以质量求发展，以服务铸品牌

护理学报 ›› 2025, Vol. 32 ›› Issue (2): 50-55.doi: 10.16460/j.issn1008-9969.2025.02.050

• 循证护理 • 上一篇    下一篇

老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析

刘硕怡1,2, 熊莉娟1, 李凌1, 王玉梅1, 何嘉1, 李鑫1, 袁淑蕾1, 郭雪琴1, 王暘婧1, 张慧娟1,2   

  1. 1.华中科技大学同济医学院附属协和医院,湖北 武汉 430022;
    2.长江大学医学部,湖北 荆州 434023
  • 收稿日期:2024-05-07 出版日期:2025-01-25 发布日期:2025-02-20
  • 通讯作者: 熊莉娟（1968-）,女,湖北武汉人,本科学历,主任护师,硕士研究生导师。E-mail: xhxlj@126.com
  • 作者简介:刘硕怡（2001-）,女,陕西西安人,本科学历,硕士研究生在读。
  • 基金资助:
    华中科技大学同济医学院护理学院2023年自主创新面上项目（ZZCX2023X002）; 华中科技大学同济医学院护理学院 2022年自主创新项目（ZZCX2022014）; 华中科技大学同济医学院护理学院2022年教学研究项目（HL202205）

Quality evaluation and content analysis of clinical practice guidelines for prevention and management of frailty in elderly hospitalized patients

LIU Shuo-yi1,2, XIONG Li-juan1, LI Ling1, WANG Yu-mei1, HE Jia1, LI Xin1, YUAN Shi-lei1, GUO Xue-qin1, WANG Yang-jing1, ZHANG Hui-juan1,2   

  1. 1. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
    2. Health Science Center, Yangtze University, Jingzhou 434023, China
  • Received:2024-05-07 Online:2025-01-25 Published:2025-02-20

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摘要： 目的 对老年住院患者衰弱预防及管理临床实践指南进行质量评价和内容分析,为老年住院患者衰弱预防及管理提供依据。方法 计算机检索国内外指南网站、相关学会网站及中英文数据库,检索时限为建库至2024年3月,根据纳入排除标准对文献进行筛选。并采用指南质量评价工具（Appraisal of Guidelines Research and Evaluation Ⅱ,AGREE Ⅱ）对指南进行质量评价及内容分析。结果 初次检索到2 765篇文献,经过筛选,最终纳入9部指南进行评价。其中,4部指南为A级（高质量）,5部为B级（中等质量）。分析归纳出涵盖筛查、评估、运动、营养、药物治疗、多学科、健康教育、社会支持、管理与监测等9个方面的35项具体推荐内容。结论 老年住院患者衰弱预防及管理相关指南整体质量较高,但在细节严谨性、实际可操作性及独立性方面存在不足,部分推荐意见缺乏针对性。有待开发适用于我国的老年住院患者衰弱预防及管理循证指南,以指导临床工作,提升患者护理质量。

关键词: 老年, 住院患者, 衰弱, 指南, 质量评价, 循证护理学

Abstract: Objective To conduct a quality evaluation and content analysis of clinical practice guidelines for the prevention and management of frailty in elderly hospitalized patients, and to provide reference for the prevention and management of frailty in this population. Methods Computer retrieval in domestic and international guideline websites, related society websites and Chinese and English databases was conducted, with the search period ranging from the inception to March 2024. The literature was screened according to the inclusion and exclusion criteria. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) was used to assess the quality of the guidelines, and the content of the guidelines was analyzed. Results Initial retrieval identified 2,765 articles, from which 9 guidelines were ultimately selected for the evaluation. Among these, 4 guidelines were categorized as grade A (high quality) and 5 as grade B (moderate quality). Totally 35 specific recommendations encompassing screening, assessment, exercise, nutrition, drug therapy, multidisciplinary approaches, health education, social support, management and monitoring were yielded. Conclusion The overall quality of the guidelines related to the prevention and management of frailty in elderly hospitalized patients is relatively high. However, there are deficiencies in terms of rigorous details, practical operability and independence, and some recommendations lack specificity. There is a need to develop evidence-based guidelines suitable for the prevention and management of frailty in elderly hospitalized patients in China, to guide clinical work and improve the quality of patient care.

Key words: elderly, hospitalized patient, frailty, guideline, quality assessment, evidence-based nursing

中图分类号: 

