Boockvar Kenneth S, Meier Diane E
James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA.
JAMA. 2006 Nov 8;296(18):2245-53. doi: 10.1001/jama.296.18.2245.
Frailty in older adults is increasingly a recognized syndrome of decline, sometimes subtle, in function and health that may be amenable to available approaches to care. Frailty manifests the following core clinical features: loss of strength, weight loss, low levels of activity, poor endurance or fatigue, and slowed performance. The presence of 3 or more of these features is associated with adverse outcomes including falls, new or worsened function impairment, hospitalization, and death. In this article, we use the case of Mrs K to describe the challenges of recognizing frailty in clinical practice, common problems and symptoms that frail older adults experience, and approaches to these issues that clinicians may incorporate into their practices. We discuss the importance of advance care planning, provider-patient communication, and appropriate palliative care and hospice referral for frail older adults. Frailty is associated with symptomatic long-term disease, decline in function, and abbreviated survival. Therefore, when frailty is severe, delivery of palliative care focused on relief of discomfort and enhancement of quality of life is highly appropriate. The application of multidisciplinary, team-based palliative approaches and of up-to-date geriatrics knowledge is beneficial for treating these patients because of the complexity of their coexisting social, psychological, and medical needs.
老年人的衰弱日益成为一种公认的功能和健康衰退综合征，有时较为隐匿，或许可通过现有的护理方法来改善。衰弱表现出以下核心临床特征：力量丧失、体重减轻、活动水平低、耐力差或疲劳以及行动迟缓。出现3种或更多这些特征与不良后果相关，包括跌倒、新的或恶化的功能障碍、住院和死亡。在本文中，我们以K夫人的病例来描述在临床实践中识别衰弱的挑战、衰弱老年人所经历的常见问题和症状，以及临床医生可纳入其实践的这些问题的处理方法。我们讨论了预先护理计划、医患沟通以及为衰弱老年人进行适当的姑息治疗和临终关怀转诊的重要性。衰弱与有症状的长期疾病、功能衰退和生存期缩短相关。因此，当衰弱严重时，提供以缓解不适和提高生活质量为重点的姑息治疗是非常合适的。由于这些患者共存的社会、心理和医疗需求的复杂性，应用多学科、基于团队的姑息治疗方法以及最新的老年医学知识对治疗他们有益。
