Walston Jeremy, Robinson Thomas N, Zieman Susan, McFarland Frances, Carpenter Christopher R, Althoff Keri N, Andrew Melissa K, Blaum Caroline S, Brown Patrick J, Buta Brian, Ely E Wesley, Ferrucci Luigi, High Kevin P, Kritchevsky Stephen B, Rockwood Kenneth, Schmader Kenneth E, Sierra Felipe, Sink Kaycee M, Varadhan Ravi, Hurria Arti
Division of Geriatric Medicine and Frailty, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Surgery, Denver Veterans Affairs Medical Center, Denver, Colorado.
J Am Geriatr Soc. 2017 Oct;65(10):2134-2139. doi: 10.1111/jgs.14902. Epub 2017 Apr 19.
Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, human immunodeficiency virus care, and nephrology, and in the behavioral and social sciences. Lack of a consensus definition, proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for frail individuals hinders incorporation of frailty assessment and frailty research into the specialties. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA), and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA-sponsored Grants for Early Medical/Surgical Specialists Transition into Aging Research program to review the current state of knowledge regarding frailty in the subspecialties and to highlight examples of integrating frailty research into the medical specialties. Research questions to advance frailty research into specialty medicine are proposed.
尽管衰弱研究领域发展迅速,但在临床专科中它仍是一个新兴概念。衰弱被定义为由于生理储备显著消耗而对压力源更易产生脆弱性,在包括心脏病学、人类免疫缺陷病毒护理和肾脏病学等多个医学专科以及行为和社会科学领域中,衰弱预示着更差的预后。缺乏共识定义、测量工具繁多、对衰弱生物学理解不足以及缺乏针对衰弱个体的经过验证的临床算法,阻碍了将衰弱评估和衰弱研究纳入各专科。2015年,美国老年医学会、国立衰老研究所(NIA)和学术内科联盟为获得NIA资助的早期医学/外科专科医生向衰老研究过渡项目的获奖者举办了一次会议,以审查各亚专科中关于衰弱的当前知识状况,并突出将衰弱研究整合到医学专科中的实例。文中还提出了推动衰弱研究进入专科医学的研究问题。