- 學位論文
Study of Osteoporotic Fractures(SOF)衰弱量表的信效度驗證－以臺灣社區長者及獨居長者分別探討
The Validity and Reliability of Osteoporotic Fractures(SOF) scale：Cases of the Elderly Living in Community and Elderly Persons Living Alone in Taiwan
摘要
研究背景與目的: 在人口高齡化及失能比例增加的影響下，為了延緩長者失能時間以降低醫療服務的支出，WHO於2002年提出活躍老化的概念強調維持長者健康為重要的課題。臺灣長期照顧十年計劃2.0政策也擴大服務對象至衰弱長者，受到衰弱目前沒有統一的定義影響，發展出不同的衰弱評估量表，其中長照2.0政策公布是使用Study of Osteoporotic Fractures (SOF)量表進行社區衰弱篩檢。然而，此量表尚未有研究證實可有效的評估臺灣社區長者。本研究目的將以較普及的Fried’s Frailty Phenotype量表作為黃金量表，驗證SOF量表是否可有效評估臺灣的社區長者。除此之外，因考量到獨居長者在心理健康及社會支持方面與一般社區長者有差異，所以也進一步探討獨居長者與一般社區長者在不同的評估量表是否有差異。 研究方法: 本研究採橫斷性問卷調查，以立意取樣的形式進行收案；收案對象分別為臺北市南港區65歲以上的一般社區長者369位及列冊關懷獨居長者102位。資料分析分為三個部分(1)將Fried’s Frailty Phenotype量表為黃金量表，以斯皮爾曼等級相關係數（Spearman’s Rank Correlation Coefficient）驗證SOF量表的同時效度。(2)將兩種量表與IADL失能及跌倒以AUC及複迴歸進行預測效度的驗證。(3)以卡方檢定、多元邏輯斯迴歸分析 (Multiple logistic regression analysis)比較一般社區長者與獨居長者在控制共變數後兩種量表的結果，並探討獨居長者適用於哪一種評估工具。 研究結果: 使用Fried’s Frailty Phenotype量表評估為衰弱的長者佔10.6%、衰弱前期的長者佔57.7%；使用SOF量表評估為衰弱的長者佔8.1%、衰弱前期的長者佔36.3%。以Fried’s Frailty Phenotype量表為黃金量表時，與SOF量表之間達中度相關 (r =0.510 , p <0.001)。兩種量表對於失能及跌倒的結果沒有一致的方向顯是哪一種量表有較好的鑑別度。在使用AUC分析結果顯示SOF量表預測跌倒的鑑別力較佳(AUCSOF=0.657,AUC Fried’s Frailty Phenotype =0.642, p <0.001 )，Fried’s Frailty Phenotype量表預測IADL失能的鑑別力較佳(AUCSOF=0.657,AUC Fried’s Frailty Phenotype =0.642, p <0.001)。以獨居長者及一般社區長者比較在兩種量表的結果，顯示兩族群在不同量表評估結果有差異(p <0.001)，兩族群在Fried’s Frailty Phenotype量表的差異較以SOF量表評估結果大，代表在控制共變數後，無論使用哪個量表，獨居長者皆比一般社區長者有較高的風險進入衰弱或衰弱前期。(Fried’s Frailty Phenotype：OR衰弱前期=0.309,p <0.001; OR衰弱=0.092,p <0.001。SOF：OR衰弱前期=1.185,p =0.707; OR衰弱=0.304,p =0.002)。透過預測跌倒及失能的結果顯示Fried’s Frailty Phenotype較能偵測獨居長者發生跌倒及失能的風險，所以獨居長者較適合使用Fried’s Frailty Phenotype(AUC跌倒=0.688；AUC失能=0.676)。 結論與建議: SOF量表可以作為有效評估臺灣社區長者衰弱的工具，但獨居長者較適合使用fried等人提出的量表。本研究結果支持政策上使用SOF量表進行臺灣社區長者的衰弱篩檢。另一方面，本研究結果發現生理指標為社區長者及獨居長者最常見的衰弱指標，因此建議可以在評估社區長者時，除了使用SOF 量表也加入「緩慢」；獨居長者方面，建議也加入「緩慢」及「虛弱」指標進行評估。隨著預防失能的議題受到重視，以有效的評估工具進行衰弱篩檢才可提供預防及失能服務提供給最需要的族群。
並列摘要
Background and purpose：Disability have become a critical issue in Taiwan due to the rapidly growing aging population. In 2002, WHO introduced the concept of active aging as well as emphasizing the importance of disability prevention for the elderly. Taiwan’s Ten-Year Long-Term Care 2.0 policy has also expanded long-term care service to the older adults with frailty, in order to prevent further disability. However, the tools for measuring frailty remains controversial, especially in Taiwan. It is more common in the world to use Fried’s Frailty Phenotype index to measure frailty. However, Taiwanese governments use the Study of Osteoporotic Fractures index (SOF index) to assess the degree of frailty for the purpose of easy application. The purpose of this study was to assess and compare the tool properties of the SOF index and the Fried’s Frailty Phenotype index in general community-dwelling older adulating living in Nai-King communities in Taiwan. In addition, since previous studies have indicated that older adults living alone may be lack of social support, and therefore may be with poor mental health comparing to other community-dwelling older adults. Thus, the present study also intended to discuss whether there were different assessment results between the group of older adults living alone and community-dwelling older adults when using the two frailty scales. Method：This study was a cross-sectional survey study and the data was collected using purposive