De Lepeleire Jan, Iliffe Steve, Mann Eva, Degryse Jean Marie
Katholieke Universiteit Leuven, Belgium.
Br J Gen Pract. 2009 May;59(562):e177-82. doi: 10.3399/bjgp09X420653.
Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population.
西方社会的人口老龄化以及健康和社会护理成本的不断上升，正将卫生政策的重点重新转向老年人的健康促进和残疾预防。然而，识别老年人高危群体并通过早期干预或多学科病例管理来改变与老龄化相关的可避免问题发展轨迹的努力，在很大程度上并不成功。本文认为，这种失败源于初级保健中对老年人医疗保健的管理视角占主导地位，并提出取而代之采用基于衰弱概念的临床范式。衰弱，最简单的定义是易受不良后果影响。它是一个动态概念，不同于残疾，容易被忽视，但也易于使用启发法（经验法则）识别，并使用简单量表进行测量。从概念上讲，衰弱与全科医学的生物心理社会模型非常契合，为从业者提供了有用的患者护理工具，并为医疗保健专员提供了一个临床重点，以便将资源投向老龄化人群。
