老人老化衰弱指標臨床效度之初步測試

Clinical Validation of Frailty Indicators among Elderly: A Preliminary Study

郭梅珍(Mei-Chen Kuo) ； 陳靜敏(Ching-Min Chen) ； 鄭綺(Chii Jeng)

《臺灣老人保健學刊》 9卷2期 (2013/12) Pp. 71-93

摘要

目的：隨著老化人口的快速成長，如何早期發現老化衰弱高危險族群，進而預防失能，已經成為重要議題。本研究運用已知族群比較效度探討臺灣地區老化衰弱常用評估工具的臨床效度，以提供臨床實務應用上之參考。方法：本研究透過對已知不同族群進行測試，以瞭解老化衰弱評估工具的區辨能力。研究對象來自北臺灣社區及養護機構之老人，由研究者分別給予老化衰弱評估：在整體功能評估方面使用巴氏量表及工具性日常活動功能量表評估其日常活動功能能力，在心理健康方面使用老人憂鬱量表及簡易心智量表評估憂鬱程度及認知狀態，在生理健康方面，則包含四肢功能、視力、呼吸功能、營養、失禁發生情形及聽力檢測。結果：共收案20位個案，結果顯示兩組在日常活動功能能力、老人憂鬱量表、簡易心智量表、四肢功能（除拇指與食指夾紙評估）、聽力、呼吸功能、營養、失禁發生情形達顯著差異，具有良好的臨床效度。但因老人並非二耳同時出現聽力障礙情形，雖聽力評估在二組達顯著差異，建議較不適合作為老化衰弱之區辨指標。雙眼近視力及上肢小肌肉功能則未達顯著差異，在評估老化衰弱上缺乏臨床效度。結論：由於我國老人多居住於社區中，早期偵測到老化衰弱的發生，可以減少老人入住機構及住院的風險，研究結果發現具有臨床效度之評估工具，可進一步提供臨床人員發現老化衰弱族群，以提供適切照護。

關鍵字

老化衰弱指標 ； 已知族群效度 ； 臨床效度

並列摘要

Objectives: As the aging population growing, early detection of frail older adults to prevent future disability care has become an important issue. This study was to establish the clinical validity of the frailty assessment tools through known groups' comparison in order to propose the feasible application for clinical practice in Taiwan. Methods: Data were collected from 2 different settings, communities and long term care facilities from northern Taiwan. The older adults were invited to complete the frailty assessment. Barthel index and instrumental activities of daily living scales were used to assess overall physical functional performance. The geriatric depression scale (GDS) and Mini Mental State Examination (MMSE) scales were used to examine subjects' psychological health. Physiological health was measured by extremity functions, vision, respiratory function, nutrition, the prevalence of urinary incontinence, and hearing. The data were compared between the two known groups to reveal the clinical validity for instruments. Results: A total of 20 older adults received the frailty assessment. The results indicated that ADL, IADL, GDS, MMSE, extremity functions except paper folding test, respiratory function, nutrition, and the prevalence of urinary incontinence had good clinical validity. Although significant difference in hearing between two groups was found, not all older adults had both hearing impairment. It is believed that hearing is not a good indicator for frailty assessment. The results of vision and motor muscle function had no significant difference in two groups which cannot provide support for the clinical validity for frailty assessment. Conclusion: These findings indicated the importance of the frailty assessment tools. Since majority of the older adults live in the community, early detecting frailty in the early stage should reduce the incidence of institution, and hospitalization.

並列關鍵字

Frailty indicator ； known-group validity ； clinical validity