門診慢性病老人衰弱症之分析

Frailty Status and Associated Factors in Outpatient Older People with Chronic Disease

呂貝蕾(Bei-Lei Lu) ； 張淑玲(Shu-Ling Chang) ； 陳晶瑩(Chin-Ying Chen) ； 吳治勳(Chih-Hsun Wu) ； 張靜怡(Ching-I Chang) ； 陳慶餘(Ching-Yu Chen)

《台灣老年醫學暨老年學雜誌》 5卷1期 (2010/02) Pp. 36-49

https://doi.org/10.29461/TGG.201002.0004

摘要

目的：探討門診慢性病老人衰弱狀態及相關因子分析。
方法：本研究資料來自於某醫學中心家庭醫學部及老年醫學部門診慢性病老人之老年病人周全性評估與衰弱研究，以問卷訪談、肌力檢查、運動及平衡功能檢查完成初次評估的資料分析。
結果：共有189位65歲以上老人完成評估。以Fried衰弱指標，衰弱的比率是19%。非衰弱組（包含無衰弱以及前衰弱）的比率是81%，衰弱個案以年齡75到79歲、女性、低教育程度、單身、獨居較多，但無統計意義。收案條件部分，衰弱個案以符合行動力障礙、慢性病數≧5項、慢性病藥物數≧8種者顯著較多。功能性回顧部分，衰弱個案有顯著較多的行動力障礙、平衡問題、近一年中跌倒、憂鬱症狀、記憶力障礙、疼痛、便秘、大便失禁、尿失禁及吞嚥功能障礙等問題。慢性病方面，衰弱個案罹患骨質疏鬆症、巴金森氏症、腦中風、白內障顯著較多。量表評分上，衰弱個案也有顯著較差的自評功能(WONCA-COOP)得分、簡式症狀量表(BSRS-5)得分、簡式智能量表(MMSE)得分、老年憂鬱量表(GDS-15)得分、迷你營養(MNA)評估得分、巴氏及工具式日常生活功能量表之得分。衰弱個案起立試驗的結果和股四頭肌肌力、生活品質也較非衰弱個案差。邏輯式回歸分析結果，預測衰弱的相關因子為行動力障礙、近一年中跌倒、慢性病用藥有八種（含）以上、慢性病有五項（含）以上以及有便秘問題。
結論：本研究顯示門診慢性病老人的衰弱率為19%，並找出相關危險因子，有助於老人衰弱的偵測。

關鍵字

衰弱 ； 周全性老年評估 ； 老人 ； 老年醫學門診

並列摘要

Objectives: To investigate frailty status and associated factors in outpatient older people with chronic disease
Methods: The research focused on the comprehensive geriatric assessment and frailty study of elder patients at outpatient clinics of Family Medicine, Geriatrics and Gerontology in a medical center. Research subjects were assessed with structured questionnaires, muscle strength tests, mobility and balance tests.
Results: 189 subjects aged 65 years and over completed the initial assessment. The rate of frail and non-frail group (including non-frail and pre-frail) were 19% and 81% respectively according to the Fried criteria. Frail subjects were more likely to be aged 75 to 79 years, female, less educated, single and lives alone. In inclusion criteria, frail subjects reported a higher rate in terms of mobility impairment, number of chronic diseases (five and over), and polypharmacy (taking eight or more kinds of medicine). Regarding functional review, frail subjects showed a significantly higher rate in mobility impairment, balance problems, fall within recent 1 year, depressive symptoms, memory impairment, pain, chronic constipation, stool incontinence, urinary incontinence and swallowing disturbance. Frail elderly were further observed to have a significantly higher rate in osteoporosis, Parkinsonism, cerebral vascular accident, and cataract. Compared to their non-frail counterparts, frail elderly also demonstrated poorer self-rated health (higher WONCA-COOP score), more affective problems (higher BSRS-5 score), cognitive impairment (lower MMSE score), depressive symptoms (higher GDS-15 score), malnutrition (lower MNA score), and impairment of basic or instrumental daily activity. Frail subjects also had poorer timed up and go test performance, quadriceps femoris muscle strength, and quality of life than non-frail subjects. With logistic regression analysis, the associated factors of frailty were mobility impairment, falls in recent 1 year, polypharmacy (taking eight or more kinds of medicine), number of chronic diseases (five and over), and constipation.
Conclusion: Our study shows that outpatient older people with chronic diseases have a higher rate of frailty. Mobility impairment, falls in recent 1 year, polypharmacy (taking eight or more kinds of medicine), number of chronic diseases (five and over) and self-reported constipation emerged to be major risk factors of frailty.

並列關鍵字

frailty ； comprehensive geriatric assessment ； elderly ； geriatric clinic