Exploring frailty, mental health and related outcomes: a multi-cultural population-based approach to ageing.

我们正面临着前所未有的人口变化，人们的寿命越来越长。这种现象正在整个地球仪发生，但速度不同。富裕国家的老年人人数增长较快，而中低收入国家的老年人过渡速度要快得多。虚弱与年老密切相关。虽然“虚弱”这个词已经成为我们日常词汇的一部分，但老年病学家和更广泛的医学界对什么构成虚弱综合征的看法却远未达成一致。在过去的二十年里，人们对这种情况的理解取得了显着的进展，提出了一些定义。有一个坚实和适当的定义虚弱是非常重要的，因为没有这样的定义，大多数临床医生将依靠本能和经验来识别虚弱的病人。虽然在了解这种情况方面取得了相当大的进展，但大部分工作都是在高收入国家进行的，主要是由临床见解驱动的。因此，不知道目前在这些情况下使用的标准是否可用于低收入和中等收入国家。在这个项目中，我的目标是调查目前的定义是否可以适用于不同的设置，包括发展中国家，以及这些定义是否善于预测一系列的结果。这些结果包括死亡、疾病、残疾、认知能力下降和医疗保健的使用。研究的一个重要部分将集中在常见的精神障碍，如焦虑和抑郁，脆弱的贡献。对晚年焦虑和抑郁的研究相对来说被忽视了，因为它强调的是年轻时的急性精神障碍和老年痴呆。然而，这些情况在老年人中非常常见，并且与较高的残疾程度，住院和较低的生活质量有关。在这些条件下进行更多的治疗和研究应该成为国家的优先事项。这项研究将是新颖的，在认知、身体和心理年龄相关变化方面采用全面和综合的方法，并使用尖端的统计分析程序。该项目还将使用在不同环境下进行的三项大型人口研究的数据。其中一项是在拉丁美洲和亚洲的一些低收入和中等收入国家进行的。另外两个是在荷兰和苏格兰进行的。这项研究的结果将有助于开发工具，帮助临床医生预测疾病的进程和治疗，也有助于政策制定者和专员规划医疗保健设施和优先考虑资源。

We are facing an unparalleled change in demographics, where people are increasingly living longer. This phenomenon is occurring across the whole globe, but at a different pace. Rich countries have experienced a steadier increase in the number of older adults, whereas low and middle-income countries are facing a much more rapid transition. Frailty is closely linked to older age. Although the word 'frail' has become part of our day-to-day vocabulary, geriatricians and the wider medical community have seen far less agreement as to what constitutes a frailty syndrome. The past two decades have seen remarkable advances in understanding this condition, with a number of definitions been put forward. Having a solid and appropriate definition of frailty is extremely important, as without such definition most clinicians would fall back on instinct and experience to identify frail patients. Although there has been considerable progress in the understanding of this condition, most of the work has been carried out in high-income countries and has been mainly driven by clinical insights. It is therefore not known whether the criteria that are currently used in those settings could be used in low and middle-income countries. In this project I aim to investigate whether the current definitions of frailty could be applied to diverse settings, including developing countries, and whether these definitions are good at predicting a range of outcomes. These outcomes include death, illness, disability, cognitive decline and usage of health care. A significant part of the research will focus on the contribution of common mental disorders, such as anxiety and depression, to frailty. The study of anxiety and depression in later life has been relatively neglected, because of an emphasis on acute psychiatric disorders in younger life and the dementias in older age. However these conditions are extremely common in older age and have been associated with higher level of disability, hospitalisation, and lower quality of life. More treatment and research in those conditions should be made a national priority. The research will be novel using a comprehensive and integrative approach in respect to cognitive, physical and psychological age-related changes, and using cutting-edge statistical analytical procedures. This project will also be using data from three large population-based studies carried out in diverse settings. One was carried out across a number of low and middle-income countries in Latin America and Asia. The other two were conducted in the Netherlands and Scotland. The findings from this research will help in developing tools that may help clinicians in predicting the course of illness and its treatment, but also policy-makers and commissioners in planning health care facilities and prioritise resources.