Önlenebilir ve Tedavi Edilebilir Bir Geriatrik Sendrom Olarak Kırılganlık: Patofizyoloji, Risk Faktörleri ve Hipertansiyonu ve Diyabetli Yaşlı Yetişkinlerde Yönetimi

Öz

Kırılganlık, azalmış fizyolojik rezervler ve stres etkenlerine karşı duyarlılığın artması ile karakterize, dinamik ve çok etkenli bir geriatrik sendromdur. Bu sendrom; fonksiyon kaybı, hastaneye yatış, bağımlılık ve mortalite gibi çeşitli olumsuz klinik sonuçlarla ilişkilidir. Yaşla birlikte görülme sıklığı artmakla birlikte, kırılganlık doğal yaşlanma sürecinden bağımsız bir durumdur ve erken dönemde uygulanacak müdahalelerle önlenebilir ya da geri döndürülebilir. Kırılganlığın gelişiminde; multimorbidite, malnütrisyon, bilişsel gerileme, polifarmasi ve sedanter yaşam tarzı gibi çeşitli risk faktörleri rol oynamaktadır. Altta yatan patofizyolojik süreçler arasında kronik inflamasyon, nöroendokrin yanıtın bozulması, sarkopeni ve immün yetmezlik yer almaktadır. Kırılganlığın değerlendirilmesine yönelik, fiziksel fenotipe ya da sağlıkla ilişkili yetersizliklerin birikimine dayalı çeşitli ölçme araçları mevcuttur. Bu değerlendirme yöntemleri, klinik karar alma süreçlerini desteklemekte ve bireye özgü tedavi planlamasının yapılandırılmasına katkı sağlamaktadır. Kırılganlığın etkin yönetimi, bireyselleştirilmiş bakım yaklaşımlarını esas alan multidisipliner bir yaklaşımı zorunlu kılmaktadır. Bu süreçte erken tanı, uygun beslenme ve fiziksel aktivite gibi önleyici stratejilerin uygulanması ile farmakolojik tedavilerin dikkatli şekilde düzenlenmesi temel unsurlar arasında yer alır. Özellikle diabetes mellitus ve hipertansiyon gibi eşlik eden komorbiditelerin varlığında, farmakoterapötik müdahalelerin daha titiz bir biçimde planlanması gerekmektedir.

Anahtar Kelimeler

• Yaşlı Erişkin
• Hipertansiyon
• Kırılganlık
• Diabetes Mellitus

Frailty as a Preventable and Treatable Geriatric Syndrome: Pathophysiology, Risk Factors, and Management in Older Adults with Hypertension and Diabetes Mellitus

Öz

Frailty is a dynamic and multifactorial geriatric syndrome characterized by decreased physiological reserves and reduced resilience to stressors, leading to adverse outcomes such as disability, hospitalization, dependency, and mortality. Although its prevalence increases with age, frailty is distinct from the natural aging process and can be prevented or reversed through early interventions. Risk factors include multimorbidity, malnutrition, cognitive decline, polypharmacy, and sedentary lifestyle. Pathophysiological mechanisms involve chronic inflammation, neuroendocrine dysregulation, sarcopenia, and immune dysfunction. Various frailty assessment tools exist, based on physical phenotype or accumulation of deficits, aiding in clinical decision-making and treatment planning. Management requires a multidisciplinary approach focused on individualized care, early detection, prevention strategies such as nutrition and exercise, and careful pharmacologic interventions-especially in the presence of comorbidities like diabetes mellitus and hypertension. Understanding frailty as a preventable and treatable syndrome highlights the importance of comprehensive geriatric assessments and proactive healthcare strategies in aging populations.

Anahtar Kelimeler

• Older Adults
• Hypertension
• Diabetes Mellitus
• Frailty

Kaynakça

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