Yaşlılarda Kırılganlığın Önlenmesi ve Yönetiminde Kanıta Dayalı Yaklaşımlar

Abstract

Kırılganlık “Bireyin artan bağımlılığını ve ölüme karşı savunmasızlığını artıran, azalan güç, dayanıklılık ve azalmış fizyolojik işlev ile karakterize edilen, birden çok nedeni ve katkıda bulunan faktörleri olan tıbbi bir sendrom.” olarak tanımlanmaktadır. Yaşlı nüfusun hızla artması ile kırılganlık insidansında da artış olduğu görülmektedir. Bu sebeple özellikle yaşlı bireylerde kırılganlığın azaltılması veya önlenmesi için biyolojik, sosyolojik, ekonomik ve çevresel stres faktörlerinin en aza indirilmesi, yaşlı bireylere kapsamlı geriatrik değerlendirme yapılması, hastalıklarda erken tanı konulması ve kırılganlığı önleyecek müdahalelerde bulunulması kırılganlık yönetiminin temel hedefini oluşturmaktadır. Kırılgan yaşlı bireyler yeniden hastaneye yatış, düşme, mortalite ve morbidite açısından risk altındadır. Uzmanlar yapılacak müdahaleler sayesinde kırılganlığın engellenebileceği veya ortaya çıkan etkilerinin zayıflatılabileceği görüşündedir. Etkinliği kanıtlanmış yöntemler arasında başlıca fiziksel aktivite, beslenme müdahaleleri, polifarmasinin önlenmesi, sosyal ortamın iyileştirilmesi ve yaşlı bireylere rutin olarak onaylanmış bir tarama yöntemi ile kırılganlık taraması yapılması gelmektedir. Bu derleme yazının amacı kırılganlığın önlenmesi ve yönetimi ile ilgili yapılan araştırmaları ve kırılganlık ile ilgili kılavuzların kanıt seviyelerinin incelenmesidir.

Keywords

• Kırılganlık
• yaşlı
• kanıta dayalı hemşirelik

Evidence-Based Approaches in the Prevention and Management of Frailty in the Elderly

Abstract

Frailty “A medical syndrome with multiple causes and contributing factors, characterized by decreased strength, stamina, and decreased physiological function, increasing an individual's increased dependence and vulnerability to death.” is defined as. It is seen that there is an increase in the incidence of fragility with the rapid increase in the elderly population. For this reason, minimizing biological, sociological, economic and environmental stress factors in order to reduce or prevent frailty, especially in elderly individuals, comprehensive geriatric evaluation of elderly individuals, early diagnosis of diseases and interventions to prevent fragility constitute the main objective of fragility management. Frail elderly individuals are at risk for rehospitalization, falls, mortality and morbidity. Experts are of the opinion that, through interventions, vulnerability can be prevented or its emerging effects can be weakened. Methods with proven efficacy include mainly physical activity, nutritional interventions, prevention of polypharmacy, improvement of social environment, and routine frailty screening of older individuals with an approved screening method. In this review, research on the prevention and management of frailty and the level of evidence for frailty guidelines are reviewed.

Keywords

• Frailty
• aged
• prevention of frailty
• evidence-based nursing.

References

1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146-56.
2. Eyigor S, Kutsal YG, Duran E, et al. Frailty prevalence and related factors in the older adult-FrailTURK Project. Age (Dordr). 2015; 37(3): 9791.
3. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6): 392-7.
4. Martin FC, O'Halloran AM. Tools for Assessing Frailty in Older People: General Concepts. Adv Exp Med Biol. 2020; 1216: 9-19.
5. Rodriguez-Manas L, Feart C, Mann G, Viña J, Chatterji S, Chodzko-Zajko W, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013; 68(1): 62-7.
6. Shinkai S, Yoshida H, Taniguchi Y, Murayama H, Nishi M, Amano H, et al. Public health approach to preventing frailty in the community and its effect on healthy aging in Japan. Geriatr Gerontol Int. 2016; 16(1): 87-97.
7. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, et al. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Dir Assoc. 2012; 13(1): 24-30.
8. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 2012(9): CD007146.

9. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA. 2020; 320(19): 2020-8.
10. Elsawy B, Higgins KE. Physical activity guidelines for older adults. Am Fam Physician. 2010 Jan 1; 81(1): 55-9.
11. De Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millán-Calenti JC. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr. 2015; 15: 154-70.
12. Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clin Interv Aging. 2017; 12: 955-61.
13. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019; 1(1): CD012424.
14. Sadjapong U, Yodkeeree S, Sungkarat S, Siviroj P. Multicomponent exercise program reduces frailty and ınflammatory biomarkers and ımproves physical performance in community-dwelling older adults: a randomized controlled trial. Int J Environ Res Public Health. 2020; 17(11): 3760.
15. Woolford SJ, Sohan O, Dennison EM, Cooper C, Patel HP. Approaches to the diagnosis and prevention of frailty. Aging Clin Exp Res. 2020; 32(9): 1629-37.
16. Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, et al. Nutritional status according to the mini nutritional assessment (MNA®) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging. 2013; 17(4): 351-6.
17. Slee A, Birch D, Stokoe D. A comparison of the malnutrition screening tools, MUST, MNA and bioelectrical impedance assessment in frail older hospital patients. Clin Nutr. 2015; 34(2): 296-301.
18. Abizanda P, López MD, García VP, Estrella Jde D, da Silva González Á, Vilardell NB, et al. Effects of an oral nutritional supplementation plus physical exercise ıntervention on the physical function, nutritional status, and quality of life in frail institutionalized older adults: The actıvnes study. J Am Med Dir Assoc. 2015; 16(5): 439.e9-16.
19. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017; 36(1): 49-64.
20. Beasley JM, Shikany JM, Thomson CA. The role of dietary protein intake in the prevention of sarcopenia of aging. Nutr Clin Pract. 2013; 28(6): 684-90.
21. Rahi B, Colombet Z, Gonzalez-Colaço Harmand M, Dartigues JF, Boirie Y, Letenneur L, et al. Higher protein but not energy ıntake ıs associated with a lower prevalence of frailty among community-dwelling older adults in the french three-city cohort. J Am Med Dir Assoc. 2016; 17(7): 627.e7-11.
22. Shikany JM, Barrett-Connor E, Ensrud KE, Cawthon PM, Lewis CE, Dam TT, et al. Macronutrients, diet quality, and frailty in older men. J Gerontol A Biol Sci Med Sci. 2014; 69(6): 695-701.
23. Schoufour JD, Franco OH, Kiefte-de Jong JC, Trajanoska K, Stricker B, Brusselle G, et al. The association between dietary protein intake, energy intake and physical frailty: results from the Rotterdam Study. Br J Nutr. 2019; 121(4): 393-401.
24. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009; 12(1): 86-90.
25. Bollwein J, Diekmann R, Kaiser MJ, Bauer JM, Uter W, Sieber CC, et al. Distribution but not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of Nürnberg. Nutr J. 2013; 12: 109-16
26. Liao CD, Chen HC, Huang SW, Liou TH. The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: a systematic review and meta-regression analysis of randomized trials. Nutrients. 2019; 11(8): 1713-26
27. Pennings B, Koopman R, Beelen M, Senden JM, Saris WH, van Loon LJ. Exercising before protein intake allows for greater use of dietary protein-derived amino acids for de novo muscle protein synthesis in both young and elderly men. Am J Clin Nutr. 2011; 93(2): 322-31.
28. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LC, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012; 13(8): 713-19.
29. Coelho-Junior HJ, Marzetti E, Picca A, Cesari M, Uchida MC, Calvani R. protein intake and frailty: a matter of quantity, quality, and timing. nutrients. 2020; 12(10): 2915-35.
30. Peng LN, Cheng YC, Yu PC, Lee WJ, Lin MH, Chen LK. Oral nutritional supplement with β-hydroxy-β-methylbutyrate (hmb) improves nutrition, physical performance and ameliorates intramuscular adiposity in pre-frail older adults: a randomized controlled trial. J Nutr Health Aging. 2021; 25(6): 767-73.
31. Wilhelm-Leen ER, Hall YN, Deboer IH, Chertow GM. Vitamin D deficiency and frailty in older Americans. J Intern Med. 2010; 268(2): 171-80.
32. Na W, Kim J, Kim H, Lee Y, Jeong B, Lee SP, et al. Evaluation of oral nutritional supplementation in the management of frailty among the elderly at facilities of community care for the elderly. Clin Nutr Res. 2021; 10(1): 24-35.
33. Gaillard C, Alix E, Sallé A, Berrut G, Ritz P. Energy requirements in frail elderly people: a review of the literature. Clin Nutr. 2007; 26(1): 16-24.
34. Vellas BJ, Hunt WC, Romero LJ, Koehler KM, Baumgartner RN, Garry PJ. Changes in nutritional status and patterns of morbidity among free-living elderly persons: a 10-year longitudinal study. Nutrition. 1997; 13(6): 515-19.
35. World Health Organization [Internet]. Medication safety in polypharmacy: technical report. [Son güncellenme tarihi 20 Haziran 2019; Erişim tarihi: 15 Mart 2022] Erişim adresi: https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11
36. Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf. 2015; 24(6): 637-46.
37. Saum KU, Schöttker B, Meid AD, Holleczek B, Haefeli WE, Hauer K, Brenner H. Is polypharmacy associated with frailty in older people? results from the Esther cohort study. J Am Geriatr Soc. 2017; 65(2): e27-32.
38. Jamsen KM, Bell JS, Hilmer SN, Kirkpatrick CM, Ilomäki J, Le Couteur D, et al. Effects of changes in number of medications and drug burden ındex exposure on transitions between frailty states and death: the concord health and ageing in men project cohort study. J Am Geriatr Soc. 2016; 64(1): 89-95.
39. Ki S, Yun JH, Lee Y, Won CW, Kim M, Kim CO, et al. Development of guidelines on the primary prevention of frailty in community-dwelling older adults. Ann Geriatr Med Res. 2021; 25(4): 237-44.
40. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Health Aging. 2019; 23(9): 771-87.
41. Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc. 2017; 18(7): 564-75.
42. You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, et al. Clinical practice guidelines for managing frailty in community-dwelling Korean elderly adults in primary care settings. Korean J Fam Med. 2021; 42(6): 413-24.