Abizanda Soler Pedro, Paterna Mellinas Gema, Martínez Sánchez Esther, López Jiménez Esther
Sección de Geriatría, Complejo Hospitalario Universitario Albacete, Albacete, Spain.
Rev Esp Geriatr Gerontol. 2010 Jul-Aug;45(4):219-28. doi: 10.1016/j.regg.2009.10.009. Epub 2010 May 20.
Comorbidity is common in the elderly and contributes to the complexity of this population subgroup. This problem is a risk factor for major adverse events such as functional decline, disability, dependency, poor quality-of-life, institutionalization, hospitalization and death, but is not the most important factor. Age and risk of functional decline rather than comorbidity (understood as a compilation of diseases) are the main characteristics defining the target population attended by geriatricians. Comorbidity indexes should not be interpreted independently in the elderly, but within a context of comprehensive geriatric assessment that includes age-related preclinical dysfunctions, frailty measures, and functional, mental and psychosocial issues. The clinical management of comorbidity in the elderly requires advanced knowledge of geriatrics because the treatment of one condition may worsen or lead to the development of others and because preclinical physiological dysfunctions modulate drug response. Recommending a specific comorbidity index is difficult and depends on multiple factors, due to their psychometric characteristics, applicability in the elderly and their construct. However, the Cumulative Illness Rating Scale, in the version adapted to the elderly, could be highly suitable. Other instruments, such as the Charlson index, the Index of CoExistent Disease and the Kaplan index are also valid and reproducible.
共病在老年人中很常见，并且导致了这一亚人群的复杂性。这个问题是诸如功能衰退、残疾、依赖、生活质量差、入住养老机构、住院和死亡等重大不良事件的一个风险因素，但并非最重要的因素。功能衰退的年龄和风险而非共病（理解为疾病的汇总）才是界定老年科医生所诊治目标人群的主要特征。共病指数在老年人中不应单独解读，而应在综合老年评估的背景下解读，综合老年评估包括与年龄相关的临床前功能障碍、衰弱指标以及功能、心理和社会心理问题。老年人共病的临床管理需要老年医学的先进知识，因为治疗一种疾病可能会使其他疾病恶化或导致其发生，并且临床前生理功能障碍会调节药物反应。由于共病指数的心理测量特征、在老年人中的适用性及其结构，推荐一个特定的共病指数很困难，且取决于多个因素。然而，适用于老年人的累积疾病评定量表可能非常合适。其他工具，如查尔森指数、共存疾病指数和卡普兰指数也有效且可重复。
