社区老年人多维衰弱评估工具的研究进展 ^*

Advancements in multidimensional frailty assessment instruments for community-dwelling elderly individuals

摘要

老年衰弱的研究已从过去的单一身体衰弱维度扩展至身体、心理和社会等方面的多维度衰弱, 这一转变对于改善社区衰弱老年人的健康状况和生活质量具有重要意义。但目前衰弱的评估工具大多数重点评估身体衰弱, 多维衰弱的评估工具较少, 且适用场景不清。本文聚焦于针对社区老年人的多维衰弱的评估工具, 从工具的评估内容、应用现状、特点及局限性等多个方面进行综述。旨在为社区老年人多维衰弱评估工具的合理选择提供指导, 助力老年人多维衰弱的有效管理。

Abstract

Research on frailty in the elderly has transitioned from an exclusive emphasis on physical frailty to encompassing other dimensions, including physical, psychological, and social factors. This transition is essential for improving the health status and quality of life of vulnerable elderly individuals. Nonetheless, the majority of existing frailty assessment instruments predominantly focus on physical frailty, with a limited number of tools designed for evaluating multidimensional frailty and ambiguous contexts for their application. This review evaluates assessment techniques for multidimensional frailty in community-dwelling elderly persons, analyzing topics such as assessment content, current application status, features, and limits. The objective is to facilitate the right selection of multidimensional frailty assessment instruments for community-dwelling elderly individuals and to enhance the successful management of multidimensional frailty within this demographic.

关键词

多维衰弱 / 社区老年人 / 评估工具 / 应用

Key words

Multidimensional frailty / Community-dwelling elderly individuals / Assessment instruments / Application

参考文献

[1] Qiu Y, Li G, Wang X, et al. Prevalence of multidimensional frailty among community—dwelling older adults: a systematic review and meta—analysis[J]. Int J Nurs Stud, 2024, 154: 104755.

[2] Gobbens R J, Luijkx K G, Wijnen—Sponselee M T, et al. Toward a conceptual definition of frail community dwelling older people[J]. Nurs Outlook, 2010, 58(2): 76-86.

[3] O’Brien T D, Roberts J, Brackenridge G R, et al. Some aspects of community care of the frail and elderly: the need for assessment[J]. Geront Clin, 2004, 10(4): 215-227.

[4] 赵琳琳, 罗琪, 胡清华, 等 . 社区老年人多维衰弱研究进展[J]. 中国全科医学, 2025, 28(10): 1281-1288.

[5] Zhao L L , Luo Q , Hu Q H , et al. Research on the multidimensional frailty in community—dwelling older adults[J]. Chin Gen Pract, 2025, 28(10): 1281-1288.

[6] Kolle A T, Lewis K B, Lalonde M, et al. Reversing frailty in older adults: a scoping review[J]. BMC Geriatr, 2023, 23(1): 751.

[7] Mitnitski A B, Mogilner A J, Rockwood K . Accumulation of deficits as a proxy measure of aging[J]. Sci World J, 2001, 1: 323-336.

[8] Zheng J, Yu P, Yang M . Development, validation, and application of the electronic frailty index: a scoping review[J]. J Am Med Dir Assoc, 2025, 26(6): 105577.

[9] Auyeung T W, Kng C P L, Chan T Y, et al. Developing an Electronic Frailty Index (eFI) and a biological age trajectory with a cohort of over one million older adults in Hong Kong[J]. J Frailty Aging, 2025, 14(2): 100021.

[10] 蔡雪梅, 姚晓东 . 基于缺陷累积概念的衰弱指数在国内外的应用现状[J]. 国际老年医学杂志, 2025(1): 85-90.

[11] Cai X M , Yao X D . Global applications of the frailty index based on the deficit accumulation model[J]. Int J Geriatr, 2025(1): 85-90.

[12] 赵欣欣, 茅丽玲, 盛飞, 等 . 上海市社区老年人电子衰弱指数的构建与实践[J]. 同济大学学报(医学版), 2024, 45(1): 51-56.

[13] Zhao X X , Mao L L , Sheng F , et al. Construction and application of electronic frailty index for older adults in Shanghai communities[J]. J Tongji Univ Med Sci, 2024, 45(1): 51-56.

[14] Rubenstein L Z . Joseph T. Freeman award lecture: comprehensive geriatric assessment: from miracle to reality[J]. J Gerontol A Biol Sci Med Sci, 2004, 59(5): M473-M477.

[15] 孙娜, 梁冰, 钱荣 . 老年综合评估在社区的应用与进展[J]. 中国临床保健杂志, 2021, 24(4): 572-576.

[16] Sun N , Liang B , Qian R . Application and progress of comprehensive geriatric assessment in community[J]. Chin J Clin Healthc, 2021, 24(4): 572-576.

[17] Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one—year mortality from comprehensive geriatric assessment in hospitalized older patients[J]. Rejuvenation Res, 2008, 11(1): 151-161.

[18] Morganti W, Veronese N, Barbagelata M, et al. Validation of a brief form of the self—administered multidimensional prognostic index: the SELFY—BRIEF—MPI project[J]. J Clin Med, 2023, 12(18): 6026.

[19] Cella A, Veronese N, Custodero C, et al. Validation of abbreviated form of the multidimensional prognostic index (MPI): the BRIEF—MPI project[J]. Clin Interv Aging, 2022, 17: 789-796.

[20] Pilotto A, Barbagelata M, Lacorte E, et al. A multicomponent personalized prevention program in the primary care setting: a randomized clinical trial in older people with noncommunicable chronic diseases (Primacare_P3 study)[J]. Trials, 2024, 25(1): 611.

