社区老年人多维衰弱评估研究进展

杨琳; 舒静; 李梦盈; 曹力震

doi:10.16766/j.cnki.issn.1674-4152.004156

社区老年人多维衰弱评估研究进展

doi: 10.16766/j.cnki.issn.1674-4152.004156

杨琳¹,
舒静^{1, 2, ,},
李梦盈^{1, 2},
曹力震¹

1.
湖北中医药大学护理学院，湖北武汉 430065
2.
湖北时珍实验室，湖北武汉 430000

基金项目:

湖北省教育厅科学技术研究项目 B2023095

详细信息

通讯作者:
舒静，E-mail：jingjing1203@sina.com

中图分类号: R197.61 R592
计量
- 文章访问数: 5
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-11-14
- 网络出版日期: 2025-11-17

Advances in multidimensional frailty assessment research in community-dwelling older adults

YANG Lin¹,
SHU Jing^{1, 2
, ,},
LI Mengying^{1, 2},
CAO Lizhen¹

1.
School of Nursing, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, China

摘要

摘要: 随着老龄化程度的加深，衰弱作为健康老化与失能的动态可逆状态，已成为影响临床实践和公共卫生的重要议题。随着研究的进展和深入，学界对衰弱的认知从单一躯体维度逐渐拓展为心理维度、社会维度和躯体维度的整合。研究表明，评估社区老年群体衰弱情况能够预测其生活质量下降、失能以及死亡等不良健康结局，及时评估和干预老年人衰弱，可积极应对人口老龄化。作为老年人健康管理的关键环节，居家社区护理在衰弱早期识别与干预中具有独特优势，有助于延缓甚至逆转老年人衰弱的进程，减少不良结局的发生。医务人员可根据衰弱评估结局从躯体、心理、社会等多个维度提供全面的健康服务。当前临床实践主要依托多维衰弱评估工具为个体化护理方案提供支撑，但该领域仍存在以下问题：(1)衰弱的概念应用广泛，但国内外尚未就多维衰弱的标准化评估工具达成一致，现有评估工具在信效度、适用场景及文化适应性上存在差异；(2)早期量表多缺乏衰弱分级及认知筛查模块，后期改良版本虽扩展维度，却因条目复杂，限制其大范围应用；(3)国内研究以引进汉化工具为主，本土化原创工具匮乏，亟待完善。本文对目前广泛使用的社区老年人多维衰弱评估工具的内容、维度、信效度以及优缺点进行综述，以期为国内医务人员识别早期衰弱、改善不良结局、制定个性化护理措施提供参考。
- 衰弱 /
- 社区 /
- 老年人 /
- 评估工具
Abstract: As aging deepens, frailty, as a dynamic and reversible state of healthy aging and disability, has become an important topic affecting clinical practice and public health. As research has progressed and deepened, the academic perception of frailty has gradually expanded from a single somatic dimension to an integration of psychological, social, and somatic dimensions. Studies have shown that assessing frailty in community-dwelling older adults can predict adverse health outcomes such as decreased quality of life, disability, and death, and that timely assessment and intervention of frailty in older adults can positively respond to population aging. As a key component of health management for older adults, home-based community care has unique advantages in early identification and intervention of frailty, which can help to slow down or even reverse the process of frailty in older adults and reduce the occurrence of adverse outcomes. Medical personnel can provide comprehensive health services from multiple dimensions, including physical, psychological, and social, according to the outcome of frailty assessment. Current clinical practice relies on multidimensional frailty assessment tools to support individualized care plans, but the following problems still exist in this area: (1) the concept of frailty is widely used, but no agreement has been reached at home and abroad on a standardized assessment tool for multidimensional frailty, and there are differences in the reliability, applicability scenarios, and cultural adaptability of the existing assessment tools; (2) most of the early scales lacked frailty grading and cognitive screening modules, and the later improved versions expanded the dimensions, but the complexity of the entries limited their wide application; (3) the domestic studies were mainly based on the importation of Chinese language tools, and there is a lack of localized and original tools, which is in urgent need of improvement. This article reviews the content, dimensions, reliability, strengths, and weaknesses of widely used multidimensional frailty assessment tools for community-dwelling older adults, with the aim of providing a reference for domestic healthcare professionals in identifying early-stage frailty, improving poor outcomes, and developing personalized care.
- Frailty /
- Community /
- Aged /
- Assessment tools

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表 1 社区老年人多维衰弱评估工具基本情况

Table 1. Basic information on multidimensional frailty assessment tools for community-dwelling older adults

