What do we know about frailty in the acute care setting? A scoping review.
What do we know about frailty in the acute care setting? A scoping review.
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DOI：
10.1186/s12877-018-0823-2
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发表时间：
2018-06-11
期刊：
影响因子：
4.1
通讯作者：
Rockwood K
中科院分区：
文献类型：
--
作者：
Theou O;Squires E;Mallery K;Lee JS;Fay S;Goldstein J;Armstrong JJ;Rockwood K
急性护理提供者科普体弱老年患者涌入的能力越来越受到压力，需要做出改变以改善为老年人提供的护理。我们的目的是进行范围审查，以映射和综合文献，解决急性护理环境中的脆弱性，以了解如何应对这一挑战。我们还旨在强调目前脆弱性研究的差距。该范围审查包括作者确定为虚弱的急性病紧急医疗服务（EMS）或住院老年患者的原始研究文章。我们检索了2000年1月至2015年9月期间的Medline、CINAHL、Embase、PsycINFO、Eric和科克伦。我们的数据库检索最初得到8658篇文章，617篇符合条件。在67%的文章中，作者将他们的参与者确定为虚弱，但没有报告他们如何测量虚弱。在204篇测量虚弱的文章中，最常见的学科是老年医学（14%），急诊科（14%）和全科医学（11%）。共采取了89项措施。这包括13种已确立的工具（51%的文章中使用）和35种非脆弱性工具（24%的文章中使用）。最常用的工具是临床虚弱量表、虚弱指数和虚弱表型（各占12%）。大多数（44%）研究人员使用脆弱性工具来预测不良健康结果。在74%的病例中，虚弱预测了检查的结果，通常是死亡率和住院时间。大多数研究（83%）是在非老年学科进行的，三分之二的文章确定参与者为虚弱而没有测量虚弱。使用的工具有很大的差异，最近发表的研究更有可能使用既定的脆弱性工具。总体而言，虚弱似乎是不良健康结果的良好预测因素。对于在临床实践中实施的脆弱性，脆弱性工具应有助于制定护理计划并改善共同决策。这将如何发生还有待确定。本文的在线版本（10.1186/s12877-018-0823-2）包含补充材料，可供授权用户使用。
The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined. The online version of this article (10.1186/s12877-018-0823-2) contains supplementary material, which is available to authorized users.
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