臺灣博碩士論文加值系統

衰弱是老人失能傾向與功能退化的前兆，也是介於生活獨立自主與死亡的中間階段。老人衰弱是目前重要且急需處理的公共健康問題，若有具有信效度之篩檢評估高齡者衰弱的工具，能確認高危險群，並及早發現及早提供適合的預防措施與服務，更是分配醫療、健康照護資源的重要指標，因此發展或確認良好之衰弱評估工具，是高齡者衰弱防治工作中最重要且急迫的任務之一。目前缺乏社區老年人衰弱的快速篩檢評估工具，欲透過翻譯日本厚生省所使用之Kihon Checklist (KCL)衰弱篩檢量表，此量表目前在日本被用來篩檢老年人的衰弱情形，並評估是否需要長期照護的介入，希望藉由KCL量表之翻譯與信效度檢定，發展出適合台灣老年人的衰弱篩檢評估工具，及早篩檢出衰弱的高危險族群。
本研究之目的為翻譯 Kihon Checklist (KCL)為中文版(KCL-Chinese, KCL-C)，並檢測其信度與效度。本研究為橫斷式研究且分成二階段, 第一階段在取得Kihon Checklist (KCL)的高齡者衰弱量表原作者之同意後，依照Brislin's model of translation進行翻譯為KCL-C，並檢測其內容效度，第二階段為KCL-C信效度檢測。第二階段收集150位台北市北投區社區老年人的資料，進行問卷內在一致性、一週後再測信度、建構效度及效標關聯校度之檢測。
量表的信度部分，內在一致性Cronbach’s α值為0.7，是可接受的結果；再測信度ICC值皆大於0.6，顯示具備良好的再測信度。效度部分結果顯示除了第19題CVI值為0.76之外，其餘題目之CVI值皆介於0.8-1.0之間，顯示本工具具備良好的內容效度；採用結構方程式檢測建構效度:規範卡方為1.88、GFI值為0.80、RMSEA值為0.08、PGFI值為0.61、PNFI值為0.53，綜合以上數據皆達到專家學者建議的標準，顯示本量表的建構效度是可接受的；效標關聯效度以Pearson’s Correlation相關係數r值檢視KCL效標關聯效度。結果顯示日常生活功能次量表與Instrumental Activities of Daily Living量表之r值為-0.609，為中度負相關，憂鬱次量表與Geriatric Depression Scale-5之r值為0.569，為中度正相關，運動功能次量表與5公尺行走秒數之r值為0.347，為低度相關，社交功能次量表與Social Support: Personal Resource Questionnaire part 2量表r值為-0.186，為低度負相關，記憶次量表與Short Portable Mental Status Questionnaire量表之r值為-0.200，為低度負相關， KCL-C總分與Fried Frailty Criteria量表r值為0.381，且為低度正相關。
中文版高齡者衰弱量表有可接受的內在一致性及良好的再測信度，效度部分其內容效度良好，建構效度在可接受的範圍內，但效標關聯效度有些部分僅呈現低度相關。本研究進一步測量KCL-C的敏感性及特異性，結果為70%與83%，是具有良好判斷力的。KCL-C量表具有良好的判斷力，使用上也具備易答性及便利性，建議本量表可做為社區老年人衰弱的快速篩檢工具。

