trajectory classes using growth mixture modeling. Hierarchical multiple linear regression models were employed to examine the independent associations between different frailty trajectory classes and 12-month social integration outcomes, while controlling for baseline social integration levels, demographic, and clinical variables. Results: A total of 347 patients completed all five follow-ups. Growth mixture modeling identified four distinct frailty development trajectories, in order of class proportion: Persistently Stable-Low Frailty (41.2%), Slow Progression (33.1%), Post-Exacerbation Fluctuation (18.5%), and Rapid Deterioration (7.2%). The four trajectory groups differed significantly in baseline characteristics such as age, lung function, and number of acute exacerbations in the past year (all Conclusion: Frailty development in older adults with COPD follows four heterogeneous trajectories, among which the Rapid Deterioration and Post-Exacerbation Fluctuation trajectories hold important clinical warning significance. Different frailty trajectory classes are independently associated with long-term social integration outcomes. In clinical practice, dynamically assessing frailty trajectories and stratifying patients based on risk has potential value for implementing targeted interventions to maintain their social functioning.
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