Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management
Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management
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DOI：
10.1007/s12603-019-1273-z
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发表时间：
2019-10-03
影响因子：
5.8
通讯作者：
Vellas, B.
中科院分区：
文献类型：
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作者：
Dent, E.;Morley, J. E.;Vellas, B.
目的国际脆弱和肉质衰弱研究会议(ICFSR)的工作小组制定了这些临床实践指南，以概述当前的证据基础，并为老年人虚弱的识别和管理提供建议。方法这些建议是使用等级方法形成的，该方法对每个建议背后的支持证据的强度和确定性(质量)进行排名。在证据基础有限或质量较低的地方，制定了基于共识的建议(CBR)。这些建议侧重于照顾身体虚弱的老年人的临床和实际方面，并促进以人为本的护理。筛查和评估建议工作组建议卫生从业者使用适用于特定环境或背景的有效工具(强烈建议)识别/筛查所有老年人的虚弱。理想情况下，筛查工具应将残疾排除在外，作为筛查过程的一部分。对于被筛选为虚弱阳性的个体，应该进行更全面的临床评估，以确定虚弱的迹象和潜在的机制(强烈建议)。管理建议针对虚弱的综合护理计划应针对多种药物(无论是合理的还是非合理的)、骨量减少的管理、体重减轻的可治疗原因以及疲惫的原因(抑郁、贫血、低血压、甲状腺功能减退和B12缺乏)(强烈建议)。所有身体虚弱的人都应得到必要的社会支持，以满足未得到满足的需要，并鼓励遵守全面的护理计划(强烈建议)。管理虚弱的一线治疗应包括多成分体力活动方案和以抵抗为基础的训练成分(强烈建议)。当体重减轻或营养不良时，建议补充蛋白质/卡路里(有条件的建议)。没有推荐系统性的额外疗法，如认知疗法、解决问题的疗法、维生素D补充剂和基于激素的治疗。目前可用的药物治疗不推荐用于治疗虚弱。
Objective The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.