老年共病衰弱相关免疫特征与护理管理进展
Advances in Frailty-Related Immune Features and Nursing Management in Older Adults with Multimorbidity
摘要: 老年共病患者衰弱的发生发展与免疫衰老、炎性衰老密切相关，随着年龄增长，免疫系统会发生改变，如免疫调节改变、应答能力变化以及慢性低度炎症被激活。这些免疫变化会与多种共病相互作用，加速机体功能衰退。上述机制往往会使得疾病负担相近的老年人群，在疾病进展和健康结局上存在差异，衰弱相关免疫特征可为理解其功能下降及健康结局的异质性提供补充生物学视角。本文围绕老年共病患者衰弱相关免疫特征、潜在机制及护理管理进展进行综述，并结合现有衰弱护理及老年共病护理管理相关证据分析其临床应用价值与边界。免疫炎症指标可作为评估衰弱及功能状态的辅助信息，其临床界值及独立决策价值尚不明确。护理管理应整合衰弱、功能、营养、多重用药及已有免疫炎症资料，通过运动、营养支持、用药管理、连续照护及动态复评实施个体化干预。衰弱相关免疫特征可为风险识别和个体化护理提供参考，为解释共病患者结局异质性提供新角度，尚不能替代标准化综合评估，也不宜作为独立的护理分层依据。
Abstract: The development and progression of frailty in older adults with multimorbidity are closely associated with immunosenescence and inflammaging. With increasing age, the immune system undergoes alterations, examples include modified immune regulation, altered response capacity, and the activation of chronic low-grade inflammation. These immune shifts can interact with multimorbidity, accelerating functional decline. These mechanisms tend to result in disparities in disease progression and health outcomes among older adults with similar disease burdens. Frailty-related immune characteristics can provide a complementary biological perspective for understanding functional decline and the heterogeneity of health outcomes in older adults with multimorbidity. In clinical practice, clinicians and nurses must account for individual patient care needs when interpreting and applying immune-related features. Older adults living with multimorbidity often present with coexisting frailty, nutritional deficits, and polypharmacy-related risks, which may influence each other during disease progression. For this reason, the interpretation of immune-inflammatory information requires integration with clinical characteristics and patient-centered assessments. Even so, existing studies have confirmed associations between immunosenescence, inflammaging and frailty as well as multimorbidity, discrepancies in measurement methods and biomarker selection limit the direct translation of these findings into clinical nursing practice. Further investigations can establish valid assessment strategies and elaborate practical pathways to embed immune-inflammatory data within nursing assessment and intervention workflows. This review examines frailty-related immune characteristics, potential mechanisms, and advances in nursing management among older adults with multimorbidity. Combined with available evidence on comprehensive frailty nursing assessment and nursing management for older adults with multimorbidity, it analyzes the clinical application value and boundaries of these contents. Current findings suggest that immunosenescence and inflammaging may contribute to frailty development through persistent inflammatory responses and related biological pathways. Such mechanisms can partly explain the heterogeneity of health outcomes in older adults with multimorbidity and provide a biological basis for understanding these differences. Immune-inflammatory indicators include inflammation-related biomarkers and immune-related biomarkers. They can serve as auxiliary clinical data for assessing frailty and functional status. However, their clinical boundaries, predictive accuracy, and independent value for clinical decision-making remain unclear. At present, immune-inflammatory indicators should neither be used as an independent basis for frailty assessment, nor as evidence for nursing assessment and nursing decision-making. Instead, frailty assessment results should be interpreted in combination with comprehensive evaluation and patients’ individual status. Several well-recognized authoritative existing scales cover multiple dimensions to identify at-risk populations and different frailty stages. Nursing management for older adults with multimorbidity requires comprehensive assessment and individualized intervention plans. Nurses should evaluate patients’ frailty status, physical function, nutritional status, polypharmacy status and immune-inflammatory indicators to formulate nursing plans. Nurses should adjust and implement exercise, nutritional support and polypharmacy management protocols according to patients’ nursing needs, with regular and dynamic reassessment. Continuous monitoring and individualized nursing management can maintain the physical function of older adults with multimorbidity, and improve nursing quality as well as the continuity of nursing services. To sum up, frailty-related immune characteristics can provide references for risk identification and individualized nursing, and offer a new perspective for explaining the heterogeneity of health outcomes among older adults with multimorbidity. However, existing evidence does not justify replacing standardized full-scale assessment with immune-related biomarkers, and such characteristics cannot be used as independent indicators for frailty evaluation or nursing stratification. Subsequent work needs to further explore how immune alterations relate to frailty development and progression, and how these findings can be translated into clinical practice. Researchers also ought to pinpoint target immune-inflammatory markers together with their clinically feasible cut-off points, and work out viable strategies to embed immune-derived data within evidence-based nursing workflows.
文章引用：王梦婷, 邵圣文. 老年共病衰弱相关免疫特征与护理管理进展[J]. 护理学, 2026, 15(10): 71-79. https://doi.org/10.12677/ns.2026.1510328

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