评估工具	开发年份	开发国家	内容框架	理论模型	报告模式	Cronbach's α系数	版本
GFI	2001	荷兰	4个维度，15个条目	衰弱整合模型	自评	0.867	土耳其版、阿拉伯版、中文版
FI	2001	加拿大	4个维度，30~70个变量	累积健康缺陷理论	他评	未报告	无
CFS	2005	加拿大	4个维度，9个等级	无	他评	不适用	韩国版、法国版、丹麦版、土耳其版、中文版
EFS	2006	加拿大	9个维度，11个条目	衰弱循环模型	他评	0.620	泰国版、土耳其版、中文版
KCL	2006	日本	7个维度，25个条目	累积健康缺陷理论	自评	0.882	英文版、巴西版、葡萄牙版、西班牙版、中文版
TFI	2010	荷兰	3个维度，15个条目	衰弱整合模式	自评	0.730	土耳其版、瑞典版、丹麦版、波兰版、巴西版、中文版
CFAI	2013	比利时	4个维度，23个条目	衰弱整合模式	自评	0.812	中文版

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参考文献(45)

[1]	国家统计局. 中华人民共和国2023年国民经济和社会发展统计公报[EB/OL]. (2024-02-29)[2024-11-28]. https://www.stats.gov.cn/sj/zxfb/202402/t20240228_1947915.html.
[2]	DOGRA S, DUNSTAN D W, SUGIYAMA T, et al. Active aging and public health: evidence, implications, and opportunities[J]. Annu Rev Public Health, 2022, 43(1): 439-459. doi: 10.1146/annurev-publhealth-052620-091107
[3]	韦思娴, 韦华. 社区老年人多病共存患者多重用药管理现状与应对策略[J]. 中国老年保健医学, 2024, 22(5): 117-119. WEI S X, WEI H. Current status and coping strategies for managing multiple medications in community-dwelling elderly patients with multimorbidities[J]. Chinese Journal of Geriatric Care, 2024, 22(5): 117-119.
[4]	郑淑娟, 李瑜, 欧阳菊艳, 等. 老年高血压合并衰弱住院患者的营养状况调查及相关因素分析[J]. 中华老年心脑血管病杂志, 2024, 26(8): 886-891. ZHENG S J, LI Y, OUYANG J Y, et al. Nutritional status and related factors of elderly hospitalized patients with hypertension and frailty[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2024, 26(8): 886-891.
[5]	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(6): 104755. DOI: 10.1016/j.ijnurstu.2024.104755.
[6]	曹成霖, 吴新春, 纪凯, 等. 老年衰弱研究进展[J]. 中国临床保健杂志, 2023, 26(2): 274-278. CAO C L, WU X C, JI K, et al. Research progress of frailty among older people[J]. Chinese Journal of Clinical Healthcare, 2023, 26(2): 274-278.
[7]	COHEN C I, BENYAMINOV R, RAHMAN M, et al. Frailty: a multidimensional biopsychosocial syndrome[J]. Med Clin North Am, 2023, 107(1): 183-197. doi: 10.1016/j.mcna.2022.04.006
[8]	STEVERINK N, SLAETS J, SCHUURMANS H, et al. Measuring frailty: developing and testing the GFI (Groningen frailty indicator)[J]. Gerontologist, 2001, 41(1): 236-237.
[9]	GVNER M, CEYLAN S, OKYAR BA瘙塁A, et al. Turkish translation, cross-cultural adaptation and reliability of the Groningen frailty indicator[J]. BMC Geriatr, 2023, 23(1): 753. DOI: 10.1186/s12877-023-04445-5.
[10]	KHAMIS R, SABBAH H, SABBAH S, et al. Evaluating the psychometric properties of the arabic version of the Groningen frailty indicator among Lebanese elderly people[J]. J Egypt Public Health Assoc, 2019, 94(1): 28. DOI: 10.1186/s42506-019-0028-3.
[11]	HUANG E Y Z, CHEUNG J, LIU J Y W, et al. Groningen frailty indicator-Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy[J]. BMC Geriatr, 2022, 22(1): 788. DOI: 10.1186/s12877-022-03437-1.
[12]	XIANG W, CHENG Y, LI Z, et al. Cross-cultural adaptation and validation of the Groningen frailty indicator in Chinese nursing home residents[J]. Aging Clin Exp Res, 2020, 32(6): 1035-1042. doi: 10.1007/s40520-019-01178-7
[13]	黄韵芝, 林清. 格罗宁根衰弱指标的汉化研究[J]. 护理学报, 2019, 26(18): 1-5. HUANG Y Z, LIN Q. Translation study of groningen frailty indicator[J]. Journal of Nursing, 2019, 26(18): 1-5.
[14]	Japanese Ministry of Health, Labour and Welfare. The manuals of the evaluation for a bility to perform daily activities on preventive[EB/OL]. (2009-03-01)[2024-09-03]. https://www.mhlw.go.jp/topics/2009/05/dl/tp0501-1c0001/.
