Santos-Eggimann Brigitte, Sirven Nicolas
1Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland.
2LIRAES, University of Paris Descartes, Sorbonne-Paris-Cité, 45 rue des Saints Pères, 75006 Paris, France.
Public Health Rev. 2016 Aug 22;37:7. doi: 10.1186/s40985-016-0021-8. eCollection 2016.
The concept of frailty as a health dimension in old age is recent and has its origin in the development of geriatric medicine. Initially an unformulated clinical intuition, it is now defined by a diminished physiological reserve of multiple organs that exposes older individuals to increased vulnerability to stressors and a higher risk of adverse outcomes. The operational definition of frailty, however, is still debated. From a diversity of models, two emerged in the early 2000s from epidemiological studies conducted in large population-based aging cohorts. The body of research emphasized prospective associations between a frailty phenotype and a range of adverse outcomes or between a frailty index measuring the accumulation of deficits and death. A few studies showed promising spontaneous remissions in the early stages of frailty, raising expectations for effective interventions. Transitions between frailty stages and effective interventions on frailty nevertheless remain two fields needing further investigation. More recently, these tools have been applied as screening instruments in clinical settings to guide individual decision-making and orient treatments. New questions are raised by the use of instruments developed to screen frailty in epidemiological research for assessing individual situations. Inquiring whether frailty screening is relevant opens a Pandora's box of doubts and debates. There are many reasons to screen for frailty both from a public health and a clinical perspective that are only exacerbated by the current demographic evolution. Open questions remain about the feasibility of frailty screening, the properties of screening tools, the relevance of an integration of socioeconomic dimensions into screening tools, and the effectiveness of interventions targeting frailty. Fifteen years after the publication of the Fried and Rockwood landmark papers proposing operational definitions of frailty, this article presents an overview of current perspectives and issues around frailty screening in populations and in individuals.
衰弱作为老年健康维度的概念是最近才出现的，其起源于老年医学的发展。最初它是一种未明确表述的临床直觉，现在则被定义为多个器官的生理储备下降，这使老年人更容易受到应激源的影响，且出现不良后果的风险更高。然而，衰弱的操作性定义仍存在争议。从多种模型中，有两种模型在21世纪初基于大规模人群的老年队列进行的流行病学研究中出现。该研究主体强调了衰弱表型与一系列不良后果之间的前瞻性关联，或者测量缺陷积累的衰弱指数与死亡之间的前瞻性关联。一些研究表明，在衰弱早期有明显的自发缓解情况，这提高了人们对有效干预措施的期望。然而，衰弱阶段之间的转变以及针对衰弱的有效干预措施仍是两个需要进一步研究的领域。最近，这些工具已被用作临床环境中的筛查工具，以指导个人决策和确定治疗方向。将流行病学研究中用于筛查衰弱的工具应用于评估个体情况引发了新的问题。探究衰弱筛查是否相关打开了一个充满疑问和辩论的潘多拉魔盒。从公共卫生和临床角度来看，有很多理由进行衰弱筛查，而当前的人口结构演变只会加剧这些理由。关于衰弱筛查的可行性、筛查工具的特性、将社会经济维度纳入筛查工具的相关性以及针对衰弱的干预措施的有效性，仍存在诸多悬而未决的问题。在弗里德（Fried）和洛克伍德（Rockwood）发表提出衰弱操作性定义的具有里程碑意义的论文十五年后，本文概述了当前关于人群和个体衰弱筛查的观点及问题。
