Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 174

Physical function (i.e., characteristics such as aerobic capacity, gait speed, balance, mobility, and muscle strength) is currently being proposed as a biomarker of healthy ageing in humans, predictive of adverse health events, disability, and mortality, in addition to tools commonly used as functional outcomes for clinical trials.³⁵ Recently, Ramirez‐Vélez et al.³⁶ showed that older adults with handgrip strength greater than the muscle weakness thresholds had lower odds of adverse events in most of the intrinsic capacity domains, as well as a lower hospitalisation rate (in men) than their weaker peers, adjusted for disease burden. Thus, multi‐morbidity, including cardiovascular disease, is not the most important factor modulating individual domains of intrinsic capacity (i.e., cognition and mental health, sensory function, metabolic rate, mobility, and muscle strength) responsible for functional decline and diminished ability to perform activities of daily living (ADLs). Moreover, physical performance measures, such as gait speed, predict mortality in older adults better than chronic diseases (e.g., hypertension), and preservation of functional capacity is now a primary focus for clinicians in the management of cardiovascular diseases, for example.^37,38 For these reasons, functional ability‐ retaining autonomy and independence as people age‐ is the cornerstone of healthy ageing, a term established by the WHO in its first world report on ageing and health.³⁹

From a clinical point of view, frailty has emerged as one of the most relevant clinical syndromes in geriatric medicine. This term relates to a distinctive ageing‐related health state in which multiple body systems gradually lose their in‐built capacity, resulting in decreased physiological reserves and resilience in the face of stressors.^40,41 Over the last few years, it has attracted increasing interest due to its direct relationship with adverse health effects such as physical and functional decline, institutionalisation,^42,43 disability, hospitalisation, poor quality of life, excess morbidity, and increased mortality.⁴⁴ Accordingly, an important conceptual idea for frailty is that the focus should be on functionality rather than the diagnosis of disease for older patients. Thus, improving or maintaining function becomes the ultimate mission for the medical care of older people. In addition, it has been shown that the best strategy is to prevent functional decline instead of trying to recover function once it has been lost.^5,45