Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Curr Opin Support Palliat Care. 2020 Sep;14(3):206-212. doi: 10.1097/SPC.0000000000000523.
Frailty is a multidimensional syndrome associated with increased risk of poor outcomes. It is estimated that at least one in five people with chronic respiratory disease is also living with frailty. In this review, we consider recent advances in how frailty can be recognized, and its associated impact on people with chronic respiratory disease. We then discuss advances in supportive and palliative care for those with both chronic respiratory disease and frailty.
The interconnectedness of chronic respiratory disease and frailty is being better understood. An increasing number of factors associated with frailty in respiratory disease have been identified, from increased symptom burden (e.g. breathlessness, fatigue) to increased exacerbations and higher mortality. These contribute to accumulating multidimensional losses in reserve, and unpredictable health. Recent advances in respiratory research, while not always with people with frailty, may inform supportive and palliative care to address frailty in chronic respiratory disease. These include rehabilitation interventions to strengthen reserves, advance care planning interventions to help manage unpredictable trajectories, and integrated models of care (e.g. incorporating respiratory, geriatric, and palliative care) to address multidimensional needs.
Recent evidence supporting the role of rehabilitation, advance care planning, and early palliative care, may be of benefit to people living with chronic respiratory disease and frailty. Models showing integration across multiple specialities and professionals may have the most potential to meet the multidimensional needs of this group. Future research should develop and test models of care that address frailty and/or explore the role of frailty in triggering integrated multidisciplinary input.
衰弱是一种与不良结局风险增加相关的多维综合征。据估计，至少有五分之一的慢性呼吸系统疾病患者也同时患有衰弱。在这篇综述中，我们考虑了如何识别衰弱的最新进展，以及它对慢性呼吸系统疾病患者的相关影响。然后，我们讨论了对同时患有慢性呼吸系统疾病和衰弱的患者的支持性和姑息性治疗的进展。
慢性呼吸系统疾病和衰弱之间的相互关系正在得到更好的理解。越来越多的与呼吸系统疾病衰弱相关的因素已经被确定，包括症状负担增加（如呼吸困难、疲劳）、加重和死亡率增加。这些因素导致储备和不可预测的健康的多维损失不断积累。最近在呼吸系统研究方面的进展，尽管并不总是针对衰弱患者，但可能为支持性和姑息性治疗提供信息，以解决慢性呼吸系统疾病中的衰弱问题。这些进展包括强化储备的康复干预措施、帮助管理不可预测轨迹的预先护理计划干预措施，以及整合护理模式（例如，整合呼吸系统、老年医学和姑息治疗），以满足多维需求。
最近支持康复、预先护理计划和早期姑息治疗作用的证据，可能对患有慢性呼吸系统疾病和衰弱的患者有益。显示多个专业和专业人员之间整合的模式可能最有潜力满足这一群体的多维需求。未来的研究应该开发和测试针对衰弱的护理模式，或探索衰弱在触发多学科综合输入中的作用。
