Frailty Syndrome: A Transitional State in a Dynamic Process
Frailty Syndrome: A Transitional State in a Dynamic Process
复制标题
DOI：
10.1159/000211949
复制
发表时间：
2009-01-01
期刊：
影响因子：
3.5
通讯作者：
Zekry, Dina
中科院分区：
文献类型：
--
作者：
Lang, Pierre-Olivier;Michel, Jean-Pierre;Zekry, Dina
虚弱长期以来被认为是残疾和合并症的同义词，在老年人中非常普遍，并赋予福尔斯、住院和死亡的高风险。然而，人们逐渐认识到，虚弱可能是一种具有生物学基础的独特临床综合征。衰弱过程似乎是从健壮到功能衰退的动态过程中的一个过渡状态。在这个过程中，总的生理储备减少，变得不太可能足以维持和修复老化的身体。虚弱的临床概念的核心是，没有单一的改变系统单独定义它，而是涉及多个系统。根据许多作者的意见，关于构成虚弱的表型的临床共识表明，其特征包括消瘦（肌肉质量和力量的损失以及体重减轻），耐力丧失，平衡和移动性降低，性能减慢，相对不活动以及潜在的认知功能下降。虚弱是临床医生容易识别的独特实体，具有多种表现，并且没有单一症状在其表现中是充分或必要的。表现包括外观（与年龄一致或不一致），营养状况（瘦，体重减轻），主观健康评级（健康感知），表现（认知，疲劳），感官/身体障碍（视力，听力，力量）和当前护理（药物，医院）。虽然脆弱过程的早期阶段在临床上可能是沉默的，但当耗尽的储备达到导致严重脆弱性的总阈值时，通过观察临床，功能，行为和生物标志物，该综合征可能变得可检测。因此，更好地了解这些临床变化及其内在机制，从虚弱前状态开始，可以证实许多老年病学家所持的印象，即虚弱增加与衰老不同，因此可能是可逆的。因此，我们提供了一个更新的生理病理学和临床和生物学特征的脆弱过程，并推测可能的预防方法。版权所有（C）2009 S. Karger AG，巴塞尔
Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches. Copyright (C) 2009 S. Karger AG, Basel