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Duas formas diferentes de pensar face ao idoso : multimorbilidade e fragilidade
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O envelhecimento populacional, que se expressa num aumento absoluto e relativo de indivíduos idosos, é uma realidade dos dias de hoje, em todo o mundo.
O envelhecimento caracteriza-se pelo desenvolvimento de múltiplas condições crónicas, pelo que os indivíduos de faixas etárias mais avançadas constituem um grupo heterogéneo com uma crescente complexidade clínica associada.
Atualmente, compreende-se que a abordagem aos indivíduos idosos constituiu um novo desafio à prática clínica, uma vez que a idade cronológica se revela insuficiente na avaliação do perfil de risco. Tal, constitui uma limitação significativa à tomada de decisões clínicas e ao estabelecimento de intervenções.
Ao longo das últimas décadas, foram surgindo diferentes modelos com o intuito de responder à problemática da gestão do envelhecimento com um grau crescente de complexidade.
Entre vários modelos destacam-se a Multimorbilidade e a Fragilidade. Os mesmos correspondem a diferentes conceitos ou condições clínicas, embora ambos se relacionem com a idade avançada e estejam correlacionados.
A Multimorbilidade compreende a coexistência de 2 ou mais doenças crónicas que se manifestem clinicamente. A Fragilidade identifica o aumento de vulnerabilidade face a um agente agressor, sendo a mesma constatada através de diferentes instrumentos, tais como o Índice de Fragilidade e o Fenótipo de Fragilidade.
O objetivo do presente trabalho é explorar os conceitos de Multimorbilidade e Fragilidade e procurar refletir, de forma crítica, acerca da aplicação prática na abordagem clínica de indivíduos idosos.
A forma de pensar sobre o idoso deve integrar a Multimorbilidade e a Fragilidade numa só visão, permitindo-nos tomar decisões clínicas mais informadas, de melhor qualidade e que sirvam os melhores interesses dos indivíduos idosos.
Population aging, expressed in an absolute and relative increase of elderly individuals, is a reality, all over the world. Aging is characterized by the development of multiple chronic conditions, so individuals of more advanced age groups constitute a heterogeneous group with an increasing associated clinical complexity. Currently, it is understood that the approach to the elderly individuals presents a new challenge to the clinical practice, since the chronological age is insufficient for the evaluation of the risk profile. This represents a significant constraint to clinical decision-making and intervention processes. Over the last decades, different models have emerged to respond to the aging management problem with an increasing degree of complexity. Among several models, Multimorbidity and Frailty stand out. They correspond to different concepts or clinical conditions, although both relate to old age and are correlated themselves. Multimorbidity comprises the coexistence of two or more chronic diseases that clinically manifested. Frailty identifies the increase of vulnerability to an aggressor agent, being verified through different instruments, such as the Frailty Index and the Frailty Phenotype. The objective of the present work is to explore the concepts of Multimorbidity and Frailty and aiming to reflect critically on the practical application in the clinical approach of elderly individuals. The way of thinking about the elderly should combine Multimorabidity and Frailty in a single vision, allowing us to make clinical decisions more informed, with better quality, that serve the best interests of the elderly.
Population aging, expressed in an absolute and relative increase of elderly individuals, is a reality, all over the world. Aging is characterized by the development of multiple chronic conditions, so individuals of more advanced age groups constitute a heterogeneous group with an increasing associated clinical complexity. Currently, it is understood that the approach to the elderly individuals presents a new challenge to the clinical practice, since the chronological age is insufficient for the evaluation of the risk profile. This represents a significant constraint to clinical decision-making and intervention processes. Over the last decades, different models have emerged to respond to the aging management problem with an increasing degree of complexity. Among several models, Multimorbidity and Frailty stand out. They correspond to different concepts or clinical conditions, although both relate to old age and are correlated themselves. Multimorbidity comprises the coexistence of two or more chronic diseases that clinically manifested. Frailty identifies the increase of vulnerability to an aggressor agent, being verified through different instruments, such as the Frailty Index and the Frailty Phenotype. The objective of the present work is to explore the concepts of Multimorbidity and Frailty and aiming to reflect critically on the practical application in the clinical approach of elderly individuals. The way of thinking about the elderly should combine Multimorabidity and Frailty in a single vision, allowing us to make clinical decisions more informed, with better quality, that serve the best interests of the elderly.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Envelhecimento Fragilidade Multimorbilidade