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《亚太地区衰弱管理临床实践指南》。

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty.

机构信息

Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.

Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore.

出版信息

J Am Med Dir Assoc. 2017 Jul 1;18(7):564-575. doi: 10.1016/j.jamda.2017.04.018.

Abstract

OBJECTIVE

To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty.

METHODS

An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation.

RECOMMENDATIONS

Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan.

CONCLUSIONS

The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.

摘要

目的

制定老年人衰弱症的筛查、评估和管理临床实践指南。

方法

采用改良的推荐分级、评估、制定与评价方法制定指南。该过程涉及对现有科学证据进行详细评估,并结合专家小组的解释。制定了三类临床实践指南建议:强推荐、有条件推荐和无推荐。

建议

强推荐包括(1)使用经过验证的测量工具来识别衰弱症;(2)规定进行包含抗阻训练的身体活动;(3)通过减少或停用任何不合适/多余的药物来解决药物滥用问题。有条件推荐包括(1)筛查和解决可改变的疲劳原因;(2)对于出现非故意体重减轻的人,筛查可逆原因并考虑食物强化和蛋白质/热量补充;(3)为维生素 D 缺乏的个体开维生素 D 处方。对于提供患者支持和教育计划,没有建议。

结论

本指南中的建议旨在供亚太地区的医疗保健提供者在管理老年衰弱症患者时使用。建议成立区域指南支持委员会,以帮助定期更新这些基于证据的指南。

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