Heppenstall Claire P, Wilkinson Tim J, Hanger H Carl, Keeling Sally
Department of Older Persons Health, University of Otago, Christchurch, Princess Margaret Hospital, PO Box 800, Christchurch, New Zealand.
N Z Med J. 2009 Jul 24;122(1299):42-53.
Frailty is a common, but under-described, condition in older people, that is now better understood thus aiding better identification and treatment. It is characterised by multisystem deterioration and loss of physiological reserve to cope with insults. The traditional physical phenotype of frailty comprises 5 key findings: weakness, sarcopaenia, weight loss, physical inactivity, and slowness (which are also modulated by psychosocial factors). Several inflammatory, endocrine and nutritional markers have been proposed as contributory, although cause-and-effect is not clear. Predisposing factors are early childhood development and lifestyle, followed by physical inactivity, chronic disease, and anorexia/ malnutrition in later adulthood. These may form a cycle of deterioration. Frailty predisposes to marked decline in physical and mental function resulting from even apparently small insults. This commonly manifests as a "domino" effect, with a small initial insult leading to a cascade of adverse events. Several interventions have been shown to be helpful for frail older adults including exercise programs, nutritional support, maximising function prior to a planned interventions such as surgery, and early intervention when an acute insult threatens independence. Specialist geriatric assessment and management identifies and treats unstable medical conditions, reviews polypharmacy, facilitates early mobilisation, offers nutritional support, and assesses social circumstances. Frail older people in whom function has been compromised may be labelled as "unable to cope" but in fact many benefit from early comprehensive geriatric assessment to enable them to regain lost function.
衰弱是老年人中一种常见但描述不足的状况，现在对此有了更好的理解，有助于更好地识别和治疗。其特征是多系统功能衰退以及应对损伤的生理储备丧失。衰弱的传统身体表型包括5个关键表现：虚弱、肌肉减少症、体重减轻、身体活动不足和行动迟缓（这些也受心理社会因素调节）。虽然因果关系尚不清楚，但已有几种炎症、内分泌和营养标志物被认为与之有关。诱发因素包括儿童早期发育和生活方式，随后是成年后期的身体活动不足、慢性病以及厌食/营养不良。这些可能形成一个衰退循环。衰弱会使即使看似轻微的损伤也导致身体和心理功能显著下降。这通常表现为“多米诺骨牌”效应，最初的小损伤会引发一系列不良事件。已证明几种干预措施对衰弱的老年人有帮助，包括运动计划、营养支持、在计划的干预措施（如手术）前最大化功能，以及在急性损伤威胁到独立性时进行早期干预。专业的老年评估和管理可识别并治疗不稳定的医疗状况、审查多重用药情况、促进早期活动、提供营养支持并评估社会状况。功能受损的衰弱老年人可能被贴上“无法应对”的标签，但实际上许多人受益于早期全面的老年评估，从而能够恢复失去的功能。
