Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2019 Jan;49(1):28-33. doi: 10.1111/imj.14182.
Frailty status is intrinsically related to every aspect of older patients' hospital journeys: the way in which they present to hospital, their health status at admission, vulnerability to complications in hospital and rate of recovery after an acute insult. In younger people, hospitalisation is usually the result of a serious illness or injury, such as sepsis or major trauma. Management can be underpinned by evidence-based algorithms relating to the precipitating insult and recovery usually follows a predictable trajectory. In older people who are frail, on the other hand, admission to hospital may be triggered by an illness that may seem minor, such as a viral infection, which causes a geriatric syndrome. A fall or delirium with no major precipitant should be considered an indicator of frailty. Promptly recognising the acute illness and the increased risk for hospital-associated complications is essential for providing safe systems of care for frail older people. Early consideration of health assets and engagement of families and community services can have an important role in successful recovery during and beyond the hospital stay. Effective decision-making about clinical interventions can benefit from explicit assessment of frailty status and consideration of patient priorities.
他们就诊的方式、入院时的健康状况、在医院发生并发症的脆弱性以及急性损伤后的恢复速度。在年轻人中，住院通常是严重疾病或外伤的结果，如败血症或重大创伤。治疗可以基于与诱发损伤相关的循证算法，并且恢复通常遵循可预测的轨迹。另一方面，对于虚弱的老年人，住院可能是由看似轻微的疾病引起的，例如病毒感染，这会导致老年综合征。跌倒或谵妄而没有明显的诱因也应被视为虚弱的指标。及时识别急性疾病和增加的医院相关并发症风险对于为虚弱的老年人提供安全的护理系统至关重要。及早考虑健康资产并让家庭和社区服务参与其中，可以在住院期间和之后的康复中发挥重要作用。通过明确评估虚弱状态并考虑患者的优先事项，可以使临床干预措施的决策更加有效。
