South Western Sydney Clinical School, The Simpson Centre for Health Services Research, The University of New South Wales, Level 3, Ingham Institute Building, 1 Campbell Street, Liverpool, NSW 2170, Sydney, Australia.
South Western Sydney Clinical School, The Simpson Centre for Health Services Research, The University of New South Wales, Level 3, Ingham Institute Building, 1 Campbell Street, Liverpool, NSW 2170, Sydney, Australia.
Eur J Intern Med. 2017 Nov;45:84-90. doi: 10.1016/j.ejim.2017.09.026. Epub 2017 Oct 6.
Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may be controlled and can be slowed down and its precursor -pre-frailty- can be treated with multidisciplinary intervention. The aim of this narrative review is to provide an overview of the different ways of measuring frailty in community settings, hospital, emergency, general practice and residential aged care; suggest occupational groups who can assess frailty in various services; discuss the feasibility of comprehensive geriatric assessments; and summarise current evidence of its management guidelines. We also suggest practical recommendations to recognise frail patients near the end of life, so discussions on goals of care, advance care directives, and shared decision-making including early referrals to palliative and supportive care can take place before an emergency arises. We acknowledge the barriers to systematically assess frailty and the absence of consensus on best instruments for different settings. Nevertheless, given its potential consequences including prolonged suffering, disability and death, we recommend identification of frailty levels should be universally attempted in older people at any health service, to facilitate care coordination, and honest discussions on preferences for advance care with patients and their caregivers.
衰弱是一种脆弱状态，是一生中许多生理系统逐渐衰退的结果。它是进行性的，且被认为在很大程度上是不可逆转的，但它的进展可以得到控制，可以减缓，其前驱阶段——虚弱前期——可以通过多学科干预来治疗。本综述的目的是概述在社区环境、医院、急诊、全科医疗和养老院中测量衰弱的不同方法；提出可以在各种服务中评估衰弱的职业群体；讨论全面老年评估的可行性；并总结其管理指南的现有证据。我们还提出了一些实用建议，以识别生命末期的虚弱患者，以便在紧急情况发生之前，可以就护理目标、预先指示和共同决策进行讨论，包括及早转介姑息治疗和支持性护理。我们认识到系统评估衰弱的障碍以及在不同环境下缺乏最佳工具的共识。然而，鉴于其潜在后果，包括延长痛苦、残疾和死亡，我们建议在任何医疗服务机构中，都应普遍尝试确定老年人的衰弱程度，以促进护理协调，并与患者及其护理人员进行关于预先护理偏好的坦诚讨论。
