PDF(Pubmed)
Abstract：
Globally, more people are living into advanced old age, with age-associated frailty, disability and multimorbidity. Achieving equity for all ages necessitates adapting healthcare systems. Clinical practice guidelines (CPGs) have an important place in adapting evidence-based medicine and clinical care to reflect these changing needs. CPGs can facilitate better and more systematic care for older people. But they can also present a challenge to patient-centred care and shared decision-making when clinical and/or socioeconomic heterogeneity or personal priorities are not reflected in recommendations or in their application. Indeed, evidence is often lacking to enable this variability to be reflected in guidance. Evidence is more likely to be lacking about some sections of the population. Many older adults are at the intersection of many factors associated with exclusion from traditional clinical evidence sources with higher incidence of multimorbidity and disability compounded by poorer healthcare access and ultimately worse outcomes. We describe these challenges and illustrate how they can adversely affect CPG scope, the evidence available and its summation, the content of CPG recommendations and their patient-centred implementation. In all of this, we take older adults as our focus, but much of what we say will be applicable to other marginalised groups. Then, using the established process of formulating a CPG as a framework, we consider how these challenges can be mitigated, with particular attention to applicability and implementation. We consider why CPG recommendations on the same clinical areas may be inconsistent and describe approaches to ensuring that CPGs remain up to date.
摘要：
全球范围内,越来越多的人生活在老年，与年龄相关的脆弱，残疾和多重性。实现所有年龄段的公平需要调整医疗保健系统。临床实践指南（CPG）在适应循证医学和临床护理以反映这些不断变化的需求方面具有重要地位。CPG可以促进对老年人的更好和更系统的护理。但是，当临床和/或社会经济异质性或个人优先事项未反映在建议或应用中时，它们也可能对以患者为中心的护理和共同决策提出挑战。的确,通常缺乏证据来使这种可变性反映在指导中。更有可能缺乏有关某些部分人口的证据。许多老年人处于与排除传统临床证据来源相关的许多因素的交汇点，多发病率和残疾的发生率更高，医疗服务更差，最终结果更差。我们描述了这些挑战，并说明了它们如何对CPG范围产生不利影响，现有证据及其总结，CPG建议的内容及其以患者为中心的实施。在这一切中,我们把老年人作为我们的焦点，但是我们所说的大部分内容将适用于其他边缘化群体。然后，利用制定CPG的既定过程作为框架，我们考虑如何缓解这些挑战，特别注意适用性和实施。我们考虑了为什么在相同临床领域的CPG建议可能不一致，并描述了确保CPG保持最新的方法。
