脆弱：费用和预防

人们对英国和美国医疗保健系统的压力越来越担心，与迅速增加的老年人数量迅速增加有关。Frailty– identified by impaired mobility, loss of balance, muscle strength, and endurance – is associated with increased risk of hospital admission, increased duration of stay, and a need for home care. Unplanned hospital admissions, including of frail older adults,成本NHS> 130亿英镑，美国医疗保健经济每年> 1.1万亿美元。

Physical activity, even minimal amounts, is associated withnumerous protective benefits例如降低患糖尿病，中风，髋部骨折的风险，改善心理健康并延迟老年人的身体恶化。有证据表明，有针对性的干预措施改善平衡和肌肉力量可以帮助减少跌倒的风险和subsequent医院入院.

我们评论的目标

The objective of我们的评论是通过专注于旨在改善老年人身体脆弱症状的随机对照试验来建立现有工作的基础，以便在研究中更轻松地进行比较。在审查中，我们描述了干预措施的积极组成部分，以尝试确定哪些有效，在哪些条件下以及在什么条件下。这听起来像是一项相对简单的任务。

It was not easy

We repeatedly came up against methodological issues that compromised our ability to make more definite recommendations and conclusions.

First and foremost was the lack of consensus on the definition of frailty or how best to assess it. We found that participants who were pre-frail, frail, and non-frail were often put into the same group and the intervention success was decided on the group as a whole, rather than the sum of its parts. This means we cannot know with any certainty if the intervention worked as well for those who were severely frail versus those who were less so.

其次，行为改变理论已显示出增加体育锻炼的预测性和解释能力，并已用于制定持续活动的维护计划。但是，几乎没有证据表明我们发现的研究中使用的干预措施是基于任何形式化的行为变化理论。

The limitations we faced in this review are common problems across many long-term health population research fields.

Moreover, most studies were relatively brief in delivery and very few had longer-term follow-up to examine if behavior change was being maintained. Given the growing demand for service provision on the one hand and the budget cuts across health and social care in the UK on the other, interventions must be able to demonstrate benefits that prove to be cost effective in the long term. So while it appears that physical activity may prevent/reduce physical signs of frailty in the short term, it needs to be maintained and integrated into normal daily life for the benefits to be felt both by the individual and by the health and social care services.

Recommendations

It may surprise some to learn that the limitations we faced in this review are common problems across many long-term health population research fields. Increasingly, there have been growing calls for core measures to be introduced and implemented by healthcare professionals, researchers, and funders. This has proven successful in other conditions such as diabetes and some cancers, and could be helpful in frailty assessment as well.

Other action we can take is to ensure that the future interventions we design are fit for purpose, are grounded in theory, and can promise to deliver real long-term health benefits in terms of frailty prevention or symptom reduction.