Abstract:

As China enters an ageing society, the number of elderly people is rising sharply, resulting in a continuous increase in the cost and burden of caring for the elderly. Frailty is an important cause of loss of self-care ability and elderly care problems in elderly people, which means that frailty is associated with a decline not only in physiological functions, but in multiple areas as well, such as mental ability and socioeconomic functioning, and is considered an important geriatric syndrome that affects the quality of life of the elderly. Comprehensive Geriatric Assessment (CGA) is a multi-dimensional and multi-disciplinary assessment process or model specifically for elderly patients. As a core tool in geriatric medicine, it uses a multi-dimensional and multi-disciplinary approach to assess the physical condition, functional status, mental health and social environment status of the elderly, and accordingly a treatment plan is developed to maintain and improve the functional status of the elderly and enhance their quality of life to the most extent. However, the use of CGA is not entirely consistent in China and abroad. This paper reviews the existing studies on frailty in the elderly, analyses the advantages and shortcomings of CGA used in frail elderly patients, and finds that interventions for frail patients at home and abroad have been valued increasingly. The development of domestic interventional studies on frailty is still in the initial stage, and most of these studies use a design of a randomized controlled trial with a sample of chronic disease inpatients. In contrast, such studies have been widely carried out abroad, in which CGA has been applied to the management of cancer patients and patients in the perioperative period besides chronic disease patients and frail community-dwelling older people. The frailty status in the elderly can be scientifically and comprehensively assessed by the CGA, and based on which targeted interventions can be implemented to prevent or delay the development of frailty, but it is generally time-consuming, and there are many difficulties in the management of the assessment recipients. In the future, it is necessary to advance the clinical application of CGA, or develop a more rapid, comprehensive and authoritative tool based on CGA for frailty assessment in the elderly, so as to provide comprehensive and personalized medical services and health guidance for frail elderly population through standardised assessment.

Key words: Frailty syndrome, Frailty assessment, Comprehensive geriatric assessment, Aged, General practice, Review

摘要：

随着中国进入老龄化社会，老年人口急剧攀升，由此造成养老成本持续增加，养老照护负担持续加重。衰弱是老年群体失去自理能力、产生养老问题的重要原因，其不仅意味着生理功能的下降，还与心理、社会经济等多领域能力衰退相关，被认为是影响老年人生活质量的重要老年综合征。老年综合评估（CGA）是专门针对老年患者的多层面、多学科的评估干预过程或模式，作为老年医学的核心技术，其采用多维度、多学科综合的方法评估老年人的躯体情况、功能状态、心理健康和社会环境状况等，并据此制定治疗计划以维持和改善老年人功能状态，最大限度提高老年人的生活质量，然而国内外对CGA的应用并不完全一致。由此，本文回顾了现有的国内外文献，探讨目前老年衰弱现状，分析CGA技术在老年衰弱患者中应用的优势与不足，发现国内外对于衰弱患者的干预逐渐重视，国内对于衰弱的干预研究处于起步状态，多以随机对照试验为主，且多应用于住院慢性病患者，国外对于衰弱的干预性研究开展较为广泛，研究者除了将CGA技术应用于慢性病衰弱患者及社区衰弱老年人，还应用于肿瘤患者及围术期患者。CGA技术的优势在于可以全面评估老年人的衰弱情况，并基于此进行干预以延缓或阻止老年衰弱的进展，但该技术总体耗费时间较长，在研究对象的管理上存在诸多困难。未来希望能推进CGA在临床上的应用，或基于CGA技术，研发更快速、更综合、更权威的老年人衰弱评估技术，通过标准化评估为存在衰弱的老年人群提供全面且个性化的医疗服务和健康指导。

关键词: 衰弱综合征, 衰弱评估, 老年综合评估, 老年人, 全科医学, 综述