Karlamangla Arun, Tinetti Mary, Guralnik Jack, Studenski Stephanie, Wetle Terrie, Reuben David
UCLA Division of Geriatrics, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA 90095, USA.
J Gerontol A Biol Sci Med Sci. 2007 Mar;62(3):296-300. doi: 10.1093/gerona/62.3.296.
Older adults generally have multiple medical problems as well as subclinical changes in several physiologic systems. This special article presents a framework (based on the World Health Organization International Classification of Functioning, Disability, and Health) for organizing comorbid processes and diseases to facilitate research and assist clinicians caring for older adults. The nosology begins with physiologic systems (e.g., cardiovascular, endocrine) and assesses each system in several domains (e.g., coronary blood flow, systemic blood pressure, and cardiac function in the cardiovascular system). Functioning in each domain can range from high-functioning, even protective, zones (e.g., high levels of high-density-lipoprotein cholesterol) to severe dysfunction (as in end-stage disease). The approach has four advantages. First, it explicitly recognizes that decrements in health begin before onset of symptomatic disease. Second, it accommodates the full range of possible performance for each system instead of measuring only negative aspects. Third, it avoids arbitrary diagnostic thresholds. Fourth, it sets up an exhaustive and mutually exclusive classification system that can stimulate development of summary indices of total comorbidity burden for both research and clinical settings. As the knowledge base grows, the nosology can be updated to add new domains and refine extant ones.
老年人通常存在多种医疗问题以及多个生理系统的亚临床变化。这篇专题文章提出了一个框架（基于世界卫生组织《国际功能、残疾和健康分类》），用于组织共病过程和疾病，以促进研究并协助照顾老年人的临床医生。该疾病分类法从生理系统（如心血管系统、内分泌系统）开始，并在几个领域评估每个系统（如心血管系统中的冠状动脉血流、全身血压和心脏功能）。每个领域的功能状态可以从高功能甚至具有保护作用的区域（如高水平的高密度脂蛋白胆固醇）到严重功能障碍（如终末期疾病）。这种方法有四个优点。第一，它明确认识到健康下降在症状性疾病发作之前就已开始。第二，它涵盖了每个系统所有可能的表现范围，而不是只测量负面方面。第三，它避免了任意的诊断阈值。第四，它建立了一个详尽且相互排斥的分类系统，可促进为研究和临床环境开发共病总负担的汇总指标。随着知识库的增长，疾病分类法可以更新，以添加新领域并完善现有领域。
