社區長者身、心、社會衰弱量表之切點初探：以台北兩行政區為例

Pilot study on cutoff values of physical, psychological and social frailty indexes in Taiwan community-dwelling older people

10.6288/TJPH.202012_39(6).109109

鐘子婷(Zi-Ting Zhong)；陳端容(Duan-Rung Chen)；陳秀熙(Hsiu-Hsi Chen)；葉彥伯(Yen-Po Yeh)；張睿詒(Ray-E Chang)；陳殷正(Yin-Cheng Chen)；陳鵬宇(Peng-Yu Chen)；陳雅美(Ya-Mei Chen)

身體衰弱 ； 心理衰弱 ； 社會衰弱 ； 身 ； 心 ； 社會衰弱整合量表（MSTQ: Modified SOF TFI QSFS Integrated Frailty Tool） ； 切點 ； physical frailty ； psychological frailty ； social frailty ； MSTQ: Modified SOF TFI QSFS Integrated Frailty Tool ； cutoff values

台灣公共衛生雜誌

39卷6期（2020 / 12 / 15）

671 - 685

繁體中文

目標：為提早篩檢長者延緩不良健康結果，探討身體（SOF+緩慢、SOF+握力）、心理（TFI, Tilburg Frailty Indicator）、社會性衰弱指標（QSFS, Questionnaire to define Social Frailty Status），以及整合性衰弱指標（MSTQ, Modified SOF TFI QSFS Integrated Frailty Tool）合適台灣族群的最佳切點。方法：收案對象為台灣北部城市兩個行政區的65歲以上長者（行政區一，n=471、行政區二，n=703），以AUC探討工具鑑別力，以約登指數找最適切點。結果：身體指標「衰弱」≥2分，「前衰」=1分；心理指標「衰弱」≥3分，「前衰」=2分；社會指標「衰弱」≥2分，「前衰」=1分。整合性衰弱指標「衰弱」≥4分，「前衰」=3分，鑑別力比單一衰弱面向好。衰弱盛行率方面，行政區（二）身體衰弱（SOF+緩慢）盛行率11.6%；（SOF+握力）14.5%；心理衰弱9.0%；社會衰弱20.0%；身（SOF+緩慢、SOF+握力）、心、社會整合量表衰弱24.6%、25.5%。結論：本研究提供身體、心理、社會性衰弱指標之「衰弱」與「前衰」切點做篩檢標準。身體（SOF+握力）、心理、社會及整合性衰弱指標鑑別力之敏感性比起（SOF+緩慢）略好。不過，仍建議依需求選擇適合量表。

Objectives: Screening for frailty among older people to guard them against adverse health outcomes is a crucial task as the population ages. This study sought to find the most optimal cutoff values for physical (SOF-walking speed、SOF-handgrip), psychological (TFI, Tilburg Frailty Indicator), and social frailty indexes (QSFS, Questionnaire to define Social Frailty Status), and Modified SOF TFI QSFS Integrated Frailty Tool (MSTQ) in Taiwanese community-dwelling older people. Methods: The study used cross-sectional survey data in two secondary sets collected from two municipalities in Taipei, with 471 and 703 older adult participants, respectively. Spearman’s rank correlation analysis was used to assess the association of three dimensions of frailty. Receiver operator characteristic curves were generated to determine the discriminant functions for these frailty indexes. Results: Modest associations were found between physical, psychological, and social frailty. The full integrated frailty indexes, which combined the three separate indexes, showed an improved discriminant function (cutoff values: frail ≥4, pre-frail = 3) relative to the single index. The cutoff values suggested for Taiwanese older adults was as follows: physical frailty (frail ≥2, pre-frail = 1), psychological frailty (frail ≥3, pre-frail = 2), and social frailty (frail ≥2, pre-frail = 1). Conclusions: Our findings supported the use of the full integrated frailty index and provided cutoff values to screen older community-dwelling people for frailty. The discriminate ability of the MSTQ was better to include SOF-handgrip comparing to include SOF walking speed as physical frailty. Researchers can select either one of the indexes as needed.

