老年人多维度衰弱与内在能力的关联及 机制综述

Review on the Association and Mechanism between Multidimensional Frailty and Intrinsic Capacity in the Elderly

摘要: 多维度衰弱和内在能力是当前老年医学的两个重要概念，分别描述老年人的功能易损状态和功能储备情况。二者的评估方法有一定重叠，但其概念和关注重点有显著差异。现有研究证据发现，随着多种功能受损的持续累积，内在能力先出现异常减低，老年个体最终可能表现出多维度衰弱特征。营养状况、骨骼肌质量与功能、认知和心理状态、共病和药物负担等反映了两者的相互作用和关联。本文将内在能力与多维度衰弱进行整合，有助于动态理解老年人的功能变化过程，也为功能评估和干预思路提供了理论基础。但相关研究仍受到评估工具异质性、纵向研究证据不足以及心理社会因素常被忽视等问题的制约，未来有必要通过标准化评估和长期随访研究，更系统地刻画内在能力下降与多维度衰弱的动态演变过程。

Abstract: Multidimensional frailty and intrinsic capacity are two key concepts in contemporary geriatric medicine, describing the development of vulnerability and changes in physical functional reserve in the elderly, respectively. Although these two frameworks share partially overlapping assessment domains, they differ substantially in conceptual hierarchy and theoretical focus. Accumulating evidence suggests that with the progressive impairment of multiple functional domains, intrinsic capacity tends to decline earlier, whereas multidimensional frailty represents a later stage characterized by the accumulation of functional deficits. Within their overlapping domains, nutritional status, skeletal muscle mass and function, cognitive and psychological status, as well as comorbidity and medication burden constitute critical nodes through which intrinsic capacity and multidimensional frailty interact in real-world settings. From this perspective, integrating intrinsic capacity with multidimensional frailty allows for a more dynamic understanding of functional changes in the elderly and provides a theoretical framework for functional assessment and intervention planning. Nevertheless, existing research remains constrained by heterogeneity in assessment tools, a lack of longitudinal evidence, and the frequent underrepresentation of psychosocial factors. Future studies employing standardized assessments and long-term follow-up are needed to more systematically characterize the dynamic trajectory from intrinsic capacity decline to multidimensional frailty.