Standardised assessment and management of frailty in elderly respiratory patients

INTERVENTION: Best practice respiratory care as well as standardised assessment for frailty. If found to be pre‐frail or frail, refer for comprehensive geriatric assessment. Best practice respiratory care at the study site involves 6 monthly one‐on‐one 30‐minute consultations with a respiratory consultant. Over the study period, each participant will attend at least two consultations, (more if needed by participant). Spirometry and 6 min walk tests will be performed before each consultation to monitor respiratory function. Consultations will be tailored to the participant's needs and may include assessing new‐onset symptoms, optimising medications for symptom management, referral to pulmonary rehabilitation programs or treatment of exacerbations. Frailty assessment will be performed using two validated screening tools: the Clinical Frailty Scale (Rockwood, 2005) and the Study of Osteoporotic Frailty Scale (Ensrud, 2008). Comprehensive geriatric assessment will include multidimensional assessment of the patient's medical, psychological and social well‐being, RUDAS dementia screen, and construction of a management plan. CONDITION: Asthma Chronic obstructive pulmonary disease (COPD) Frailty PRIMARY OUTCOME: Acute health care utilisation, patient‐reported in weekly diary card Frequency of exacerbations Health‐related quality of life SECONDARY OUTCOME: 6‐minute walk test, a standardised respiratory function test assessing functional capacity Change in frailty status Grip strength Institutionalisation into a facilitated living residence or nursing home. Mortality Spirometry (FEV1, FEV1/FVC), to assess severity of airway disease INCLUSION CRITERIA: Symptomatic COPD or asthma