Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands.
BMC Geriatr. 2018 Apr 4;18(1):84. doi: 10.1186/s12877-018-0776-5.
A fundamental issue in elderly care is targeting those older people at risk and in need of care interventions. Frailty is widely used to capture variations in health risks but there is no general consensus on the conceptualization of frailty. Indeed, there is considerable heterogeneity in the group of older people characterized as frail. This research identifies frailty profiles based on the physical, psychological, social and cognitive domains of functioning and the severity of the problems within these domains.
This research was a secondary data-analysis of older persons derived from The Older Person and Informal Caregiver Minimum Dataset. Selected respondents were 60 years and older (n = 43,704; 59.6% female). The following variables were included: self-reported health, cognitive functioning, social functioning, mental health, morbidity status, and functional limitations. Using latent class analysis, the population was divided in subpopulations that were subsequently discussed in a focus group with older people for further validation.
We distinguished six frailty profiles: relatively healthy; mild physically frail; psychologically frail; severe physically frail; medically frail and multi-frail. The relatively healthy had limited problems across all domains. In three profiles older people mostly had singular problems in either the physical or psychological domain and the severity of the problems differed. Two remaining profiles were multidimensional with a combination of problems that extended to the social and cognitive domains.
Our research provides an empirical base for meaningful frailty profiles. The profiles showed specific patterns underlying the problems in different domains of functioning. The heterogeneous population of frail older people has differing needs and faces different health issues that should be considered to tailor care interventions. Evaluation research of these interventions should acknowledge the heterogeneity of frailty by profiling.
老年人护理的一个基本问题是针对那些有风险和需要护理干预的老年人。衰弱被广泛用于捕捉健康风险的变化，但在衰弱的概念化方面没有普遍共识。事实上，在被定义为衰弱的老年人群体中存在相当大的异质性。本研究基于身体、心理、社会和认知功能领域以及这些领域内问题的严重程度，确定衰弱特征。
本研究是对来自老年人和非正式护理者最小数据集的老年人的二次数据分析。选择的受访者年龄在 60 岁及以上（n=43704；59.6%为女性）。包括以下变量：自我报告的健康状况、认知功能、社会功能、心理健康、发病状况和功能限制。使用潜在类别分析，将人群分为亚人群，然后在一个焦点小组中与老年人进行讨论，以进一步验证。
我们区分了六种衰弱特征：相对健康；轻度身体虚弱；心理虚弱；严重身体虚弱；医学虚弱和多重虚弱。相对健康的人群在所有领域的问题都有限。在三个特征中，老年人大多在身体或心理领域只有单一问题，问题的严重程度不同。其余两个特征是多维的，问题涉及社会和认知领域。
我们的研究为有意义的衰弱特征提供了实证基础。这些特征显示了不同功能领域问题背后的特定模式。衰弱的老年人群体具有不同的需求和面临不同的健康问题，应该考虑为他们量身定制护理干预措施。这些干预措施的评估研究应该通过特征分析来承认衰弱的异质性。
