衰弱与否:这是个问题——对衰弱的批判性叙述性综述

To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty.

作者信息

Sciacchitano Salvatore, Carola Valeria, Nicolais Giampaolo, Sciacchitano Simona, Napoli Christian, Mancini Rita, Rocco Monica, Coluzzi Flaminia

机构信息

Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy.

Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy.

出版信息

J Clin Med. 2024 Jan 26;13(3):721. doi: 10.3390/jcm13030721.

Abstract

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.

摘要

诸多因素促使衰弱成为一个新兴、重要且广受欢迎的概念。首先,历史上许多影响人类的大流行病,包括最近的新冠疫情,对衰弱人群的影响比对非衰弱人群更为严重。其次,在包括意大利在内的许多发达国家,人类预期寿命的增加导致老年人口比例上升,而这部分人群更易衰弱,这就是为什么与其他各类医疗保健专业人员相比,衰弱在老年医学专家中是一个更为普遍关注的问题。第三,根据衰弱的发生情况和程度对人群进行分层,有助于医疗保健决策者充分规划可用的人力专业资源和经济资源的分配。由于衰弱被认为是完全可预防的,因此在临床结果和医疗成本方面的潜在益处都有相应的影响。衰弱在许多不同背景下正成为一个流行、普遍且几乎无处不在的概念,包括临床医学、身体健康、生活方式行为、心理健康、卫生政策以及社会经济规划科学等领域。最近人们已经认识到新的“衰弱科学”的出现。然而,关于衰弱的确切定义、所涉及的致病机制、评估衰弱的最合适方法,以及因此谁应被视为衰弱人群,仍存在争议。本叙述性综述旨在从多个不同方面和角度分析衰弱,特别关注所提出的致病机制、在评估衰弱时所考虑的各种因素,以及生物标志物在衰弱早期识别中的新兴作用,尤其是线粒体的作用。根据关于这一主题的大量文献,很明显衰弱是一种非常复杂的综合征,涉及许多不同领域并影响多个生理系统。因此,对其管理应采用全面、多方面的整体方法和个性化干预策略,以减缓其进展,甚至完全扭转这种状况的进程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef8d/10856357/c75a0a99a27f/jcm-13-00721-g001.jpg

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