Center of Aging Medicine, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy -
Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy -
Panminerva Med. 2019 Dec;61(4):486-492. doi: 10.23736/S0031-0808.19.03731-5. Epub 2019 Jul 30.
Chronic diseases and frailty represent the clinical expressions of the accumulations of biological deficits that occur with aging. However, when addressing chronic diseases, the evaluation of frailty is yet far to be part of routine clinical practice. Frailty and chronic diseases are often treated as different identities. However, the two concepts are related and present a certain amount of overlap and the presence of chronic diseases contributes to the onset of frailty. By taking into considerations not only the physical domain and function, but also psychological, socioeconomical and spiritual factors, frailty is a good descriptor of complexity found in older age. Strategies to identify, manage, and prevent frailty at any age in individuals with multimorbidity or chronic conditions are advised. Benefits and harms of pharmacological treatments should be weighted in older people considering the underlying frailty status. In fact, frailty acts as a modifier of the risks and benefits of chronic diseases treatments. Moreover, some treatments could lead to frailty itself (i.e. proton pump inhibitors, diuretics, hypoglycemic drugs, antihypertensive treatments), underlining the need of an individualized and flexible prescribing decision-making in this population. For these reasons, a different pathway of care for older patients with frailty and chronic diseases seems necessary. An assessment of frailty should be simple and not time consuming in order to address patient's needs and expectations, evaluating the social background, lifestyle and priorities. Empowering the patient implies a personalized evaluation and the development of individualized management plans which would ultimately lead to a reorganization of the health care provision and eventually increase quality of life in the elderly multimorbid frail patient.
慢性疾病和虚弱代表了随着年龄增长而发生的生物缺陷积累的临床表现。然而，在处理慢性疾病时，虚弱的评估远未成为常规临床实践的一部分。虚弱和慢性疾病通常被视为不同的实体。然而，这两个概念是相关的，存在一定程度的重叠，并且慢性疾病的存在会导致虚弱的发生。通过不仅考虑身体领域和功能，还考虑心理、社会经济和精神因素，虚弱是对老年人复杂性的一个很好的描述。建议在患有多种慢性疾病或慢性疾病的个体中，无论年龄大小，都采取策略来识别、管理和预防虚弱。在考虑潜在虚弱状态的情况下，应权衡老年人药物治疗的益处和危害。事实上，虚弱是慢性疾病治疗风险和益处的修饰剂。此外，一些治疗方法本身可能导致虚弱（即质子泵抑制剂、利尿剂、降糖药、降压治疗），这突出了在这一人群中需要个体化和灵活的处方决策。出于这些原因，对于患有虚弱和慢性疾病的老年患者，似乎需要一种不同的护理途径。虚弱评估应该简单且不耗时，以满足患者的需求和期望，评估社会背景、生活方式和优先事项。赋予患者权力意味着进行个性化评估和制定个体化管理计划，这最终将导致医疗保健服务的重新组织，并最终提高老年多病虚弱患者的生活质量。
