Frailty: an emerging concept for general practice
Frailty: an emerging concept for general practice
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DOI：
10.3399/bjgp09x420653
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发表时间：
2009-05-01
影响因子：
5.9
通讯作者：
Degryse, Jean Marie
中科院分区：
文献类型：
--
作者：
De Lepeleire, Jan;Iliffe, Steve;Degryse, Jean Marie
西方社会的人口老龄化以及保健和社会护理费用的上升，使保健政策的重点重新放在促进老年人的健康和预防残疾上。然而，通过早期干预或多学科病例管理来识别老年人中的高危群体并改变与老龄化相关的可避免问题的轨迹的努力基本上没有成功。本文认为，这种失败产生的主导地位，在初级保健的管理角度对老年人的医疗保健，而不是建议通过一个临床范式的基础上的概念的脆弱性。脆弱，在其最简单的定义中，是对不利结果的脆弱性。这是一个动态的概念，不同于残疾，容易被忽视，但也容易使用经验法则加以识别，并使用简单的量表加以衡量。从概念上讲，脆弱性与全科医学的生物心理社会模型非常吻合，为医生提供了有用的病人护理工具，并为医疗保健专员提供了针对老龄化人口的临床重点资源。
Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population.