臺灣博碩士論文加值系統

研究背景與目的：衰弱(Frailty)是引起老年人健康惡化、功能衰退常見的症候群，將造成容易受傷、增加罹病、跌倒、失能或死亡風險等各種負面的結果。隨著老年人口的不斷增加以及國民平均壽命的延長，對於預防老年人健康情形衰退以及失能情形的發生，是當前研究的重點方向。本研究的目的為探討不同衰弱程度的老年人是否在常用功能性測試上有差異，以及利用功能性測試篩檢老年人的衰弱程度之可行性。
研究方法：本研究收取484位年齡大於65歲社區健康老年人。檢測內容將包括問卷訪談以及功能性測試(手握力、膝伸直肌力、6分鐘行走距離、30秒坐站測試、計時-起走測試與功能性前伸)。檢測完成後，將受測者依照類似於Fried之衰弱定義分作正常(0分)、衰弱傾向(1-2分)、衰弱(3-5分)三組，以單因子變異數分析(ANOVA)檢定各項功能性測試在三組間是否有差異；再使用ROC曲線分析來檢測各項功能性測試對於衰弱與衰弱傾向的篩檢效度、合適切點及其敏感度與特異性。
結果：不同衰弱程度的三組老年人，男性在手握力(F=22.66，p<0.001)、六分鐘行走(F=24.09，p<0.001)、三十秒坐站(F=19.12，p<0.001)、計時起走(F=43.41，p<0.001)與功能性前伸(F=15.70，p<0.001)有顯著差異；女性在手握力(F=24.33，p<0.001)、膝伸直肌力(F=12.92，p<0.001)、六分鐘行走(F=17.60，p<0.001)、三十秒坐站(F=30.69，p<0.001)、計時起走(F=68.79，p<0.001)與功能性前伸(F=12.82，p<0.001)有顯著差異。男性可利用六分鐘走(AUC=0.636，p=0.002)、三十秒坐站測試(AUC=0.675，p<0.001)、計時-起走(AUC=0.633，p=0.001)等項篩檢衰弱傾向；可利用手握力(AUC=0.868，p<0.001)、六分鐘行走(AUC=0.832，p<0.001)、三十秒坐站(AUC=0.738，p=0.006)、計時-起走(AUC=0.876，p<0.001)、功能性前伸(AUC=0.815，p<0.001)篩檢衰弱。女性可利用膝伸直肌力(AUC=0.583，p=0.019)、六分鐘行走(AUC=0.635，p<0.001)、三十秒坐站(AUC=0.646，p<0.001)、計時起走(AUC=0.630，p<0.001)等項篩檢衰弱傾向；可利用手握力(AUC=0.824，p<0.001)、膝伸直肌力(AUC=0.680，p=0.004)、六分鐘行走(AUC=0.715，p=0.009)、三十秒坐站(AUC=0.825，p<0.001)、計時-起走(AUC=0.851，p<0.001)、功能性前伸(AUC=0.735，p<0.001)等篩檢衰弱，並具有良好的敏感度與特異性。
結論：不同衰弱程度老人在多數功能性測試有顯著差異，且功能性測試可以有效的篩檢老年衰弱與衰弱傾向，其中以三十秒坐站最適用於篩檢衰弱傾向；以計時起走最適用於篩檢衰弱的老年人。