  • R473.59
[1] 杨晓奇. 积极应对人口老龄化国家战略与发展老龄经济[J].老龄科学研究,2021,9(3):1-12. DOI:10.3969/j.issn.2095-5898.2021.03.002.
[2] Wang X, Hu J, Wu D.Risk factors for frailty in older adults [J]. Medicine (Baltimore), 2022,101(34):e30169. DOI:10.1097/MD.0000000000030169.
[3] He B, Ma Y, Wang C, et al.Prevalence and risk factors for frailty among community-dwelling older people in China: a systematic review and Meta-analysis[J].J Nutr Health Aging, 2019,23(5):442-450. DOI:10.1007/s12603-019-1179-9.
[4] 沈妍交,曹立,郝秋奎,等.老年病科住院患者衰弱状况及其影响因素[J].中国老年学杂志,2019, 39(24):6117-6120. DOI:10.3969/j.issn.1005-9202.2019.24.067.
[5] 陶代娣. 老年住院共病患者衰弱状况及其危险因素研究[D]. 合肥:安徽医科大学,2022.
[6] 赵梦. 养老机构老年人衰弱识别及影响因素的纵向研究[D]. 济南:山东大学,2020.
[7] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[8] 颜红艳. 基于循证构建老年肝癌患者围手术期运动管理方案[D]. 成都:电子科技大学,2023.
[9] 肖星婷,王娴,王燕,等.乳腺癌患者化疗所致脱发预防及护理的证据总结[J].中华护理杂志,2021,56(7):1072-1078. DOI:10.3761/j.issn.0254-1769.2021.07.020.
[10] Yang TH, Ziemba R, Shehab N, et al.Assessment of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code assignment validity for case finding of medication-related hypoglycemia acute care visits among Medicare beneficiaries[J]. Med Care, 2022,60(3):219-226. DOI:10.1097/MLR.0000000000001682.
[11] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010,182(18):E839-E842. DOI:10.1503/cmaj.090449.
[12] 明州彦. 养老机构脑卒中吞咽障碍患者营养风险管理循证护理实践方案的构建及应用[D]. 南宁:广西中医药大学,2023.
[13] Amer YS, Anabrees J, Abdelmawla M, et al.Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: a systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument[J]. Front Pediatr,2023(11):1092578.DOI:10.3389/fped.2023.1092578.
[14] 周芬,郝玉芳,丛雪,等.指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J].护理学报,2018,25(18):56-58.DOI:10.16460/j.issn1008-9969.2018.18.056.
[15] 任宣霖,樊落,田金徽,等. ICU气管插管患者拔管指南的质量评价与内容分析[J].中华护理杂志,2022,57(8):1001-1007. DOI:10.3761/j.issn.0254-1769.2022.08.017.
[16] Bennett RJ, Taljaard DS, Olaithe M, et al.Evaluating random error in clinician-administered surveys: theoretical considerations and clinical applications of interobserver reliability and agreement[J]. Am J Audiol, 2017,26(3):191-201. DOI:10.1044/2017_AJA-16-0100.
[17] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[18] Buchebner D, Bartosch P, Malmgren L, et al.Association between vitamin D, frailty, and progression of frailty in community-dwelling older women[J]. J Clin Endocrinol Metab, 2019,104(12):6139-6147. DOI:10.1210/jc.2019-00573.
[19] British Columbia. (2017). Frailty in older adults -early identification and management[EB/OL].[2017-10-27]. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc guidelines/frailty-full_guideline.pdf.
[20] Marcucci M, Damanti S, Germini F, et al.Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines[J]. BMC Med, 2019,17(1):193. DOI:10.1186/s12916-019-1434-2.
[21] Fairhall N, Langron C, Sherrington C, et al.Treating frailty-a practical guide[J]. BMC Med, 2011(9):83. DOI:10.1186/1741-7015-9-83.
[22] NICE. Dementia, disability and frailty in later life-mid-life approaches to delay or rrevent onset?[EB/OL].[2015-10-20]. https://www.nice.org.uk/guidance/ng16.
[23] Dent E, Lien C, Lim WS, et al.The Asia-Pacific clinical practice guidelines for the management of frailty[J]. J Am Med Dir Assoc, 2017,18(7):564-575. DOI:10.1016/j.jamda.2017.04.018.
[24] Dent E, Morley JE, Cruz-Jentoft AJ, et al.Physical frailty: ICFSR international clinical practice guidelines for identification and management[J]. J Nutr Health Aging, 2019,23(9):771-787. DOI:10.1007/s12603-019-1273-z.
[25] Mackei D.Guidelines on physical activity for older people (aged 65 years and over) [EB/OL]. [2013-01-10].https://www.health.govt.nz/publication/guidelines-physical-activity-older-people-aged-65-years-and-over.
[26] Ruiz JG, Dent E, Morley JE, et al.Screening for and managing the person with frailty in primary care: ICFSR consensus guidelines[J]. J Nutr Health Aging, 2020,24(9):920-927. DOI:10.1007/s12603-020-1492-3.
[27] Lorbergs AL, Prorok JC, Holroyd-Leduc J, et al.Nutrition and physical activity clinical practice guidelines for older adults living with frailty[J]. J Frailty Aging, 2022,11(1):3-11. DOI:10.14283/jfa.2021.51.
[28] 林卫,陈宁园.2020年《ICFSR初级保健中衰弱的筛查和管理指南》解读及对我国初级保健衰弱管理的启示[J].中国老年保健医学,2021,19(5):30-34. DOI:10.3969/j.issn.1672-2671.2021.05.009.
[29] 郑璐芳. 《老年衰弱管理实践指南》的构建与转化研究[D]. 长春:吉林大学,2023.
[30] Zhang Y, Coello PA, Brożek J, et al.Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach[J].Health Qual Life Outcomes, 2017,15(1):52. DOI:10.1186/s12955-017-0621-0.
[31] Tringale M, Stephen G, Boylan AM, et al.Integrating patient values and preferences in healthcare: a systematic review of qualitative evidence[J]. BMJ Open, 2022,12(11):e067268. DOI:10.1136/bmjopen-2022-067268.
[32] Schünemann HJ, Al-Ansary LA, Forland F, et al.Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines[J]. Ann Intern Med,2015,163(7):548-553. DOI:10.7326/M14-1885.
[33] Gundersen L.The effect of clinical practice guidelines on variations in care[J]. Ann Intern Med, 2000,133(4):317-318. DOI:10.7326/0003-4819-133-4-200008150-00102.
[34] 程湘玮,王培红,屠凤鸣,等.妊娠期糖尿病产妇分娩的新生儿血糖管理审查指标的制订及障碍因素分析[J].中华护理杂志,2020,55(10):1497-1502. DOI:10.3761/j.issn.0254-1769.2020.10.009.
[35] Zhang L, Ma L, Sun F, et al.A multicenter study of multimorbidity in older adult inpatients in China[J]. J Nutr Health Aging, 2020,24(3):269-276. DOI:10.1007/s12603-020-1311-x.
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