Lang Pierre-Olivier, Michel Jean-Pierre, Zekry Dina
Department of Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Hospital of Trois-Chêne, Geneva, Switzerland.
Gerontology. 2009;55(5):539-49. doi: 10.1159/000211949. Epub 2009 Apr 4.
Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches.
长期以来，衰弱一直被视为残疾和共病的同义词，在老年人中高度普遍，并导致跌倒、住院和死亡的高风险。然而，人们逐渐认识到衰弱可能是一种具有生物学基础的独特临床综合征。衰弱过程似乎是从强健到功能衰退的动态进展中的一个过渡状态。在此过程中，总的生理储备减少，维持和修复衰老身体的能力也越来越不足。衰弱临床概念的核心在于，它不是由单一系统的改变来定义的，而是涉及多个系统。综合众多作者的观点，关于构成衰弱的表型的临床共识表明，其特征包括消瘦（肌肉量、力量和体重均下降）、耐力丧失、平衡和活动能力下降、表现迟缓、相对不活动，以及可能的认知功能下降。衰弱是临床医生容易识别的一种独特实体，有多种表现形式，且单一症状在其表现中既不充分也非必要。表现包括外貌（与年龄相符与否）、营养状况（消瘦、体重减轻）、主观健康评分（健康感知）、表现（认知、疲劳）、感觉/身体损伤（视力、听力、力量）以及当前护理情况（用药、住院）。尽管衰弱过程的早期阶段在临床上可能不明显，但当储备耗尽达到导致严重脆弱性的总体阈值时，通过观察临床、功能、行为和生物学标志物可能会发现该综合征。因此，从衰弱前期开始更好地理解这些临床变化及其潜在机制，可能会证实许多老年医学专家的观点，即衰弱加剧与衰老不同，因此可能是可逆的。我们因此提供了关于衰弱过程的生理病理学、临床和生物学特征的最新情况，并推测了可能的预防方法。
