摘要 背景與目的:國外所發展之VES量表(Vulnerable Elders Survey)能有效辨識出不同衰退程度的老人,且預測其所遭遇的衰退及死亡風險。此量表在國外已逐漸被廣泛使用於各類研究,反觀國內則並無一易於使用的工具,可用來辨識出處於不同衰退情況及死亡風險的老人。本研究以具有全國代表性之老人樣本為研究對象,探討VES量表是否能預測台灣老人之死亡風險,以及最適合台灣使用之VES量表模式。 研究方法:本研究設計為縱貫式世代研究,資料來源為二零零三年度之「台灣地區中老年身心社會生活狀況長期追蹤調查」與死亡檔,研究樣本經篩選過後,總樣本為2421位居住於社區之老年人,其中四年後仍存活者有1965人,已死亡者有456人。本研究以Kaplan-Meier以及COX存活模型進行分析。 結果: 10分法、單切點VES量表、以及雙切點VES量表與四年內死亡間皆呈現顯著相關。以COX存活分析之-2對數概似值比較不同切點模式之VES量表間預測模型適合度差異,結果發現10分法VES量表預測模型適合度最高,但若要使用有切點之VES量表,則應選擇雙切點VES量表較佳,VES得分為3-6分以及7-10分者,死亡風險分別為0-2分者的2.33倍及4.12倍。而在使用VES量表時,僅需考慮到性別與婚姻狀況兩變項,即可讓四年內死亡情形之預測模型適合度達到最佳。 結論:本研究之研究結果可供醫療服務提供者於老年患者狀況評估時,有一簡單評量工具,可迅速篩檢出一般老人中,急需積極介入治療之脆弱老人,以降低其死亡風險。
Abstract Background and Study Purpose: The Vulnerable Elders Survey (VES) has been developed and used to identify elderly with increased risk of disability and mortality. At present this instrument has never been used to predict the risk of mortality for elderly in Taiwan. This study use a nationally representative sample to test whether this instrument can be used to predict mortality in Taiwan’s elderly. Method: Data for this longitudinal cohort study came from 2003 wave of the Survey of Health and Living Status of the Elderly in Taiwan. Data on mortality came from the death registry maintained by the Department of Health. The analytical file contains 1965 community-dwelling elderly 65 years and older. Among these, 1965 were still alive four years later, while 456 have died. Kaplan-Meier and Cox proportional hazard models were used for analyses. Results: The three VES models with different cut-points were all significantly associated with increased risk of death. The 10-point VES has the best model-fitting. However, the VES with two cut-points is recommended to identify elderly with higher risk of death. Those with VES scores between 3-6 and 7-10 had 2.33 and 4.12 times higher risk of death within four years. Adding gender and marital status will optimize model fitting for all three VES models. Conclusion: VES is an easy clinical tool that can be used by clinicians to identify vulnerable elderly who are at higher risk of death.