1. 方佩欣, PH,張睿詒, RE(2020)。高齡社區長者社會衰弱之範域文獻回顧。台灣衛誌，39，112-128。
   連結：
2. 胡倍瑜, BY,游曉微, HW,邱慈穎, TW,林莉玲, LL,陳端容, DR,陳雅美, YM(2019)。Study of Osteoporotic Fractures（SOF Index）衰弱量表的效度驗證－一般社區長者以及獨居長者的應用。台灣衛誌，38，648-659。
   連結：
3. 賴郁菁, YC,廖媛美, YM,林碧珠, PC(2019)。第II型糖尿病病人身體活動與生活品質之探討。護理雜誌，66，57-66。
   連結：
4. Chen, CY,Wu, SC,Chen, LJ,Lue, BH(2010).The prevalence of subjective frailty and factors associated with frailty in Taiwan.Arch Gerontol Geriatr,50(Suppl 1),S43-S47.
5. Chen, LJ,Chen, CY,Lue, BH,Tseng, MY,Wu, SC(2014).Prevalence and associated factors of frailty among elderly people in Taiwan.Int J Gerontol,8,114-119.
6. Clegg, A,Young, J,Iliffe, S,Rikkert, MO,Rockwood, K(2013).Frailty in elderly people.Lancet,381,752-762.
7. Collard, RM,Boter, H,Schoevers, RA,Voshaar, RCO(2012).Prevalence of frailty in communitydwelling older persons: a systematic review.J Am Geriatr Soc,60,1487-1492.
8. Dent, E,Kowal, P,Hoogendijk, EO(2016).Frailty measurement in research and clinical practice: a review.Eur J Intern Med,31,3-10.
9. Dong, LJ,Liu, N,Tian, XY(2017).Reliability and validity of the Tilburg Frailty Indicator (TFI) among Chinese community-dwelling older people.Arch Gerontol Geriatr,73,21-28.
10. Ensrud, KE,Ewing, SK,Taylor, BC(2008).Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.Arch Intern Med,168,382-389.
11. Faller, JW,do Nascimento Pereira, D,de Souza, S,Nampo, FK,de Souza Orlandi, F,Matumoto, S(2019).Instruments for the detection of frailty syndrome In older adults: a systematic review.PLoS One,14,e0216166.
12. Fitten, LJ(2015).Psychological frailty in the aging patient.Nestle Nutr Inst Workshop Ser,83,45-53.
13. Fried, LP,Tangen, CM,Walston, J(2001).Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci,56,M146-M156.
14. Gobbens, RJ,Luijkx, KG,van Assen, MA(2013).Explaining quality of life of older people in the Netherlands using a multidimensional assessment of frailty.Qual Life Res,22,2051-2061.
15. Gobbens, RJ,van Assen, MALM,Luijkx, KG,Wijnen-Sponselee, MT,Schols, JMG(2010).The Tilburg Frailty Indicator: psychometric properties.J Am Med Dir Assoc,11,344-355.
16. Hu, BY,Yu, HW,Chiu, TW,Lin, LL,Chen, YM(2018).The validity of the Study of Osteoporotic Fractures (SOF) Index for assessing community-based older adults in Taiwan.Innov Aging,2(Suppl 1),1015.
17. Kiely, DK,Cupples, LA,Lipsitz, LA(2009).Validation and comparison of two frailty indexes: The MOBILIZE Boston Study.J Am Geriatr Soc,57,1532-1539.
18. Makizako, H,Shimada, H,Doi, T(2018).Social frailty leads to the development of physical frailty among physically non-frail adults: a four-year follow-up longitudinal cohort study.Int J Environ Res Public Health,15,490.
19. Makizako, H,Shimada, H,Tsutsumimoto, K(2015).Social frailty in community-dwelling older adults as a risk factor for disability.J Am Med Dir Assoc,16,1003.e7-1003.e11.
20. Metzelthin, SF,Daniëls, R,van Rossum, E,de Witte, L,van den Heuvel, WJ,Kempen, GIJM(2010).The psychometric properties of three self-report screening instruments for identifying frail older people in the community.BMC Public Health,10,176.
