Professor Debra L. Waters PhD, Director of Gerontology Research, University of Otago, School of Physiotherapy and Department of Medicine, PO Box 56, Dunedin, New Zealand 9054, Email:
J Nutr Health Aging. 2021;25(3):382-391. doi: 10.1007/s12603-020-1549-3.
This study aims to appraise and summarize consistent recommendations from clinical practice guidelines (CPGs) for identification and management of frailty to maintain and improve functional independence of elderly population.
A systematic search of Ovid MEDLINE, Embase, PubMed, PsycINFO, and CINAHL electronic databases using database-specific search terms in two broad areas "guidelines" and "frailty", and a manual search of websites with the key phrase "frailty guideline" was performed. The inclusion criteria included CPGs focusing on identifying and managing frailty in population >65 years old, published in English since January 2010. Three reviewers independently assessed guideline quality using the AGREE II instrument. Data extraction was performed, followed by compilation and comparison of all recommendations to identify the key consistent recommendations.
Six CPGs met the inclusion criteria; however, only three CPGs had high methodological quality in accordance with AGREE II appraisal. The average AGREE II scores of all six CPGs were: 84.5%, 68%, 46.5%, 81.5%, 56.3%, and 60.2% for domains 1-6 (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence) respectively. A total of 54 recommendations were identified, with 12 key recommendations suggested frequently by the CPGs.
The AGREE II instrument identified strengths and weaknesses of the CPGs, but failed to assess clinical implications and feasibility of the guidelines. Further research is needed to improve clinical relevance of CPGs in the identification and management of frailty. The feasibility in implementing these guidelines with regards to cost-effectiveness of frailty screening warrants further investigation.
本研究旨在评估和总结针对老年人虚弱识别和管理的临床实践指南（CPG）中的一致性建议，以维持和提高老年人群的功能独立性。
使用 Ovid MEDLINE、Embase、PubMed、PsycINFO 和 CINAHL 电子数据库中的特定数据库搜索词，在“指南”和“虚弱”两个广泛领域中进行系统搜索，并使用关键短语“虚弱指南”手动搜索网站。纳入标准包括关注 65 岁以上人群虚弱识别和管理的 CPG，发表于 2010 年 1 月以后的英文文献。三位评审员使用 AGREE II 工具独立评估指南质量。进行数据提取，然后编译和比较所有建议，以确定关键的一致性建议。
符合纳入标准的 CPG 有 6 个，但只有 3 个 CPG 符合 AGREE II 评估的高质量标准。所有 6 个 CPG 的平均 AGREE II 评分分别为：领域 1-6（范围和目的、利益相关者参与、制定严谨性、表述清晰度、适用性和编辑独立性）的 84.5%、68%、46.5%、81.5%、56.3%和 60.2%。共确定了 54 条建议，其中 12 条关键建议被 CPG 频繁提及。
AGREE II 工具确定了 CPG 的优势和劣势，但未能评估指南的临床意义和可行性。需要进一步研究以提高 CPG 在虚弱识别和管理中的临床相关性。实施这些指南的可行性，包括虚弱筛查的成本效益，值得进一步调查。