Frailty is a fairly common biological syndrome in the elderly. It causes vulnerability to adverse outcomes, such as co-morbidity, falling, or death. The purposes of this study are to test if the results of the functional tests are significant different in different levels of frailty, and to examine the feasibility of using functional tests as screen tools for elderly frailty. Developing these simple tests as screening tools for elderly frailty may help in early identification and early intervention of the high risk elderly. This may prevent deterioration of their health status and further disability, increase their quality of life and decrease the family and society burden.
In this study, we recruited 484 community-dwelling elderly aged over 65 years old. After a consent form, each participant went through a interview with a questionnaire, two strength tests (grip strength and knee extension) and four functional tests (including 6 minute walking distance, 30 sec sit-to-stand, timed up and go and functional reach). All the subjects were classified into normal, prefrail, and frail groups after the tests. One-way ANOVA was used to test the differences of the results of functional tests in the three groups. Receiver operating characteristic (ROC) curve was applied to examine the feasibility of each strength and functional test in screening the frailty elderly. Area under curve(AUC), cut points, sensitivity and specificity of each test were provided.
The result showed that different levels of frailty elderly were significantly different in functional tests including grip strength (F=22.66，p<0.001)、6 minute walk test (F=24.09，p<0.001)、30 seconds sit-to-stand (F=19.12，p<0.001)、timed up and go (F=43.41，p<0.001)and functional reach (F=15.70，p<0.001) for male, and including grip strength (F=24.33，p<0.001)、knee extension muscle strength (F=12.92，p<0.001)、6 minute walk test (F=17.60，p<0.001)、30 seconds sit-to-stand (F=30.69，p<0.001)、timed up and go (F=68.79，p<0.001) and functional reach (F=12.82，p<0.001) for female. Six minute walking test(AUC=0.636，p=0.002), 30 sit-to stand(AUC=0.675，p<0.001), timed up and Go (AUC=0.633，p=0.001) could discriminate prefrail from normal older men. Grip strength(AUC=0.868，p<0.001), 6 minute walking test(AUC=0.832，p<0.001), 30 seconds sit-to-stand (AUC=0.738，p=0.006), timed up and go(AUC=0.876，p<0.001), functional reach (AUC=0.815，p<0.001) could discriminate frail from other older men. Moreover, knee extension muscle strength (AUC=0.583，p=0.019)、6 minute walking test (AUC=0.635，p<0.001)、30 sit-to stand (AUC=0.646，p<0.001)、Timed up and Go (AUC=0.630，p<0.001)could discriminate prefrail from normal older women. Grip strength (AUC=0.824，p<0.001)、knee extension(AUC=0.680，p=0.004)、6 minute walking test (AUC=0.715，p=0.009)、30 sit-to stand (AUC=0.825，p<0.001)、Timed up and Go (AUC=0.851，p<0.001)、functional reach (AUC=0.735，p<0.001) could discriminate frail from other older women.
Conclusion：These functional tests were feasiable in screening different levels of frailty elderly with good to acceptable validity. And the cut-points, sensitivity and specificity in this study provided a scientific evidence for screening elderly.

目錄
指導教授推薦書
口試委員會審定書
授權書 - iii -
誌謝 - iv -
中文摘要 - v -
英文摘要 - vii -
目錄 - ix -
圖表目錄 - xi -
第一章 緒論(INTRODUCTION) - 13 -
1.1研究背景 - 13 -
1.2研究目的 - 16 -
1.3研究假說 - 17 -
1.4研究的重要性 - 17 -
1.5名詞操作型定義 - 18 -
第二章 文獻回顧(LITERATURE REVIEW) - 21 -
2.1人口老化的問題 - 21 -
2.2功能衰退防治的重要性 - 22 -
2.3 衰弱及其相關研究 - 23 -
2.3.1衰弱之定義 - 27 -
2.3.2衰弱相關機制 - 29 -
2.3.3 衰弱相關危險因子 - 31 -
2.3.4 小結 - 39 -
2.4衰弱的測量及分組 - 40 -
2.5衰弱的篩檢 - 42 -
2.5.1心肺耐力 - 44 -
2.5.2 肌力與肌耐力 - 45 -
2.5.3 自主平衡調控能力測試 - 49 -
2.5.4 活動能力測試 - 49 -
2.6總結 - 51 -
第三章 研究方法(METHOD) - 53 -
3.1樣本選取 - 53 -
3.2收案場所 - 54 -
3.3研究設計及流程 - 54 -
3.4測量項目及工具 - 55 -
3.5統計分析方法 - 58 -
3.6功能測試項目之信效度檢定 - 59 -
第四章 結果(RESULT) - 61 -
4.1 受測者基本資料與功能性測試結果分析 - 62 -
4.2 不同衰弱程度之人口統計學變項與功能性測試變項之分析與比較 - 63 -
4.2.1 衰弱得分與衰弱分組 - 63 -
4.2.2 依不同衰弱程度分組比較結果 - 65 -
4.3 各功能性測試對衰弱的篩檢能力 - 66 -
第五章 討論(DISCUSSION) - 70 -
5.1研究對象之人口統計與功能性表現測試變項之特性 - 71 -
5.2研究對象之衰弱得分與衰弱分組之分布情形 - 72 -
5.3 依不同衰弱程度，探討其人口統計變項與功能性表現差異 - 77 -
5.4功能性表現對衰弱程度之篩檢能力、切點、敏感度與特異性 - 86 -
5.5優點及限制 - 90 -
5.6未來研究方向 - 91 -
第六章 結論(CONCLUSION) - 94 -
參考文獻 - 95 -

