适用于中国急诊医疗体系的老年衰弱量表研制与应用评价

The elderly patients presenting to hospital emergency departments (EDs) are often frail, i.e., they have not only the presenting acute illnesses, but also the continuously accumulating health deficits that make their physical bodies very susceptible. Frailty can be delayed or even reversed, if early medical interventions are in place. However, the current “disease-centered” emergency healthcare service model is likely to disregard the overall frail status of the elderly patients. It often provides conventional acute care only surrounding the treatment of presenting acute illnesses, which tends to cause excessive or contradictory body reactions of the frail elderly patients and thus further increases the risk for patient adverse outcomes. Assessment or screening (then targeted interventions) for frailty, is a key problem to be solved in the contemporary elderly emergency healthcare system. To date, China has not yet developed a tool for screening elderly frailty for use in the EDs, and has limited research relating to the elderly frailty in the ED environment. Therefore, this project aims to establish a scale for screening elderly frailty in the emergency healthcare system in China, and then apply the established scale to investigate the epidemiological characteristics and influencing factors for frailty among elderly ED patients, as well as to explore the potential of frailty for predicting adverse outcomes such as functional decline and mortality. Implementation of this project will enhance the abilities in early screening and risk predicting of elderly frailty in the emergency care system, can provide novel ideas for treating and managing the elderly ED patients, and will bring about practical significance for promoting the elderly emergency care system reform and realizing the advocacy of healthy aging.

急诊老年患者常伴衰弱症，即在罹患急性疾病的同时，还处于一种健康缺陷不断累积所致的机体危险状态。衰弱进程在早期医疗干预下可得到延缓甚至逆转，但是，现行以疾病为导向的急诊医疗模式，容易忽视老年患者的整体衰弱状态，局限于主诉疾病给予常规急诊治疗，常引发衰弱患者过度或矛盾的机体反应，增加其不良预后发生的风险。衰弱的评估筛查（从而针对性地干预）是现代老年急诊医疗体系亟待关注和解决的问题，而我国目前尚未开发出应用于急诊环境的衰弱评估工具，针对急诊老年人群的衰弱研究也是近乎空白。因此，本课题拟研制适用于我国急诊医疗体系的衰弱评估量表，并应用量表阐述我国急诊老年患者中衰弱的流行现状及其影响因素，以及探讨衰弱对失能和死亡等不良健康结局发生的预测作用。本项目将提高急诊体系内的老年衰弱评估筛查和风险预测能力，为治疗和管理急诊老年患者提供崭新的思路，对促进老年急诊医疗服务模式改革和实现健康老龄化具有重要现实意义。

项目背景：我国提出“健康中国”国家战略，强调关注老年等重点人群健康。然而我国老龄服务大多局限于常规认知的疾病，却忽视了老年高发的衰弱问题。尤其是现行以疾病为导向的急诊医疗，容易忽视老年患者的整体衰弱状态，局限于主诉疾病给予常规急诊治疗，常引发衰弱患者过度或矛盾的机体反应，增加其不良预后发生风险。衰弱的评估筛查（从而针对性地干预）是现代老年急诊医疗体系亟待关注和解决的问题。.研究内容：本课题致力于研制适用于我国急诊医疗体系的衰弱评估量表，并应用量表阐述我国急诊老年患者中衰弱流行现状及其影响因素、探讨衰弱对不良健康结局的预测作用。.关键数据和重要结果：①对CP-FI-CGA量表进行汉化和跨文化检验，汉化版量表的总体Cronbach’s α系数为0.934，内容效度为0.973，各条目与总分的相关系数介于0.139-0.850(均p<0.001)，衰弱评分与其它有关工具（如ADL/IADL评分、生活满意度等）具有较强相关性(均p<0.001)，说明量表具有较好的信效度、适用于我国急诊科老年患者衰弱评估。②横断面研究显示急诊老年患者中、重度衰弱占比达40.4%，衰弱具有普遍性。年龄、职业、居住方式、行为习惯、社会支持、共病和多重用药等一系列特征与衰弱具有显著相关性(均p<0.05)。③前瞻性队列研究阐释了衰弱对急诊老年患者不良预后具有预警价值（如随访1年内住院：AOR=1.39,95%CI=1.20-1.62；死亡：HR=1.78,95%CI=1.53-2.07）。④本课题另外利用已有数据库对相关领域进行了扩展研究：一方面揭示了基于社区老年人群的衰弱评估也能够显著预测卫生服务利用负担增加；另一方面揭示了融合老年衰弱理念的急诊医疗干预模式对于改善老年急诊服务具有节约成本效益（年均净成本=-AU$8,444,512；95%CI=-15,018,055~-3,358,820）。.科学意义：本项目构建出一种适用于急诊医疗体系的有效且实用的衰弱评估量表，弥补了以往缺乏有效实用工具的不足，有助于提高急诊体系内的老年衰弱评估筛查和风险预测能力；在应用潜能方面，本项目将老年衰弱概念引入急诊医疗体系，为治疗和管理急诊老年患者提供了新思路，对优化老年急诊医疗服务模式从而促进健康老龄化具有借鉴意义。