心力衰竭患者衰弱测评工具的研究进展

心力衰竭患者衰弱的发生率高,衰弱可预测心力衰竭患者的不良预后。在临床工作中采用适宜的测评工具对衰弱进行早期识别,有助于协助风险分层、临床决策、预防不良结局等。本文对当前心力衰竭患者衰弱常用测评工具的研究现况进行综述,概述其主要内容、应用范围、应用效果及局限性,分析现存测评工具的特点及不足,旨在为我国心力衰竭患者衰弱特异性测量工具的开发和医务人员对衰弱的临床护理及管理提供参考依据。     

衰弱评估及其在肿瘤患者中的应用研究概况

受手术、化疗和放射治疗等综合因素的影响,肿瘤患者容易出现衰弱,而衰弱与肿瘤患者的结局密切相关。本文就衰弱的定义、评估工具及衰弱评估在肿瘤患者中的应用概况进行了综述,以期为临床早期识别肿瘤患者衰弱及进行有效管理提供参考。     

糖尿病患者衰弱评估工具预测效能的系统评价

目的了解糖尿病患者衰弱发生率及衰弱评估工具对糖尿病患者不良健康结局的预测效能。方法计算机检索PubMed、Embase、Web of Science、PEDro、The Cochrane Library、CINAHL、中国知网、万方、中国生物医学文献数据库和维普数据库中关于糖尿病患者衰弱与不良健康结局关系的队列研究,检索时限为2001年1月至2019年4月,按照纳入和排除标准筛选文献并提取资料,采用STATA15.1软件进行Meta分析,对无法合并的资料进行描述性分析。结果共纳入12项队列研究,563 221例患者。综合分析糖尿病患者衰弱发生率为0.3%～74.0%,衰弱评估工具评估的衰弱情况与糖尿病患者死亡、住院、失能、跌倒等不良健康结局密切相关。Meta分析显示,与其他衰弱评估工具相比,FRAIL是目前在糖尿病患者中应用最广泛的评估工具,且对死亡结局和住院风险具有良好的预测效能。结论不同工具评估的衰弱发生率差异较大。对于社区老年糖尿病患者进行衰弱的初步简单筛查时,可首选FRAIL量表。但由于纳入研究数量有限,仍需大样本的前瞻性队列研究验证结论。     

衰弱状态对老年患者围术期不良事件影响的研究进展

在社会老龄化趋势不断加速的背景下,老年人口的外科手术比例也持续上升。尽管手术、麻醉技术和围术期医学在不断进步,老年手术患者仍在遭受不良术后结局的困扰。衰弱指老年人多系统生理储备下降,外界轻微的伤害性刺激便可引起生理机能快速而剧烈的变化,是术后不良事件发生的一个重要的风险因素。本文回顾了近年来衰弱与围术期不良事件联系的相关文献,拟就衰弱的概念、衰弱的评估工具、衰弱对围术期结局的影响以及衰弱患者围术期优化策略进行综述,以期为临床优化衰弱老年患者的身体机能,避免围术期不良结局提供理论支持。     

基于累积缺陷原则构建的衰弱指数及其应用进展

衰弱是因机体生理储备和应激适应能力下降和失调而易发生不良结局的临床状态或综合征。目前衰弱的评估无金标准,但研究发现累积缺陷模型对各种不良临床事件的预测能力高于其他衰弱评估方法。本文主要对基于累积缺陷原则构建的衰弱指数及其构建方法、常见种类及其应用等方面相关研究进行综述,为衰弱评估提供新思路和新方法。     

老年脑卒中患者衰弱相关研究进展

脑卒中是老年人常见的脑血管疾病之一。衰弱是指生理系统中与年龄相关的渐进性衰退,导致内在能力储备减少,对应激源的易感性增加。随着年龄的增长,衰弱发生率逐渐增高,而老年脑卒中患者因疾病特点更容易发生衰弱,从而导致一系列不良结局的发生,增加疾病负担。本文从老年脑卒中患者衰弱发生现状、评估工具、影响以及干预措施几个方面进行综述,旨在为临床工作者制定合理有效的衰弱评估及干预方案提供参考,构建高质量、高水平的老年脑卒中患者衰弱管理体系。     

