Development of Frailty Indicators for the Community-Dwelling Older Adults

社區老人老化衰弱指標之發展

10.1097/JNR.0b013e318273652b

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

老化衰弱 ； 老化衰弱指標 ； 多元研究法 ； frailty ； frailty indicator ； triangulation

The Journal of Nursing Research

20卷4期（2012 / 12 / 01）

261 - 271

英文

背景　高齡化社會的快速到來，使老化衰弱問題成為重要議題。儘管認同老化衰弱的評估在進行照護規劃的重要性，但目前對於老化衰弱的評估並沒有一致的看法。目的　藉由進行老化衰弱之質性與量性結果交叉比較，以初步建立臺灣老年人老化衰弱的指標。方法　兼顧質性及量性研究法，在2010年8月至9月期間，於北臺灣六所老人服務中心方便取樣10位社區住民。研究者用深度訪談及錄音來收集資料，同時根據生理、功能和心理社會健康三層面之質化分析結果，研究者以擬定之一系列健康評估逐一評估受訪者，並記錄其量化結果。結果　本研究共訪談及評估10位女性老人，依成功老化的定義，呈現在「整體功能能力」、「心理健康」及「生理健康」之三個主題下之老化衰弱經驗和感受。進一步將受訪者的老化衰弱狀況與老化衰弱感受進行比較，以確認質化和量化結果的一致性。結果發現，雖然評估結果顯示受訪者雖處於相對健康的狀態，但在訪談中仍有許多關於老化衰弱的主訴，顯見現有評量工具之限制。結論／實務應用　老化衰弱指標的建立，可作為評估個案整體性健康的表現，期望本結果可使醫療照護人員能夠深入的瞭解老年人老化衰弱過程。

Background: Faster than anticipated increases in population, aging is making the issue of frailty among the elderly increasingly important. Despite general agreement that a frailty assessment is important for planning care for the older adults, a lack of consensus remains regarding the best methodology to use for frailty assessments.Purpose: The aim of this study was first to cross-examine results between perception of frailty and physical assessment outcomes then try to establish frailty indicators for elderly people in Taiwan.Methods: This study used both qualitative and quantitative methods. From August to September 2010, researchers recruited a convenience sample of 10 community older adults from six different elderly centers in northern Taiwan. Qualitative in-depth interviews were conducted in Mandarin or Taiwanese and audiotaped. After the in-depth interview, researchers conducted a series of physical assessments on the participants.Results: Ten elderly women were interviewed and assessed. The three themes identified by this study related to frailty perception included overall physical function performance, psychological health, and physiological health. These reflected the concept of successful aging. Participant frailty was compared with subjective perceptions to identify and/or check for consistency between qualitative and quantitative results. Although quantitative results revealed that participants were in fairly good health, there were many complaints about frailty during the qualitative interview. Better sensitive measures reflecting frailty changes are thus needed.Conclusions: These indicators can be considered as an integration of all maintained functions. We hope that results will provide better insights into understanding the process of frailty among the older adults.

