骨科住院老年患者衰弱评估工具的范围综述

A Scoping Review of Frailty Assessment Tools for Elderly Orthopedic Inpatients

背景随着我国人口老龄化加剧,骨科围术期老年患者人数呈逐年递增趋势,衰弱在接受骨科手术的老年患者中越来越常见且日益引起关注,术前尽早评估老年人的衰弱状态,早期进行干预,对于改善患者预后和减少并发症的发生具有重要意义。目的对骨科住院老年患者使用的衰弱评估工具进行范围综述,为骨科住院老年患者衰弱评估工具的选择提供参考依据。方法计算机检索PubMed、CINAHL、PsycINFO、Scopus、Embase、中国知网、万方数据知识服务平台共7个数据库,检索时间为2006—2021年。由2名研究者独立筛选文献并提取文献的基本特征(第一作者、发表时间、国家、基本信息、研究工具和结局指标)及涉及的衰弱评估工具基本特点(名称、研究国家、研究类型、量表维度、量表条目、评估截点值、评估时间等)。结果共检索出1733篇文献,最终纳入25项研究共12种衰弱评估工具。分析结果表明,目前评估工具种类繁多,不同的研究使用了不同的衰弱评估工具,Fried’s衰弱表型(FP)标准和衰弱指数(FI)是常用的两种衰弱评估工具,运用准确有效的工具进行衰弱的筛查对加强术前风险分层和改善术后预后至关重要,患者自我报告埃德蒙顿衰弱量表(REFS)、简易衰弱问卷(FRAIL)、PRISMA-7问卷和Groningen衰弱指标量表(GFI)不需要使用额外的测量仪器设备,测量人员也不需要经过培训即可完成评估。结论骨科住院老年患者选择衰弱评估工具时需综合考虑患者特征和临床环境资源状况、工具的性能等因素,但目前仍缺乏衰弱评估的金标准,未来需要更多的研究对现有的量表进行信效度评价或研制开发适合我国骨科住院老年患者的衰弱评估工具。

Background With the aggravation of population aging in China,the number of elderly perioperative orthopedic patients is increasing,and the growing prevalence of frailty in older patients undergoing orthopedic surgery has attracted increasing attention.Early preoperative assessment and intervention of frailty are of great significance for improving postoperative prognosis and reducing the occurrence of complications in this population.Objective To perform a scoping review of frailty assessment tools for elderly orthopedic inpatients,and to provide a reference for the selection of frailty assessment tools for this group.Methods Seven databases(PubMed,CINAHL,PsycINFO,Scopus,Embase,CNKI and Wanfang Data)were searched for studies on frailty assessment tools for older orthopedic inpatients from 2006 to 2021.Two researchers independently screened the literature and extracted the basic characteristics of the literature(the flint author,publication time,country,basic information,research tools and outcome indicators)and the basic characteristics of involved frailty assessment tools(name,study country,study type,scale dimension,number of items,assessment cut-off value,assessment time,etc.).Results A total of 1733 studies were retrieved,and 25 of them with 12 frailty assessment tools were included.The analysis showed that there are a variety of assessment tools,and different studies have used different frailty assessment tools.Frailty Phenotype and Frailty Index are the two common tools.The application of accurate and effective tools for frailty screening is crucial to improving preoperative risk stratification and postoperative prognosis.Frailty assessment using the Reported Edmonton Frail Scale,FRAIL Scale,PRISMA-7 Questionnaire or the Groningen Frailty Index can be completed without the use of additional measuring equipment and surveyors with an experience of training.Conclusion The selection of an optimal frailty assessment tool for elderly orthopedic inpatients should be in accordance with patient features,clinical resources and the performance of the tool.However,there is still lack of a gold standard for frailty assessment.Future studies are needed to assess the reliability and validity of existing frailty assessment scales or to develop frailty assessment tools applicable to Chinese older orthopedic inpatients.