老年慢性心力衰竭合并衰弱的研究进展

慢性心力衰竭(CHF)是一种严重的临床疾病,具有高死亡率及再住院率,是65岁以上老年人住院最常见的原因。衰弱是以生理储备下降、机体易损性增加、抗应激能力减退为主要特征的常见老年综合征。CHF合并衰弱具有较高的发病率,两者通过共同的病理生理机制对疾病的预后产生不良的影响。衰弱的识别在CHF人群中十分重要,实现对衰弱诊断标准及评估工具的统一能够增加对衰弱早期预防、识别及临床管理的能力。本文就老年CHF患者合并衰弱的发病情况、机制及评估的研究进展做一综述。     

老年糖尿病患者认知衰弱研究进展

老年糖尿病患者认知障碍与躯体衰弱共存被称为认知衰弱,其已成为老年糖尿病的新型并发症,并增加了跌倒、失能、住院、死亡等不良结局的风险。及时采取干预措施可延缓甚至阻止认知衰弱向痴呆的发展,降低不良结局的发生风险,但目前老年糖尿病患者认知衰弱的诊断标准及评估方法尚未达成共识,因此本文就老年糖尿病患者认知衰弱的概念、现状、评估及干预展开综述,为未来的研究提供参考。     

老年心力衰竭患者合并衰弱的最新研究进展

衰弱作为一种常见的老年综合征,以多系统功能障碍,体内平衡受损,生理储备下降,以及死亡风险增加为特点。心力衰竭（HF）是由各种心脏结构或功能性疾病导致心室充盈和(或)射血能力受损而引起的一组综合征,常常合并衰弱,与身体机能下降、跌倒、失能及认知倒退等相关。衰弱在老年心力衰竭患者中很常见,二者具有共同的机制特征,与炎症、肌肉减少症和高负担合并症等密切相关。衰弱与老年心力衰竭患者较差的临床表现、功能和生活质量有关,因此开发简单、易操作并经过充分验证的评估工具识别衰弱至关重要。这些评估工具可以在常规临床环境中有效和快速地识别衰弱的心衰患者,以更好地改善临床预后。对于患有心力衰竭和衰弱的老年患者,应进一步研究新的治疗与管理策略,例如通过多学科评估和干预解决多系统疾病的模式。提高对心力衰竭合并衰弱的认识并加以管理,以期有助于改善患者不良预后和生活质量的提高。     

老年人衰弱评估工具及其应用研究进展

<正>社区中老年人衰弱的发生率为6.9%~14.9%〔1~3〕,85岁及以上高龄老年人中衰弱的发生率更高,尤其是高龄老年女性衰弱占45.1%〔4〕。衰弱的老年人占用了大量卫生服务资源,且健康结局依旧难以改善,加重了家庭照护者的身心负担和社会养老与医疗的负担〔5〕。通过早期筛查衰弱老年人并及时给予预防干预措施,可以有效地避免或延缓不良结局的发生〔6〕。本文介绍国外老年人群衰弱评估工具及其在研究中的应用情况。     

Frailty defined by deficit accumulation and geriatric medicine defined by frailty

As nonreplicative cells age, they commonly accumulate subcellular deficits that can compromise function. As people age, they too experience problems that can accumulate. As deficits (symptoms, signs, illnesses, disabilities) accumulate, people become more susceptible to adverse health outcomes, including worse health and even death. This state of increased risk of adverse health outcomes is indistinguishable from the idea of frailty, so deficit accumulation represents another way to define frailty. Counting deficits not only allows grades of frailty to be discerned but also provides insights into the complex problems of older adults. This process is potentially useful to geriatricians who need to be experts in managing complexity. A key to managing complexity is through instruments such as a comprehensive geriatric assessment, which can serve as the basis for routine clinical estimation of an individual's degree of frailty. Understanding people and their needs as deficits accumulate is an exciting challenge for clinical research on frailty and its management by geriatricians.     

Frailty in cardiovascular disease: Screening tools

Cardiovascular disease (CVD) is the leading cause of death in developed countries and disproportionately affects older adults. Frailty is a complex clinical syndrome with multiple causes and contributing factors in which there is increased vulnerability when exposed to a minor stressor and increased risk for adverse outcomes, such as disability, hospitalization and mortality. Frailty is an important prognostic factor in patients with CVD, and so identifying this feature when assessing these patients may help to individually tailor cardiovascular treatment. The first step is to identify frailty. Several tools have been validated as screening methods for frailty. However, they diverge with regard to complexity, nature, feasibility and the outcome they can predict. The aim of this review is to describe the available screening tools for frailty and to examine their usefulness in patients with CVD.     

