Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China.
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clin Interv Aging. 2014 Mar 19;9:433-41. doi: 10.2147/CIA.S45300. eCollection 2014.
Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.
衰弱是一种常见且重要的老年综合征，其特征是与年龄相关的多器官系统生理储备和功能下降，导致对不良健康结果的易感性增加。文献中描述了两种主要的衰弱模型。衰弱表型将衰弱定义为一种独特的临床综合征，符合五个表型标准中的三个或更多：虚弱、缓慢、低水平的体力活动、自我报告的疲惫和非故意的体重减轻。衰弱指数将衰弱定义为全面老年评估中确定的累积缺陷。最近在理解衰弱的发病机制方面取得了重大进展。慢性炎症可能是导致衰弱综合征的关键病理生理过程，它直接通过其他中间生理系统（如肌肉骨骼、内分泌和血液系统）间接导致衰弱综合征。衰弱的复杂多因素病因还包括肥胖和特定疾病。主要的临床应用包括风险评估和分层。这可以应用于社区中的老年人群和各种护理环境中。衰弱也可用于评估手术患者和心血管疾病、癌症或人类免疫缺陷病毒感染患者的风险，以及评估老年人疫苗的有效性。目前，运动和全面的老年跨学科评估和治疗是衰弱的关键干预措施。随着对衰弱的生物学基础和复杂性的理解进一步提高，可能会开发出更有效和有针对性的干预策略和创新的老年护理模式。