[15]	ASSANTACHAI P, MUANGPAISAN W, INTALAPAPORN S, et al. Kihon checklist: Thai version[J]. Geriatr Gerontol Int, 2021, 21(8): 749-752. doi: 10.1111/ggi.14213
[16]	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. 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]. Journal of Nursing Science, 2021, 36(3): 10-13.
[17]	WANG Q, TAO A, ZHANG Y, et al. Psychometric properties of the simplified Chinese version of Kihon checklist in the Chinese older people[J]. Int J Older People Nurs, 2023, 18(2): e12524. DOI: 10.1111/opn.12524.
[18]	MATSUZAKI H, KISHIMOTO H, NOFUJI Y, et al. Predictive ability of the total score of the Kihon checklist for the incidence of functional disability in older Japanese adults: an 8-year prospective study[J]. Geriatr Gerontol Int, 2022, 22(9): 723-729. doi: 10.1111/ggi.14435
[19]	刘盼, 李耘, 马丽娜. 《初级保健机构中衰弱筛查和管理: 国际衰弱和肌肉减少症研究会议工作组指南》解读[J]. 中国全科医学, 2021, 24(25): 3141-3147. LIU P, LI Y, MA L N. Interpretation of screening for and managing the person with frailty in primary care: ICFSR consensus guidelines[J]. Chinese General Practice, 2021, 24(25): 3141-3147.
[20]	GOBBENS R J, VAN ASSEN M A, LUIJKX K G, et al. The Tilburg frailty indicator: psychometric properties[J]. J Am Med Dir Assoc, 2010, 11(5): 344-355. doi: 10.1016/j.jamda.2009.11.003
[21]	DONG L, LIU N, TIAN X, et al. Reliability and validity of the Tilburg frailty indicator (TFI) among Chinese community-dwelling older people[J]. Arch Gerontol Geriatr, 2017, 73(6): 21-28.
[22]	夏宇晓, 冯秀丽, 郭玮, 等. 住院老年患者衰弱评估及对术后并发症预测效能的比较[J]. 昆明医科大学学报, 2022, 43(7): 121-127. XIA Y X, FENG X L, GUO W, et al. Comparison of frailty assessment methods for predicting postoperative complications in hospitalized elderly patients[J]. Journal of Kunming Medical University, 2022, 43(7): 121-127.
[23]	LEE J, KIM G S, KIM S, et al. Use of the Tilburg frailty indicator in longitudinal studies with older adults: a scoping review[J]. J Adv Nurs, 2023, 79(7): 2429-2443. doi: 10.1111/jan.15675
[24]	DE WITTE N, GOBBENS R, DE DONDER L, et al. The comprehensive frailty assessment instrument: development, validity and reliability[J]. Geriatric Nursing, 2013, 34(4): 274-281. doi: 10.1016/j.gerinurse.2013.03.002
[25]	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. WANG K, CHENG C X, LI S X. Reliability and validity of Chinese version of comprehensive frailty assessment instrumen[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017, 23(1): 72-76.
[26]	MITNITSKI A B, MOGILNER A J, ROCKWOOD K. Accumulation of deficits as a proxy measure of aging[J]. Sci World J, 2001, 1(2): 321027. DOI: 10.1100/tsw.2001.58.
[27]	SHI S M, OLIVIERI-MUI B, MCCARTHY E P, et al. Changes in a frailty index and association with mortality[J]. J Am Geriatr Soc, 2021, 69(4): 1057-1062. doi: 10.1111/jgs.17002
[28]	KHANNA A K, MOTAMEDI V, BOULDIN B, et al. Automated electronic frailty index-identified frailty status and associated postsurgical adverse events[J]. JAMA Netw Open, 2023, 6(11): e2341915. DOI: 10.1001/jamanetworkopen.2023.41915.
[29]	任燕, 杨永学, 陈善萍, 等. 基于累积缺陷原则构建的衰弱指数及其应用[J]. 中华老年多器官疾病杂志, 2024, 23(3): 229-232. REN Y, YANG Y X, CHEN S P, et al. Frailty index model based on the principle of cumulative defects and its application[J]. Chinese Journal of Multiple Organ Diseases in the Elderly, 2024, 23(3): 229-232.
