Geriatric Cardiology Section, University of Pittsburgh Medical Center, University of Pittsburgh, and the Geriatric, Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Duke Clinical Research Institute, and Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
Can J Cardiol. 2016 Sep;32(9):1082-7. doi: 10.1016/j.cjca.2016.05.015. Epub 2016 Jun 2.
Mechanisms of aging predispose to cardiovascular disease (CVD), as well as to aggregate health challenges. For older adults, CVD is likely to exist in combination with comorbid conditions, disability, polypharmacy, falling risks, and body composition changes. These other dimensions of health result in cumulative weakening with greater clinical complexity that confound basic precepts of CVD presentation, prognosis, and treatments. A convenient operational tool is needed to gauge this age-related vulnerability such that it can be integrated in the evaluation and treatment of CVD. Frailty is a concept that is neither disease- nor age-specific, but is used to characterize the reserve that a person has available to tolerate stresses associated with aging, disease, and even therapy. Frailty arises from specific biological mechanisms in association with cumulative physiological decrements, psychosocial stresses, and physical impairments. Performance-based and survey tools have been developed and tested to measure frailty. Although different frailty tools vary in practicality, measured domains, and precise applications, all are useful in identifying risks that commonly accrue with age. Although comparisons between frailty tools are ongoing and sometimes even controversial, the rationale to integrate routine use of frailty screening as part of routine care is relatively straightforward and easy to envision. Frailty assessment applied as a vital sign (for standard maintenance and evaluation of new symptoms) enhances perspectives of risk, decision-making, and opportunities for tailored CVD management.
衰老的机制使心血管疾病 (CVD) 更容易发生，也使多种健康挑战更易聚集。对于老年人来说，CVD 很可能与合并症、残疾、多种药物治疗、跌倒风险和身体成分变化同时存在。这些健康的其他方面导致了累积的衰弱，临床复杂性增加，使 CVD 的表现、预后和治疗的基本原理变得复杂。需要一种方便的操作工具来衡量这种与年龄相关的脆弱性，以便将其纳入 CVD 的评估和治疗中。
虚弱不是一种特定于疾病或年龄的概念，但用于描述一个人有能力承受与衰老、疾病甚至治疗相关的压力的储备。虚弱是与累积的生理衰退、心理社会压力和身体损伤相关的特定生物学机制引起的。已经开发和测试了基于表现和调查的工具来测量虚弱。尽管不同的虚弱工具在实用性、测量的领域和精确的应用方面存在差异，但所有这些工具都有助于识别随着年龄增长而常见的风险。
虽然对虚弱工具的比较仍在进行，有时甚至存在争议，但将虚弱筛查常规用于常规护理作为常规护理的一部分的理由相对简单明了，易于想象。虚弱评估作为生命体征（用于标准维护和新症状的评估）的应用增强了风险、决策和定制 CVD 管理机会的观点。