21. Mitnitski, AB,Mogilner, AJ,Rockwood, K(2001).Accumulation of deficits as a proxy measure of aging.Scientific World Journal,1,323-336.
22. Op het Veld, LP,Beurskens, AJHM,de Vet, HCW(2019).The ability of four frailty screening instruments to predict mortality, hospitalization and dependency in (instrumental) activities of daily living.Eur J Ageing,16,387-394.
23. Op het Veld, LP,Rossum, E,Kempen, GIJM,de Vet, HCW,Hajema, K,Beurskens, AJHM(2015).Fried phenotype of frailty: cross-sectional comparison of three frailty stages on various health domains.BMC Geriatr,15,77.
24. Park, H,Jang, IY,Lee, HY,Jung, HW,Lee, EJ,Kim, DH(2019).Screening value of social frailty and its association with physical frailty and disability in communitydwelling older Koreans: aging study of PyeongChang Rural Area.Int J Environ Res Public Health,16,2809.
25. Shimada, H,Lee, S,Doi, K,Bae, S,Tsutsumimoto, K,Arai, H(2019).Prevalence of psychological frailty in Japan: NCGG-SGS as a Japanese National Cohort Study.J Clin Med,8,1554.
26. Teo, N,Gao, Q,Nyunt, MSZ,Wee, SL,Ng, TP(2017).Social frailty and functional disability: findings from the Singapore longitudinal ageing studies.J Am Med Dir Assoc,18,637.e13-637.e19.
27. Van Campen, C(2011).Frail Older Persons in the Netherlands.Nerherlands:Netherlands Institute for Social Research.
28. van Oostrom, S,van der A, DL,Rietman, ML(2017).A four-domain approach of frailty explored in the Doetinchem Cohort Study.BMC Geriatr,17,196.
29. Verver, D,Merten, H,de Blok, C,Wagner, C(2019).A cross sectional study on the different domains of frailty for independent living older adults.BMC Geriatr,19,61.
30. Wu, YC,Tung, HH,Wei, J(2019).Quality of life, demoralization syndrome and health-related lifestyle in cardiac transplant recipients -- a longitudinal study in Taiwan.Eur J Cardiovasc Nurs,18,149-162.
31. Zhang, X,Tan, SS,Franse, CB(2019).Association between physical, psychological and social frailty and health-related quality of life among older people.Eur J Public Health,29,936-942.
32. 呂貝蕾, BL,張淑玲, SL,陳晶瑩, CY,吳治勳, CH,張靜怡, CI,陳慶餘, CY(2010)。門診慢性病老人衰弱症之分析。台灣老年醫學暨老年學雜誌，5，36-49。
33. 衛生福利部：長期照顧十年計畫2.0(106-115年)。https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi9oszF5KntAhUKwosBHdF8BBwQFjAAegQIAhAC&url=https%3A%2F%2Fwww.mohw.gov.tw%2Fdl46355-2d5102fb-23c8-49c8-9462-c4bfeb376d92.html&usg=AOvVaw1qN1rzYNWvVGLO5QNBJko。引用2020/11/25。Ministry of Health and Welfare, R.O.C. (Taiwan). Ten-Year Long-Term Care Program 2.0 in Taiwan (2017-2026). Available at: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi9oszF5KntAhUKwosBHdF8BBwQFjAAegQIAhAC&url=https%3A%2F%2Fwww.mohw.gov.tw%2Fdl-46355-2d5102fb-23c8-49c8-9462-c4bfeb376d92.html&usg=AOvVaw1qN1rzYNWvVGLO-5QNBJko. Accessed November 25, 2020. [In Chinese]

1. 劉禮慧,張睿詒(2022)。生理、認知、社會衰弱、及多面向衰弱之文獻回顧。台灣公共衛生雜誌，41(4)，374-382。
2. 謝佳容,劉苑蓉,黃冠評(2022)。以方塊踏步團體活動介入於日照中心長者衰弱改善的效果：一項前驅研究。台灣健康照顧研究學刊，26，42-71。