Delirium and frailty in older adults: Clinical overlap and biological underpinnings

IF 9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2024-10-01 DOI:10.1111/joim.20014
Giuseppe Bellelli, Federico Triolo, Maria Cristina Ferrara, Stacie G. Deiner, Alessandro Morandi, Matteo Cesari, Daniel Davis, Alessandra Marengoni, Marco Inzitari, Leiv Otto Watne, Kenneth Rockwood, Davide Liborio Vetrano
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Abstract

Frailty and delirium are two common geriatric syndromes sharing several clinical characteristics, risk factors, and negative outcomes. Understanding their interdependency is crucial to identify shared mechanisms and implement initiatives to reduce the associated burden. This literature review summarizes scientific evidence on the complex interplay between frailty and delirium; clinical, epidemiological, and pathophysiological commonalities; and current knowledge gaps. We conducted a PubMed systematic search in June 2023, which yielded 118 eligible articles out of 991. The synthesis of the results—carried out by content experts—highlights overlapping risk factors, clinical phenotypes, and outcomes and explores the influence of one syndrome on the onset of the other. Common pathophysiological mechanisms identified include inflammation, neurodegeneration, metabolic insufficiency, and vascular burden. The review suggests that frailty is a risk factor for delirium, with some support for delirium associated with accelerated frailty. The proposed unifying framework supports the integration and measurement of both constructs in research and clinical practice, identifying the geroscience approach as a potential avenue to develop strategies for both conditions. In conclusion, we suggest that frailty and delirium might be alternative—sometimes coexisting—manifestations of accelerated biological aging. Clinically, the concepts addressed in this review can help approach older adults with either frailty or delirium from a different perspective. From a research standpoint, longitudinal studies are needed to explore the hypothesis that specific pathways within the biology of aging may underlie the clinical manifestations of frailty and delirium. Such research will pave the way for future understanding of other geriatric syndromes as well.

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老年人的谵妄和虚弱:临床重叠与生物学基础。
虚弱和谵妄是两种常见的老年综合征,它们具有一些共同的临床特征、风险因素和不良后果。了解它们之间的相互依存关系对于确定共同机制和实施减轻相关负担的措施至关重要。本文献综述总结了有关虚弱与谵妄之间复杂相互作用的科学证据、临床、流行病学和病理生理学共性以及当前的知识空白。我们于 2023 年 6 月在 PubMed 上进行了系统检索,从 991 篇文章中筛选出 118 篇符合条件的文章。由内容专家对结果进行了综合,突出了重叠的风险因素、临床表型和结果,并探讨了一种综合征对另一种综合征发病的影响。发现的共同病理生理机制包括炎症、神经变性、代谢不足和血管负担。综述表明,虚弱是导致谵妄的一个风险因素,并在一定程度上支持谵妄与加速虚弱有关。所提出的统一框架支持在研究和临床实践中整合和测量这两个概念,并将全球科学方法确定为针对这两种情况制定策略的潜在途径。总之,我们认为虚弱和谵妄可能是生物衰老加速的另一种表现形式,有时甚至是并存的表现形式。在临床上,本综述所涉及的概念有助于从不同的角度来看待患有虚弱或谵妄的老年人。从研究的角度来看,需要进行纵向研究,以探讨衰老生物学中的特定途径可能是虚弱和谵妄临床表现的基础这一假设。此类研究将为今后了解其他老年综合症铺平道路。
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来源期刊
Journal of Internal Medicine
Journal of Internal Medicine 医学-医学:内科
CiteScore
22.00
自引率
0.90%
发文量
176
审稿时长
4-8 weeks
期刊介绍: JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.
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