圖表目錄
圖附錄
圖 1- 1 不同年齡層衰弱的盛行率 - 102 -
圖 2- 1 不同年齡層健保門診花費 - 102 -
圖 2- 2 不同年齡層健保住院花費 - 102 -
圖 2- 3 衰弱、失能與共病之相關性 - 103 -
圖 2- 4 衰弱循環機制假說I(AHMED) - 103 -
圖 2- 5衰弱循環機制假說I I(MUHLBERG) - 104 -
圖 2- 6 發炎指標與衰弱風險比 - 104 -
圖 2- 7 衰弱機制假說III (摘錄自WALSTON,2006) - 105 -
圖 2 - 8衰弱機制假說IV - 105 -
圖 3 - 1 實驗流程圖 - 106 -
圖 4 - 1衰弱得分 - 106 -
圖 4 - 2衰弱分組 - 107 -
圖 4 - 3共病數量 - 107 -
圖 4 - 4運動習慣 - 107 -
圖 4 - 5自覺健康 - 108 -
圖 5 - 1男女年齡分布 - 108 -
表附錄
表 1 - 1診斷測試(DIAGNOSTIC TEST) - 109 -
表 2 - 1 衰弱定義 - 110 -
表 2 - 2衰弱相關的因子 - 111 -
表 2 - 3 衰弱操作型定義 (FRIED, 2001) - 111 -
表 2 - 4衰弱操作型定義 (呂碧鴻, 2008) - 112 -
表 3 - 1本研究初始衰弱特徵參考定義 - 113 -
表 3 - 2 各項目所需工具與單位 - 115 -
表 3 - 3各功能性測試之”再測信度”與”效標效度” - 116 -
表 3 - 4各功能性測試之”測試者間信度” - 116 -
表 4 - 1 人口統計變項之常態分布檢定 - 117 -
表 4 - 2 功能性測試之常態分布檢定 - 117 -
表 4 - 3 各變項之男女差異情形 - 117 -
表 4 - 4 衰弱得分 - 118 -
表 4 - 5 衰弱分組 - 118 -
表 4 - 6依不同衰弱程度比較人口統計學變項 - 119 -
表 4 - 7依不同衰弱程度比較功能性測試 - 120 -
表 4 - 8 共病數量 - 121 -
表 4 - 9 運動習慣 - 121 -
表 4 - 10 自覺健康 - 121 -
表 4 - 11功能性測驗篩檢衰弱傾向(男性) - 122 -
表 4 - 12功能性測驗篩檢衰弱(男性) - 122 -
表 4 - 13功能性測驗篩檢衰弱傾向(女性) - 122 -
表 4 - 15功能性測驗篩檢不同衰弱程度之切點、敏感度、特異性(男性) - 123 -
表 4 - 16功能性測驗篩檢不同衰弱程度之切點、敏感度、特異性(女性) - 123 -
表 5 - 1 不同文獻握力比較(男性) - 124 -
表 5 - 2 不同文獻握力比較(女性) - 124 -
表 5 - 3 不同研究對於六分鐘行走的指導語 - 124 -
附錄一(APPENDIX I) - 125 -
附錄二(APPENDIX II) - 127 -

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