Outcomes of pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: a systematic review

BACKGROUND: Outcome heterogeneity in pulmonary rehabilitation (PR) for older adults with chronic obstructive pulmonary disease (COPD) limits evidence synthesis and hampers clinical standardization. This review aimed to identify and categorize the outcome indicators, measurement tools, and assessment time points in PR studies for older COPD patients, to inform a future core outcome set (COS). METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-COnsensus-based Standards for the selection of health Measurement INstruments (PRISMA-COSMIN) 2024 guideline. The study protocol was prospectively registered with PROSPERO (CRD420250652844). Eight databases were searched from inception to February 2025. Study characteristics, outcome indicators, measurement tools, and time points were extracted. Outcomes were categorized into domains based on the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy and analyzed descriptively. RESULTS: A total of 95 studies (n = 204,626) were included, reporting 590 outcome indicators consolidated into 148 unique types across six domains: Physiological/Clinical (64.92%), Functional Status (18.14%), Life Impact, Psychosocial, Adverse Events, and Mortality. Geriatric-specific outcomes such as balance and physical activity were identified but inconsistently reported; for instance, balance function was assessed in only 3 studies (3.16%), frailty in 2 studies (2.11%), and physical activity ability in 6 studies (6.32%). Reporting of adverse events (e.g., falls) and mortality was notably limited. The overall evidence quality ranged from moderate to high. CONCLUSION: Outcome assessment in PR for older adults with COPD is multidimensional and requires age-specific sensitivity. This review provides a critical evidence base for clinical practice and future research. Future research should develop a COS integrating geriatric-specific indicators to enhance consistency and personalization of care. The findings directly support clinicians and researchers in selecting appropriate, comprehensive outcome measures that reflect the priorities of older adults with COPD, thereby improving the impact of rehabilitation programs.