[30]	KASKIRBAYEVA D, WEST R, JAAFARI H, et al. Progression of frailty as measured by a cumulative deficit index: a systematic review[J]. Ageing Res Rev, 2023, 84(2): 101789. DOI: 10.1016/j.arr.2022.101789.
[31]	STOLZ E, MAYERL H, GODIN J, et al. Reliability of the frailty index among community-dwelling older adults[J]. J Gerontol A Biol Sci Med Sci, 2024, 79(2): glad227. DOI: 10.1093/gerona/glad227.
[32]	HANLON P, WELSH S A, EVANS N R. Constructing a quality frailty index: you get out what you put in[J]. Age Ageing, 2024, 53(1): afad248. DOI: 10.1093/ageing/afad248.
[33]	程连, 阮金婷, 梁镭, 等. 衰弱评估工具在基层医疗中的应用现状[J]. 中华全科医学, 2024, 22(3): 486-490. doi: 10.16766/j.cnki.issn.1674-4152.003432 CHENG L, RUAN J T, LIANG L, et al. Application status of frailty assessment tools in primary care[J]. Chinese Journal of General Practice, 2024, 22(3): 486-490. doi: 10.16766/j.cnki.issn.1674-4152.003432
[34]	ROCKWOOD K, SONG X, MACKNIGHT C, et al. A global clinical measure of fitness and frailty in elderly people[J]. Can Med Assoc J, 2005, 173(5): 489-495. doi: 10.1503/cmaj.050051
[35]	PULOK M H, THEOU O, VAN DER VALK A M, et al. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine[J]. Age Ageing, 2020, 49(6): 1071-1079. doi: 10.1093/ageing/afaa089
[36]	JUNG H W, JANG I Y, BACK J Y, et al. Validity of the clinical frailty scale in Korean older patients at a geriatric clinic[J]. Korean J Intern Med, 2021, 36(5): 1242-1250. doi: 10.3904/kjim.2020.652
[37]	FOURNAISE A, NISSEN S K, LAURIDSEN J T, et al. Translation of the updated clinical frailty scale 2.0 into Danish and implications for cross-sectoral reliability[J]. BMC Geriatr, 2021, 21(1): 269. DOI: 10.1186/s12877-021-02222-w.
[38]	A瘙塁IK Z, KILINÇ 瘙塁, KUR瘙塁UN Ö, et al. Validation of the clinical frailty scale version 2.0 in Turkish older patients[J]. Geriatr Gerontol Int, 2022, 22(9): 730-735. doi: 10.1111/ggi.14445
[39]	CHOU Y C, TSOU H H, CHAN D D, et al. Validation of clinical frailty scale in Chinese translation[J]. BMC Geriatr, 2022, 22(1): 604. DOI: 10.1186/s12877-022-03287-x.
[40]	CHURCH S, ROGERS E, ROCKWOOD K, et al. A scoping review of the clinical frailty scale[J]. BMC Geriatr, 2020, 20(1): 393. DOI: 10.1186/s12877-020-01801-7.
[41]	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. doi: 10.1093/ageing/afl041
[42]	AYGÖR H E, FADILOǦLU Ç, 瘙塁AHIN S, et al. Validation of Edmontion FRAIL scale into elderly Turkish population[J]. Arch Gerontol Geriatr, 2018, 76: 133-137. doi: 10.1016/j.archger.2018.02.003
[43]	ROOPSAWANG I, THOMPSON H, ZASLAVSKY O, et al. The reported Edmonton frail scale-Thai version: development and validation of a culturally-sensitive instrument[J]. Nurs Health Sci, 2020, 22(3): 685-693. doi: 10.1111/nhs.12713
[44]	葛晓红, 高丽红. 埃德蒙顿衰弱量表的汉化及信效度检验[J]. 中国实用护理杂志, 2021, 37(5): 352-358. GE X H, GAO L H. Cross-cultural adaptation and reliability and validity testing of the Chinese version of Edmonton Frail Scale[J]. Chinese Journal of Practical Nursing, 2021, 37(5): 352-358.
[45]	CASTRO M L, ALVES M, MARTINS A, et al. Reproducibility and validity of the Portuguese Edmonton frail scale version in cardiac surgery patients[J]. Rev Port Cardiol, 2023, 42(4): 295-304. doi: 10.1016/j.repc.2022.03.009