sampling. We collected 369 general community-dwelling older adults and 102 older adults who were living alone from Nangang District of Taipei City. All participants were above 65 years old. For data analysis, (1) Spearman’s Rank Correlation Coefficient was adopted to understand the association between frailty as measured by the Fried’s Frailty Phenotype index and the SOF index. (2) Area under the curve (AUC) analysis and multiple regression analysis were used to test respective models by measuring the predictive validity of fall and IADL disability from Frailty Phenotype index and SOF index. (3) Chi-square test and multiple logistic regression analysis were applied to evaluate the applicable index for elderly who lives alone. Results：Using the Fried’s Frailty Phenotype index, 10.6% and 57.7% of the overall participants were assessed as frail and prefrail respectively. Using the SOF index, 8.1% and 36.3% were assessed as frail and prefrail respectively. The Spearman’s Rank Correlation Coefficient showed moderate association (r = 0.510, p < 0.001) between the Fried’s Frailty Phenotype index and the SOF index. However, these two frailty indexes were inconsistent with their ability to predict fall and disability. Besides, this study also compares with the difference between the older adults who lived alone and the community-dwelling older adults. The result of AUC showed that the SOF predicted fall better (AUCSOF=0.657, AUC Fried’s Frailty Phenotype =0.642, p <0.001) and the Fried’s Frailty Phenotype index predicted IADL disability better (AUCSOF=0.657, AUC Fried’s Frailty Phenotype =0.642, p <0.001). With covariates included, using the Fried’s Frailty Phenotype index showed that older adults who were living alone had a higher risk of becoming prefrail (OR prefrail = 0.309, p <0.001) and frail (OR frailty = 0.092, p <0.001) when compared to the general community-dwelling older adults. However, using the SOF index showed that older adults who were living along had an equal risk of becoming prefrail (OR prefrail = 1.185, p = 0.707) and higher risk of becoming frail (OR frailty = 0.304, p < 0.001) comparing to the general community-dwelling older adults. Moreover, the AUC comparisons revealed Fried’s Frailty Phenotype index is more sensitive to predict the risk of fall and disability (AUC fall = 0.688; AUC disability =0.676). Therefore, people who live alone suitable for using Fried’s Frailty Phenotype index to evaluate their frailty status. Conclusions and recommendations：We found that the SOF index is a validated tool to evaluate frailty especially for general community-dwelling older adults in Taiwan. However, the Fried’s Frailty Phenotype index is more sensitive for the elderly who lived alone. Our study findings support the long-term care policy which used the SOF index to screen and measure frailty regulations by the Taiwanese governments. We recommend that the SOF index and indicators of slowness should be combined used for measuring the status of frailty among older adults who live in the community. In addition, we also recommend that the SOF index and indicators of slowness and weakness should be combined used for measuring the status of frailty among older adults who live alone. To support healthy aging and disability prevention is an important challenge for public health in Taiwan, with a good tool to t evaluate frailty status will greatly contribute to success.