Definiert das Alter den geriatrischen Patienten?

Zusammenfassung

Ältere Menschen stellen einen wachsenden Anteil unserer täglich medizinisch und chirurgisch zu versorgenden Patienten dar. Allerdings definiert das kalendarische Alter alleine den älteren Patienten nur unzureichend. Vielmehr scheint das biologische Alter oder das Maß an Gebrechlichkeit entscheidend für die Charakterisierung zu sein. Auch der Prozentsatz der Menschen, die gebrechlich sind, ist in den letzten Jahrzehnten stetig gestiegen. Gebrechlichkeit oder Frailty ist ein geriatrisches Syndrom, welches durch verringerte physische und psychische Reserven zur Kompensation gekennzeichnet ist. Die beiden am häufigsten genutzten Ansätze zur Definition von Gebrechlichkeit sind der phänotypische Ansatz und der Ansatz der Defizitakkumulation. Für ältere Patienten haben sich in diesem Zusammenhang 2 Interventionspunkte in der klinischen Praxis herauskristallisiert: 1. die präinterventionelle/operative Identifizierung von Hochrisikopatienten, um sowohl die Patientenerwartungen als auch die chirurgische Entscheidungsfindung zu steuern, und 2. periinterventionelle/operative Optimierungsstrategien für gebrechliche Patienten. Noch fehlt ein mit vertretbarem Zeitaufwand in der klinischen Praxis umsetzbarer, objektiver Goldstandard zur Analyse der Frailty.

Abstract

Whereas the proportion of elderly patients is increasing, age by itself is not a good parameter to characterize this population. Instead, the biological age or frailty seems to be more relevant. The percentage of frail people is increasing in our society as well. Frailty as a geriatric syndrome is characterized by a reduced physical and psychical coping reserve. It can be defined phenotypically or by the accumulation of deficits. In the clinical practice, frailty seems to be important within two intervention points: 1. the preinterventional/-operative identification of high-risk patients to clarify the patientʼs expectations and the interventional decisions and 2. to optimize the intervention itself. Unfortunately, a gold standard of frailty assessment in the clinical practice does not exist.

Was ist wichtig?

Mit der steigenden Lebenserwartung steigt auch das Alter der zu versorgenden Patienten. Insbesondere bei über 70-Jährigen scheint weniger das kalendarische Alter, sondern die Gebrechlichkeit den Patienten zu definieren, obwohl ein einheitlicher Goldstandard zur Bestimmung der Gebrechlichkeit noch fehlt.

Schlüsselwörter

biologisches Alter - Gebrechlichkeit - kalendarisches Alter - präinterventionelle Analytik

Key words

calendar age - biological age - frailty - preinterventional analytics

Publication History

Article published online:
22 October 2020

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