Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA.
Ann Palliat Med. 2024 Jul;13(4):976-990. doi: 10.21037/apm-23-559. Epub 2024 Jun 6.
Frailty is a common geriatric syndrome characterized by a decline in physical and cognitive abilities and an increased vulnerability to stressors such as illnesses and injuries. As the global population is aging, the prevalence of frailty is growing. Frail older adults are at substantial risk of developing mobility and self-care difficulties, hospitalization, and death. Frailty is also associated with a high symptom burden and psychosocial stress, including malnutrition, pain, fatigue, weakness, cognitive loss, depression, falls, and sleep disorders, among others. The role of palliative care is gaining attention in medical literature because frailty is associated with increased morbidity and mortality. While there are no specific guidelines yet for when palliative care should be consulted in older patients with frailty, it has been proposed that palliative care should be considered in frail patients with continued functional decline, increased healthcare utilization, and uncontrolled symptoms. Palliative care can aid in communication with patients and families, establishing goals of care and treatment preferences, improving pain and symptom control, addressing psychosocial and spiritual needs, advance care planning, caregiver needs, and end-of-life care. Once frailty is identified, a comprehensive evaluation of the patient's physical, psychosocial, and spiritual aspects of care is essential for establishing a patient-centered treatment plan. This paper aims to guide clinicians in providing patient-centered care for older adults with frailty in the outpatient setting. Through a comprehensive literature review, we describe the leading models of frailty, frailty screening tools used in the clinical setting, and the assessment and management of palliative care needs in frail patients. We also describe emerging models of care focusing on palliative care for older adults with frailty and discuss issues related to access to palliative care for this population.
衰弱是一种常见的老年综合征，其特征是身体和认知能力下降，对压力源（如疾病和伤害）的易感性增加。随着全球人口老龄化，衰弱的患病率正在增加。衰弱的老年人有很大的风险出现行动和自我护理困难、住院和死亡。衰弱还与高症状负担和心理社会压力有关，包括营养不良、疼痛、疲劳、虚弱、认知丧失、抑郁、跌倒和睡眠障碍等。姑息治疗在医学文献中的作用越来越受到关注，因为衰弱与发病率和死亡率的增加有关。虽然目前还没有针对衰弱的老年患者何时应咨询姑息治疗的具体指南，但有人提出，在持续功能下降、医疗保健利用增加和症状未得到控制的衰弱患者中，应考虑姑息治疗。姑息治疗可以帮助与患者和家属进行沟通，确定护理和治疗的目标以及偏好，改善疼痛和症状控制，解决心理社会和精神需求，进行预先护理计划，满足护理人员的需求，并进行临终关怀。一旦确定衰弱，对患者身体、心理社会和精神方面的全面评估对于制定以患者为中心的治疗计划至关重要。本文旨在指导临床医生为门诊环境中的衰弱老年患者提供以患者为中心的护理。通过全面的文献回顾，我们描述了衰弱的主要模型、临床环境中使用的衰弱筛查工具，以及衰弱患者的姑息治疗需求的评估和管理。我们还描述了关注衰弱的老年患者姑息治疗的新兴护理模式，并讨论了为这一人群提供姑息治疗的相关问题。
