Lee David R, Santo Eilann C, Lo Joan C, Ritterman Weintraub Miranda L, Patton Mary, Gordon Nancy P
Department of Medicine, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
Graduate Medical Education, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
BMC Fam Pract. 2018 Oct 19;19(1):170. doi: 10.1186/s12875-018-0851-1.
Frailty is a condition of increasing importance, given the aging adult population. With an anticipated shortage of geriatricians, primary care physicians will increasingly need to manage care for frail adults with complex functional risks and social-economic circumstances.
We used cross-sectional data from 4551 adults ages 65-90 who responded to the 2014/2015 cycle of the Kaiser Permanente Northern California Member Health Survey (MHS), a self-administered survey that covers multiple health and social characteristics, to create a deficits accumulation model frailty index, classify respondents as frail or non-frail, and then compare prevalence of functional health issues including Activities of Daily Living (ADL)/Instrumental Activities of Daily Living (IADL) and social determinants of health (SDOHs) by frailty status.
The overall prevalence of frailty was 14.3%, higher for women than men, increased with age, and more common among those with low levels of education and income. Frail older adults were more likely than non-frail to have ≥ 3 chronic diseases (55.9% vs. 10.1%), obesity (32.7% vs. 22.8%), insomnia (36.4% vs. 8.8%), oral health problems (25.1% vs. 4.7%), balance or walking problems (54.2% vs. 4.9%), ≥ 1 fall (56.1% vs. 19.7%), to use ≥ 1 medication known to increase fall risk (56.7% vs. 26.0%), and to need help with ≥2 ADLs (15.8% vs. 0.8%) and ≥ 2 IADLs (38.4% vs. 0.8%). They were more likely to feel financial strain (26.9% vs. 12.6%) and to use less medication than prescribed (7.4% vs. 3.6%), less medical care than needed (8.3% vs 3.7%), and eat less produce (9.5% vs. 3.2%) due to cost. Nearly 20% of frail adults were unpaid caregivers for an adult with frailty, serious illness or disability.
This study examined the prevalence of frailty and identified modifiable and non-modifiable risk factors of health. The frail older adult population is heterogeneous and requires a patient-centered assessment of their circumstances by healthcare providers and caregivers to improve their quality of life, avoid adverse health events, and slow physical and mental decline. The characteristics identified in this study can be proactively used for the assessment of patient health, quality of life, and frailty prevention.
鉴于成年人口老龄化，衰弱这一状况的重要性日益凸显。由于预计老年医学专家短缺，初级保健医生将越来越需要为具有复杂功能风险和社会经济状况的衰弱成年人提供护理。
我们使用了来自4551名65 - 90岁成年人的横断面数据，这些人回应了北加利福尼亚凯撒医疗集团成员健康调查（MHS）2014/2015周期的调查，这是一项自我管理的调查，涵盖多种健康和社会特征，以创建一个缺陷累积模型衰弱指数，将受访者分类为衰弱或非衰弱，然后按衰弱状态比较功能健康问题的患病率，包括日常生活活动（ADL）/工具性日常生活活动（IADL）以及健康的社会决定因素（SDOHs）。
衰弱的总体患病率为14.3%，女性高于男性，随年龄增长而增加，在教育和收入水平较低的人群中更为常见。与非衰弱的老年人相比，衰弱的老年人更有可能患有≥3种慢性病（55.9%对10.1%）、肥胖（32.7%对22.8%）、失眠（36.4%对8.8%）、口腔健康问题（25.1%对4.7%）、平衡或行走问题（54.2%对4.9%）、≥1次跌倒（56.1%对19.7%）、使用≥1种已知会增加跌倒风险的药物（56.7%对26.0%），以及需要在≥2项ADL方面获得帮助（15.8%对0.8%）和≥2项IADL方面获得帮助（38.4%对0.8%）。他们更有可能感到经济压力（26.9%对12.6%），并且由于费用原因，用药少于规定剂量（7.4%对3.6%）、接受的医疗护理少于所需（8.3%对3.7%）以及食用的农产品较少（9.5%对3.2%）。近20%的衰弱成年人是患有衰弱、重病或残疾的成年人的无薪照料者。
本研究调查了衰弱的患病率，并确定了健康的可改变和不可改变的风险因素。衰弱的老年人群是异质性的，医疗保健提供者和照料者需要以患者为中心对其情况进行评估，以改善他们的生活质量，避免不良健康事件，并减缓身心衰退。本研究中确定的特征可被积极用于评估患者健康、生活质量和衰弱预防。
