Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

被引：887

作者：

Dent, E. ^{[1
,2
]}

Morley, J. E. ^{[3
]}

Cruz-Jentoft, A. J. ^{[4
]}

Woodhouse, L. ^{[5
]}

Rodriguez-Manas, L. ^{[6
]}

Fried, L. P. ^{[7
]}

Woo, J. ^{[8
]}

Aprahamian, I ^{[9
]}

Sanford, A. ^{[3
]}

Lundy, J. ^{[10
]}

Landi, F. ^{[11
]}

Beilby, J. ^{[1
]}

Martin, F. C. ^{[12
]}

Bauer, J. M. ^{[13
]}

Ferrucci, L. ^{[14
]}

Merchant, R. A. ^{[15
]}

Dong, B. ^{[16
,17
]}

Arai, H. ^{[18
]}

Hoogendijk, E. O. ^{[19
]}

Won, C. W. ^{[20
]}

Abbatecola, A. ^{[21
]}

Cederholm, T. ^{[22
,23
]}

Strandberg, T. ^{[24
,25
,26
]}

Gutierrez Robledo, L. M. ^{[27
]}

Flicker, L. ^{[28
]}

Bhasin, S. ^{[29
]}

Aubertin-Leheudre, M. ^{[30
]}

Bischoff-Ferrari, H. A. ^{[31
,32
]}

Guralnik, J. M. ^{[33
]}

Muscedere, J. ^{[34
]}

Pahor, M. ^{[35
]}

Ruiz, J. ^{[36
,37
]}

Negm, A. M. ^{[38
]}

Reginster, J. Y. ^{[39
,40
]}

Waters, D. L. ^{[41
]}

Vellas, B. ^{[42
]}

机构：

[1] Torrens Univ Australia, Adelaide, SA, Australia

[2] Baker Heart & Diabet Inst, Melbourne, Vic, Australia

[3] St Louis Univ, Sch Med, Div Geriatr Med, St Louis, MO 63104 USA

[4] Hosp Univ Ramon Y Cajal IRYCIS, Serv Geriatria, Madrid, Spain

[5] Univ Alberta, Dept Phys Therapy, Rehabil Med, Edmonton, AB, Canada

[6] Hosp Univ Getafe, Serv Geriatria, Madrid, Spain

[7] Columbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USA

[8] Chinese Univ Hong Kong, Dept Med, Hong Kong, Peoples R China

[9] Fac Med Jundiai, Grp Invest Multimorbid & Mental Hlth Aging GIMMA, Geriatr Div, Internal Med Dept, Jundiai, Brazil

[10] Perry Cty Mem Hosp, Perryville, MO USA

[11] Fdn Policlin A Gemelli, Rome, Italy

[12] Kings Coll London, Populat Hlth Sci, London, England

[13] Heidelberg Univ, Ctr Geriatr Med, Agaples Bethanien Krankenhaus, Heidelberg, Germany

[14] NIA, Intramural Res Program, Bethesda, MD 20892 USA

[15] Natl Univ Hlth Syst, Natl Univ Hosp, Dept Med, Div Geriatr Med, Singapore, Singapore

[16] Sichuan Univ, West China Hosp, Dept Geriatr, Chengdu, Sichuan, Peoples R China

[17] Sichuan Univ, West China Hosp, Natl Clin Res Ctr Geriatr, Chengdu, Sichuan, Peoples R China

[18] Natl Ctr Geriatr & Gerontol, Obu, Japan

[19] Amsterdam UMC Locat VU Univ Med Ctr, Dept Epidemiol & Biostat, Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands

[20] Kyung Hee Univ, Coll Med, Dept Family Med, Elderly Frailty Res Ctr, Seoul, South Korea

[21] Alzheimers Dis Clin Dept, Azienda Sanit Locale ASI Frosinone, Frosinone, Italy

[22] Uppsala Univ, Dept Publ Hlth & Caring Sci, Clin Nutr & Metab, Stockholm, Sweden

[23] Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden

[24] Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland

[25] Univ Helsinki, Helsinki, Finland

[26] Helsinki Univ Hosp, Helsinki, Finland

[27] Natl Inst Geriatr, Mexico City, DF, Mexico

[28] Univ Western Australia, Med Sch, Western Australian Ctr Hlth & Ageing, Perth, WA, Australia

[29] Harvard Med Sch, Res Program Means Hlth Aging & Metab, Boston Claude D Pepper Older Amer Independence Ct, Brigham & Womens Hosp, Boston, MA 02115 USA

[30] Univ Quebec Montreal, Dept Sci Activite Phys, CRIUGM, Montreal, PQ, Canada

[31] Univ Hosp, Dept Geriatr & Aging Res, Zurich, Switzerland

[32] Univ Zurich, Zurich, Switzerland

[33] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Div Gerontol, Baltimore, MD 21201 USA

[34] Queens Univ, Dept Crit Care Med, Kingston, ON, Canada

[35] Univ Florida, Dept Aging & Geriatr Res, Gainesville, FL USA

[36] Univ Miami, Miller Sch Med, Miami VA Healthcare Syst GRECC, Miami, FL 33136 USA

[37] Univ Miami, Miller Sch Med, Div Geriatr & Palliat Med, Miami, FL 33136 USA

[38] McMaster Univ, Sch Rehabil Sci, Fac Hlth Sci, Hamilton, ON, Canada

[39] WHO Collaborating Ctr Publ Hlth Aspects Musculosk, Liege, Belgium

[40] King Saud Univ, Chair Biomarkers Chron Dis, Dept Biochem, Coll Sci, Riyadh, Saudi Arabia

[41] Univ Otago, Sch Physiotherapy, Dept Med, Dunedin, New Zealand

[42] Univ Paul Sabatier, CHU Toulouse, Gerontopole UMR Inserm 1027, Toulouse, France

来源：

JOURNAL OF NUTRITION HEALTH & AGING | 2019年 / 23卷 / 09期

基金：

英国医学研究理事会;

关键词：

Aged; 80 and over; Practice guideline; Frailty; diagnosis; therapy*; Patient Care Planning; standards; VITAMIN-D SUPPLEMENTATION; OLDER PERSONS PRESCRIPTIONS; MIDDLE-INCOME COUNTRIES; 26-YEAR FOLLOW-UP; SCREENING TOOL; ORAL-HEALTH; EXERCISE INTERVENTIONS; POSTOPERATIVE OUTCOMES; GERIATRICS SOCIETY; FUNCTIONAL DECLINE;

D O I：

10.1007/s12603-019-1273-z

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

030301 [社会学]; 100201 [内科学];

摘要：

Objective The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

引用

页码：771 / 787

页数：17

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