[21] 陈雨朦, 刘青青, 王玫, 等 . 基于概念框架的衰弱评估工具发展及应用现状[J]. 护士进修杂志, 2024, 39(10): 1113-1117.

[22] Chen Y M , Liu Q Q , Wang M , et al. Development and application of frailty assessment tool based on conceptual framework[J]. J Nurses Train, 2024, 39(10): 1113-1117.

[23] Rolfson D B, Majumdar S R, Tsuyuki R T, et al. Validity and reliability of the Edmonton frail scale[J]. Age Ageing, 2006, 35(5): 526-529.

[24] Fabrício—Wehbe S C C, Cruz I R, Haas V J, et al. Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community[J]. Rev Lat Am Enfermagem, 2013, 21(6): 1330-1336.

[25] 郭欣颖, 郝莹, 张宇, 等 . 中文版Edmonton衰弱评估量表在住院老年病人中的信效度研究[J]. 实用老年医学, 2022, 36(6): 623—626, 631.

[26] Guo X Y , Hao Y , Zhang Y , et al. Reliablity and validity of the Chinese version of Edmonton Frailty Scale for Chinese elderly inpatients[J]. Pract Geriatr, 2022, 36(6): 623—626, 631.

[27] 韩君, 王君俏, 谢博钦, 等 . Fried衰弱表型和FRAIL量表及埃德蒙顿衰弱评估量表在社区高龄老年人衰弱筛查中一致性和适用性的比较研究[J]. 中国全科医学, 2021, 24(21): 2669-2675.

[28] Han J , Wang J Q , Xie B Q , et al. Comparison of consistency and validity of fried frailty phenotype, FRAIL scale and Edmonton frailty scale for frailty screening among community—dwelling older adults[J]. Chin Gen Pract, 2021, 24(21): 2669-2675.

[29] Gobbens R J J, van Assen M A L M, Luijkx K G, et al. The Tilburg frailty indicator: psychometric properties[J]. J Am Med Dir Assoc, 2010, 11(5): 344-355.

[30] Metzelthin S F, Daniels R, van Rossum E, et al. The psychometric properties of three self—report screening instruments for identifying frail older people in the community[J]. Tijdschr Gerontol Geriatr, 2011, 42(3): 120-130.

[31] 奚兴, 郭桂芳, 孙静 . 中文版Tilburg衰弱评估量表的信效度研究[J]. 护理学报, 2013, 20(16): 1-5.

[32] Xi X , Guo G F , Sun J . Reliability and validity of Chinese version of Tilburg frailty indicator[J]. J Nurs, 2013, 20(16): 1-5.

[33] 李菲, 刘慧松, 查龙肖, 等 . 中文版老年人衰弱评估量表的修订和信效度评价[J]. 护理学杂志, 2017, 32(7): 18-20, 27.

[34] Li F , Liu H S , Zha L X , et al. Reliability and validity testing of the Chinese version of Tiburg Frailty Indicator[J]. J Nurs Sci, 2017, 32(7): 18-20, 27.

[35] van der Ploeg T, Gobbens R . A comparison of different modeling techniques in predicting mortality with the Tilburg frailty indicator: longitudinal study[J]. JMIR Med Inform, 2022, 10(3): e31480.

[36] Japanese Ministry of Health, Labour and Welfare. The manuals of the evaluation for the ability to perform daily activities on preventive care[EB/OL]. (2009)[2025—1—13]. http://www.mhlw.go.jp/topics/2009/05/dl/tp0501—1c0001.pdf.

[37] 王志燕, 高欢玲, 张红梅, 等 . Kihon老年衰弱筛查量表的汉化及信效度检验[J]. 护理学杂志, 2021, 36(3): 10-13.

[38] Wang Z Y , Gao H L , Zhang H M , et al. Translation and reliability and validity testing of the Chinese Version of the Kihon Checklist (KCL)[J]. J Nurs Sci, 2021, 36(3): 10-13.

[39] De Witte N, Gobbens R, De Donder L, et al. The comprehensive frailty assessment instrument: development, validity and reliability[J]. Geriatr Nurs, 2013, 34(4): 274-281.

[40] Imani M, Khajeh M, Khosravi A, et al. Validation of the Persian version of the comprehensive frailty assessment instrument plus in community—dwelling older adults[J]. Geriatr Nurs, 2021, 42(6): 1287-1293.

[41] 王坤, 陈长香, 李淑杏 . 衰弱综合评估工具的汉化及信效度检验[J]. 中国康复理论与实践, 2017, 23(1): 72-76.

[42] Wang K , Chen C X , Li S X . Reliability and validity of Chinese version of comprehensive frailty assessment instrument[J]. Chin J Rehabil Theory Pract, 2017, 23(1): 72-76.

[43] Navarro—Flores E, de Bengoa Vallejo R B, Losa—Iglesias M E, et al. The reliability, validity, and sensitivity of the Edmonton Frail Scale (EFS) in older adults with foot disorders[J]. Aging, 2020, 12(24): 24623-24632.

[44] 王志燕 . 老年衰弱筛查Kihon Checklist(KCL)量表的汉化及应用[D]. 太原: 山西医科大学, 2021.

[45] Wang Z Y . Reliability and Validity of Chinese Version of the elderly Kihon Checklist and the Application in the elderly[D]. Taiyuan: Shanxi Medical University, 2021.

[46] Vo N T, Tu Y K, Lin K C, et al. Diagnostic accuracy of the FRAIL scale, Groningen frailty indicator, Tilburg frailty indicator, and PRISMA—7 for frailty screening among older adults in community settings: a systematic review and network meta—analysis[J]. Gerontologist, 2024, 64(6): gnae008.

基金资助

^*国家自然科学基金(82074510)