1. Chang, C. H.,Lin, Y. H.,Yeh, S. H.,Lin, L. W.(2010).Managing problem behaviors in cognitively impaired older people: The competence and preparedness of healthcare providers in long-term care facilities.The Journal of Nursing Research,18(3),164-173.
   連結：
2. Lu, S. R.,Lin, H. Y.,Lin, K. C.,Lin, H. R.(2008).Quality of life in middle-aged and older Taiwanese patients with rheumatoid arthritis.The Journal of Nursing Research,16(2),121-130.
   連結：
3. Shyu, Y. I.,Yang, C. T.,Huang, C. C.,Kuo, H. C.,Chen, S. T.,Hsu, W. C.(2010).Influences of mutuality, preparedness, and balance on caregivers of patients with dementia.Journal of Nursing Research,18(3),155-163.
   連結：
4. Ministry of the Interior, Taiwan, ROC, Department of Statistics. (2011). Key domestic statistical indices. Retrieved from http://sowf.moi.gov.tw/stat/indices/list.xls (in Chinese)
5. Bryman, A.(Ed.),Burgess, R.(Ed.)(1999).Qualitative research.London, England:Sage.
6. Buchman, A. S.,Boyle, P. A.,Wilson, R. S.,Liping, G.,Bienias, J. L.,Bennett, D. A.(2008).Pulmonary function, muscle strength and mortality in old age.Mechanisms of Ageing and Development,129(11),625-631.
7. Buchner, D. M.,Wagner, E. H.(1992).Preventing frail health.Clinics in Geriatric Medicine,8(1),1-17.
8. Cigolle, C. T.,Ofstedal, M. B.,Tian, J.,Blaum, C. S.(2009).Comparing models of frailty: The health and retirement study.Journal of the American Geriatrics Society,57(5),830-839.
9. Council for Economic Planning and Development, Department of Manpower Planning(2010)。Population projections for Taiwan: 2010-2060。Taiwan Economic Forum，8(9)，66-70。
10. Flood, M.(2005).A mid-range nursing theory of successful aging.Journal of Theory Construction and Testing,9(2),35-39.
11. Fried, L. P.,Tangen, C. M.,Walston, J.,Newman, A. B.,Hirsch, C.,Gottdiener, J.,McBurnie, M. A.(2001).Frailty in older adults: Evidence for a phenotype.Journals of Gerontology Series A: Biological Sciences & Medical Sciences,56(3),M146-M156.
12. Gurina, N. A.,Frolova, E. V.,Degyse, J. M.(2011).A roadmap of aging in Russia: The prevalence of frailty in communitydwelling older adults in the St. Petersburg district-The "crystal" study.Journal of the American Geriatrics Society,59(6),980-988.
13. Jones, D. M.,Song, X.,Rockwood, K.(2004).Operationalizing a frailty Index from a standardized comprehensive geriatric assessment.Journal of the American Geriatrics Society,52(11),1929-1933.
14. Kiely, D. K.,Cupples, L. A.,Lipsitz, L. A.(2009).Validation and comparison of two frailty indexes: The MOBILIZE Boston study.Journal of the American Geriatrics Society,57(9),1532-1539.
15. Lawton, M. P.,Brody, E. M.(1969).Assessment of older people: Self-maintaining and instrumental activities of daily living.The Gerontologist,9(3, Pt. 2),179-186.
16. Lekan, D.(2009).Frailty and other emerging concepts in care of the aged.Southern Online Journal of Nursing Research,9(3),1-29.
17. Martocchia, A.,Indiano, I.,Tafaro, L.,Frugoni, P.,Amici, A.,Cacciafesta, M.,Falaschi, P.(2009).The evaluation of the presence of comorbidity by the MariglianoYCacciafesta polypathology scale (MCPS) and the cumulative illness rating scale (CIRS) in elderly subjects with disability.Archives of Gerontology and Geriatrics,49(1),150-152.
18. Nicholl, L.,Hobart, J.,Dunwoody, L.,Cramp, F.,Lowe-Strong, A.(2004).Measuring disability in multiple sclerosis: Is the Community Dependency Index an improvement on the Barthel Index?.Multiple Sclerosis,10(4),447-450.
19. Onishi, J.,Suzuki, Y.,Umegaki, H.,Kawamura, T.,Imaizumi, M.,Iguchi, A.(2007).Which two questions of Mini-Mental State Examination (MMSE) shouldwe start from?.Archives Gerontology and Geriatrics,44(1),43-48.
20. Pomeroy, I. M.,Clark, C. R.,Philip, I.(2001).The effectiveness of very short scales for depression screening in elderly medical patients.International Journal of Geriatric Psychiatry,16(3),321-326.
21. Rockwood, K.,Fox, R. A.,Stolee, P.,Robertson, D.,Beattie, B. L.(1994).Frailty in elderly people: An evolving concept.Canadian Medical Association Journal,150(4),489-495.
22. Rockwood, K.,Song, X.,MacKnight, C.,Bergman, H.,Hogan, D. B.,McDowell, I.,Mitnitski A.(2005).A global clinical measure of fitness and frailty in elderly people.Canadian Medical Association Journal,173(5),489-495.
23. Rockwood, K.,Stadnyk, K.,MacKnight, C.,McDowell, I.,Hébert, R.,Hogan, D. B.(1999).A brief clinical instrument to classify frailty in elderly people.The Lancet,353(9148),205-206.
24. Rolfson, D. B.,Majumdar, S. R.,Tsuyuki, R. T.,Tahir, A.,Rockwood, K.(2006).Validity and reliability of the Edmonton Frail Scale.Age & Aging,35(5),526-529.
25. Strawbridge, W. J.,Shema, S. J.,Balfour, J. L.,Higby, H. R.,Kaplan, G. A.(1998).Antecedents of frailty over three decades in an older cohort.The Journals of Gerontology: Series B,53B(1),S9-S16.
26. Studenski, S.,Hayes, R. P.,Leibowitz, R. Q.,Bode, R.,Lavery, L.,Walston, J.,Perera, S.(2004).Clinical global impression of change in physical frailty: Development of a measure based on clinical judgment.Journal of the American Geriatrics Society,52(9),1560-1566.
27. Tong, A. Y. C.,Man, D. W. K.(2002).The validation of the Hong Kong Chinese version of the Lawton Instrumental Activities of Daily Living Scale for institutionalized elderly persons.Occupation, Participation and Health,22(4),132-142.
28. Vaz Fragoso, C. A.,Gahbauer, E. A.,Van Ness, P. H.,Gill, T. M.(2009).Sleep-wake disturbances and frailty in community-living older persons.Journal of the American Geriatrics Society,57(11),2094-2100.
29. Wong, C. H.,Weiss, D.,Sourial, N.,Karunananthan, S.,Quail, J. M.,Wolfson, C.,Bergman, H.(2010).Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: A cross-sectional study.Aging Clinical and Experimental Research,22(1),54-62.
30. Woo, J.,Tang, N. L. S.,Suen, E.,Leung, J. C. S.,Leung, P. C.(2008).Telomeres and frailty.Mechanisms of Aging and Development,129(11),642-648.
31. Woodhouse, K. W.,Wynne, H.,Baillie, S.,James, O. F. W.,Rawlins, M. D.(1988).Who are the frail elderly?.Quarterly Journal of Medicine,255,505-506.
32. Yesavage, J. A.,Brink, T. L.,Rose, T. L.,Lum, O.,Huang, V.,Adey, M.,Leirer, V. O.(1982).Development and validation of a geriatric depression screening scale: A preliminary report.Journal of Psychiatric Research,17(1),37-49.