Perception, coping, and needs of frailty in older patients with COPD: a qualitative study from patient, caregiver, and healthcare provider perspectives

Abstract

Multidimensional frailty substantially affects health outcomes in older adults with chronic obstructive pulmonary disease (COPD); however, its comprehensive management remains insufficiently investigated. Existing research has largely focused on physical frailty from the patient perspective, with limited attention to the multidimensional nature of frailty, the perspectives of other stakeholders, and integrated management approaches. This study explored stakeholders’ perceptions of, coping strategies for, and unmet needs related to multidimensional frailty among older patients with COPD. Guided by stakeholder theory, this descriptive qualitative study recruited 11 patient–caregiver dyads and 11 healthcare professionals through purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis to explore the perceptions, coping strategies, and needs of patients and key stakeholders regarding multidimensional frailty. The analysis identified three overarching themes, nine subthemes, and 62 initial codes. The three themes were as follows: (1) perceptions and recognition of multidimensional frailty, (2) coping with multidimensional frailty, and (3) needs related to multidimensional frailty management. The nine subthemes were increased dependence, limited recognition of multidimensional frailty, early recognition of multidimensional frailty, active coping, passive coping, educational needs, needs for improved physical functioning, needs for psychological and emotional adjustment, and needs for social support. Representative initial codes included patients’ dependence in physical activities and emotional attachment; caregivers’ observations of functional decline, role transitions, and increased caregiving burden; and healthcare professionals’ perceptions of progressive functional decline, dynamic dependence, and manifestations of dependence. Cognitive biases and healthcare system limitations impede the early identification of multidimensional frailty in older patients with COPD. Promoting a patient-centered approach to address this issue will require systematic training, the establishment of multidisciplinary teams, and targeted health education for patients, caregivers, and healthcare professionals.