Frailty is a sign of the disability and loss function in elderly, and is the intermediate stage between independent living and death. Frailty is an important public health issue that we have to face now. If we have a good reliable and valid tool, we can identify the high risk group of frailty and provide appropriate preventions and services. In addition it would be the indicator to assign the health care services. Therefore to develop a good tool to assess frailty is one of the urgent missions in frailty prevention.
The purpose of this study was to translate the Kihon Checklist (KCL) to Chinese version (KCL-C) and evaluate the reliability and validity. This is a cross sectional study and have two stages. In first stage is to get the permission from the KCL original author. Then according to Brislin's model of translation to translate KCL to KCL-C. The second stage is to evaluate reliability and validity, and we recruited 150 elders who live in Beitou District, Taipei City. And we checked the internal consistency, one week test-retest reliability, content validity, construct validity and criteria validity.
KCL-C has good reliability and validity. The internal consistency of the KCL-C is acceptable which Cronbach’s α 0.7. The ICC is between 0.865 and 1.0 that shows KCL-C has excellent one week test-retest reliability. The CVI of content validity are between 0.8and 1.0 except question 19. Thus the content validity of KCL-C is excellent. To use the fit of the model from structural equation model to test the construct validity. The NC is 1.88, GFI is 0.8, RMSEA is 0.077, PGFI is 0.61, and PNFI is 0.53. Based on the above results, we can know that these values are up to the standards set by experts and scholars, indicating that the construct validity of this scale is acceptable. The validity of the correlation criterion was evaluated by Pearson's Correlation. Instrumental Activity of Daily Living (IADL), Frailty Criteria (FFC), Short Portable Mental Status Questionnaire (SPMSQ), Geriatric Depression Scale (GDS-5), and Personal Resource Questionnaire 85-Part 2 (PRQ-85 part 2) used to examine the criteria validity of KCL-C and its subscales. The results show that the r value of KCL-C and IADL is -0.609, which is moderately negative correlation. The r value of the KCL-C motor function subscale and the 5-meter walking time is 0.347, which is low positive correlation. The r value of KCL-C social function subscale and PRQ85 scale is -0.186, which is low negative correlation. The r value of KCL-C memory subscale and SPMSQ scale is -0.200, which is low negative correlation. The r value of KCL-C depression subscale and GDS-5 is 0.569, which is moderate positive correlation. The r value of KCL-C total score and FFC scale r is 0.38, which is low positive correlation.
The internal consistency, test-retest reliability and content validity of KCL-C are good. The construct validity is acceptable. The criteria validity is not very well so we check the sensitivity and specificity of KCL-C in this study. KCL-C shows a sensitivity of 70% and a specificity of 83% that we can know the KCL-C has excellent discrimination. KCL-C has excellent discrimination and the questions of KCL-C are easy to answer and convenience. So KCL-C can be used as a screening tool of frailty. Finally we recommended for the overall use of the scale, not separate.

目錄
中文摘要 I
英文摘要 III
目錄 V
附件目錄 VII
表目錄 VIII
圖目錄 IX
第一章、緒論 1
第一節 研究背景與重要性 1
第二節 研究動機 4
第三節 研究目的 5
第四節 研究問題 6
第二章、文獻查證 7
第一節 衰弱的定義與特性 7
第二節 衰弱的影響 11
第三節 衰弱的篩檢工具 12
第四節 量表之翻譯 17
第五節 信效度 19
第三章、研究方法 24
第一節 研究設計 24
第二節 研究場域與樣本數 25
第三節 研究過程 26
第四節 研究工具 29
第五節 資料分析方法 32
第六節 研究流程圖 36
第七節 倫理考量 37
第四章、研究結果 38
第一節 中文版高齡者衰弱量表之發展 38
第二節 前驅性試驗個案基本屬性 40
第三節 量表之信度結果 44
第四節 量表之效度結果 45
第五章 討論 48
第一節 中文版高齡者衰弱量表信度討論 48
第二節 中文版高齡者衰弱量表效度討論 49
第三節 中文版高齡者衰弱量表發展之重要性 52
第四節 研究限制 53
第六章 結論與建議 54
第一節 結論 54
第二節 建議 55
參考資料 56
中文部分 56
英文部分 59

附件目錄
附件一、衰弱的篩檢工具 67
附件二、研究工具 74
附件三、人體研究暨倫理委員會同意書 83
附件四、中文版PRQ85量表授權同意書 84
附件五、PRQ85量表授權同意書 85
附件六、日文版KCL量表授權同意翻譯證明 86
附件七、第一版KCL-C專家名單 87
附件八、第二版KCL-C專家名單 88
附件九、第二版KCL-C 89
附件十、KCL-C內容效度專家名單 90

表目錄
表3-1 KCL-C與其次量表之效標對照表 28
表3-2 描述性統計 32
表3-3 推論性統計 34
表3-4 整體適配指標評估標準 35
表4-1 KCL-C內容效度CVI值 39
表4-2 高齡者基本屬性分布情形 41
表4-3 高齡者各量表得分情形 43
表4-4 組內相關係數ICC值 44
表4-5 中文版高齡者衰弱量表適配指標評估結果 45
表4-6 中文版高齡者衰弱量表校標關聯效度檢定結果 47

圖目錄
圖1 研究流程圖 36
圖2 KCL-C驗證性分析圖 46
圖3 ROC曲線 51

中文部分
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英文部分
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