Frailty in surgical patients

Objective

To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice.

Background

Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome.

Methods

Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases.

Results

Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients.

Conclusion

Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.

     

Development of frailty measurement tools using administrative health data: A systematic review

ObjectivesFrailty is an increasingly common health condition and is seen more often due to the ageing population. This study reviews the evidence on the development and validation of these automated frailty measurement tools.DesignSix databases: PubMed, EMBASE, MEDLINE, CINAHL, Scopus, and Web of Science were electronically searched. Selected studies must have developed and validated a new frailty measurement tool using administrative health data and published results in a peer-reviewed, English-language journal. Selected studies were synthesized narratively.Setting and participantsThe review focused on large scale studies using administrative health data in developed countries. Participants included older people aged 65 years and above.MeasuresThe main measures of review studies include discrimination power and the prediction ability of adverse health outcomes; performance against established frailty measures; and validation records.ResultsFive studies were selected for narrative synthesis after screening the full-text. All frailty measurement tools in the selected five studies produced strong discrimination power with C-statistics ranging from 0.61−97. Two studies were independently validated in studies by other authors or conducted in other locations; one study developed an early prediction model, and no study has been applied in practice.Conclusions and implicationsAutomated frailty measurement tools using administrative health data are still in the early development stage with five tools developed since 2016. Selected studies have strong prediction of adverse health outcomes. Future studies should include validation and refinement of these tools in other countries and assessment of their clinical utility and capacity to inform cost-effective policy and practice.     

Operationalizing a frailty index from a standardized comprehensive geriatric assessment

OBJECTIVES: To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. DESIGN: Secondary analysis of a 3-month randomized, controlled trial of a specialized mobile geriatric assessment team. SETTING: Rural Nova Scotia. Participants were seen in their homes. PARTICIPANTS: Frail older adults, of whom 92 were in the intervention group and 77 in the control group. MEASUREMENTS: A standard CGA form that accounts for impairment, disability, and comorbidity burden was scored and summed as a frailty index (FI-CGA). The FI-GCA was stratified to describe three levels of frailty. Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes (institutionalization or mortality, whichever came first). RESULTS: The three levels of frailty were mild (FI-CGA 0-7), moderate (FI-CGA 7-13), and severe (FI-CGA>13). Demographic and social traits were similar across groups, but greater frailty was associated with worse function (r=0.55) and mental status (r=0.33). Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty (unadjusted hazard ratio=1.9 and 5.5, respectively). There was no difference between frailty groups in mean 3-month goal-attainment scaling scores. Intrarater reliability was 0.95. CONCLUSION: The FI-CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes.     

Screening of the frail patient in the emergency department: A systematic review

BackgroundSeveral frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department.AimTo assess the accuracy of the screening tools used in the emergency department to detect frailty in patients ≥ 65 years by their ability to identify the risk of adverse outcomes.MethodsAn extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted and evaluated from the results of the included studies.ResultsFour studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used in the emergency department were described and compared. Predictive values for various outcomes are represented and discussed.ConclusionsThe results suggest that frailty successfully predicts increased risk of hospitalization, nursing home admission, mortality and prolonged length of stay after an initial emergency department visit. Frailty does however not predict increased risk of 30 day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed.Learning pointsAlthough frail elders in need of further geriatric assessment should be identified as soon as possible, this systematic review only identified four cohort studies of frailty assessment in emergency departments.Although frailty screening appeared to predict the risk of mortality and of admission to hospital/nursing home, these four studies did not show that it could predict return visits to emergency departments within 30 days.Randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment are clearly needed.     

衰弱与心血管疾病关系的研究进展

衰弱是一种复杂的老年综合征,可导致老年人抗应激能力和维持自身稳态能力降低,与跌倒、失能和死亡等不良结局相关。心血管疾病在老年人群中有很高的发病率,且越来越多的研究发现衰弱和心血管疾病关系密切,衰弱能够影响多种心血管疾病如心力衰竭、高血压等预后。因此,在临床工作中充分认识衰弱和心血管疾病的关系以及衰弱对心血管疾病预后的影响,可帮助临床医师为心血管疾病患者制定更好的疾病管理策略,有效地延缓或避免不良结局发生。