台灣老年衰弱症研究台灣老年衰弱症研究與防制策略與防制策略陳慶餘台大醫學院家庭醫學科台灣老年學暨老年醫學會

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2010/12/162010/12/16 台日高齡化社會研討會台日高齡化社會研討會

Senility: MultiSenility: Multi--systems declinesystems decline

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Psycho-Neuro-Musculoskeletal systemsIncluding Vision, Hearing,

Communication

GastrointestinalEndocrine

Metabolismsystems

Skin system

CardiopulmonaryHemato immune

systems

Genito-Urinary systems

衰老：多重器官系統

功能衰退

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Goal: Early detection and disability Goal: Early detection and disability preventionprevention

(Multi-systems)

早期偵測和失能預防

Normal ageing

Frailty Syndrome

Performance

Pre-Frail

Frailty

Age

Disability

Percentage of people reporting chronic diseases, Percentage of people reporting chronic diseases, by age and number of diseases, Taiwan, 2001by age and number of diseases, Taiwan, 2001

Percent

Source: 2001 NHIS, Taiwan

Chronic diseases indicate stroke, DM, hypertension, and disease of heart, lung, liver, and kidney.

共病症情況

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Geriatric Syndrome –an overlapping concept

AGING-Increased vulnerability to

disease and accidents over time

Geriatric Syndrome

Multidimensional

Unstable

Heterogeneous

DISABILITY-Functional limitations

resulting from impairments

COMORBIDITY-Disease processes

resulting from biology

and exposures

老病失能之關念

Six Concepts of Geriatric SyndromeSix Concepts of Geriatric Syndrome老年病症候群老年病症候群

Aging-related: time factor, life span, how old?

Multi-system involved: psycho-neuro-communication- musculoskeletal axis

Function declining: mobility-centered

Complex etiology: bio-psycho-socio-environmental and spiritual factors, beyond evolution

Poor outcome: vulnerable, disability, medical overuse, mortality

Treatable: the earlier the better

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Common geriatric syndromeCommon geriatric syndrome常見老年病症候群常見老年病症候群

Functional decline, Frailty Fatigue, anorexia, weight loss and

malnutrition 3D’s (dementia, delirium, depression) Sleep disorder, Dizziness Immobility, falls and gait disorder,

Pressure sore Incontinence/chronic constipation Polypharmacy Pain

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Published(255)台灣老年醫學研究 (1989-2008) n %A. Gerontology 74 29.0

1.Biomarker 4 1.6

2.Elder Communication/ Social Activity/ Emotional Reaction 34 13.3

3.Longevity/ Mortality 5 2.04.Quality of Life 26 10.25.Gender Issue 5 2.0

B. Geriatric Syndrome 142 55.71.Frailty / Mobility/ Disability/ Fall 54 21.22.Cognitive/Depression/Dementia/Delirium 49 19.2

3.Nutrition/ Metabolic Syndrome/ Obesity (Body Composition) 17 6.7

4.Other Geriatric Syndrome (Incontinence, vision, sleep, pain, dysphagia, others)

22 8.6

C. Geriatric Care 35 13.41.Disease Prevention 1 0.42.CGA 5 2.03.Home care/ Long-term Care 17 6.74.Palliative Care 1 0.45.Physical Exercise/ Rehabilitation 11 4.3

D. Geriatric Policy and Education 4 1.61.Health Promotion/Integrated care model 4 1.62.Geriatric Education Training 0 0.0 8

Growth in the Number of Papers on Geriatric Growth in the Number of Papers on Geriatric Studies in Taiwan Studies in Taiwan 老年醫學論文數老年醫學論文數

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Breakdown of Papers on Geriatric Syndrome Studies in Breakdown of Papers on Geriatric Syndrome Studies in Taiwan by AuthorTaiwan by Author’’s Academic/ Professional Background s Academic/ Professional Background

老年醫學研究領域老年醫學研究領域

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老化與疾病造成的功能衰退及不良預後之研究架構老化與疾病造成的功能衰退及不良預後之研究架構

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老化

疾病

功能衰退

•自由基•老化細胞•遠端粒縮短

•DNA損害•系統損害/負荷•發炎

•神經退化•癌症•慢性感染

•心血管疾病•糖尿病/肥胖

發炎

代謝改變

神經內分泌失調

獨特性老年病症候群

•瞻妄•憂鬱•貧血•吞嚥困難•便秘•尿失禁•壓瘡•失眠

表現性老年病症候群

•衰弱•體重減輕•耗竭•肌力弱•活動少

共同危險因子

•年齡•認知功能•營養•身體活動•自我照顧能力

不良預後

•跌倒•失能•依賴•死亡

原因 機轉 器官系統功能

身體功能

結果

圖示老年病症候群與衰弱症研究進展圖示老年病症候群與衰弱症研究進展

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衰弱症相關因子及預後研究

新穎生物指標研究

老年病症候群相關研究

老年周全性評估(兩階段)

老化

疾病

功能衰退

•自由基•老化細胞•遠端粒縮短

•DNA損害•系統損害/負荷•發炎

•神經退化•癌症•慢性感染

•心血管疾病•糖尿病/肥胖

發炎

代謝改變

神經內分泌失調

獨特性老年病症候群

•瞻妄•憂鬱•貧血•吞嚥困難•便秘•尿失禁•壓瘡•失眠

表現性老年病症候群

•衰弱•體重減輕•耗竭•肌力弱•活動少

共同危險因子

•年齡•認知功能•營養•身體活動•自我照顧能力

不良預後

跌倒 失能 依賴 死亡

原因 機轉 器官系統功能 身體功能 結果

Frailty Assessment by Revised CriteriaFrailty Assessment by Revised Criteria衰弱症評估指標衰弱症評估指標

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Dr. Fried Criteria Weight loss > 3 kg/yr

Exhaustion: as defined either one question positive◦ (a) I felt that everything I did was an

effort; (b) I could not get going. Low physical activity:

◦ men < 383 Kcal/wk; ◦ women < 270 Kcal/wk

Walk time:◦ men: height <=173 cm, >= 7 sec;

>173 cm, >=6 sec◦ women: height <=159 cm, >= 7 sec;

>159 cm, >=6 sec Grip strength: stratified by gender

and BMI◦ Men: <=29-32◦ Women: <=17-21

Revised Frailty Criteria (Taiwan) Weight loss > 3 kg/yr

Exhaustion: as defined either one question positive

Low physical activity:◦ men < 642 Kcal/wk; ◦ women < 396 Kcal/wk

Walk time:◦ men: >= 7 sec, ◦ women: >= 7sec

Grip strength:◦ men: <=23 kg; ◦ women: <= 14 kg

Frailty Study

Prevalence of FrailtyPrevalence of Frailty社區衰弱症盛行率社區衰弱症盛行率

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Indicators§ N %

Shrinking 52 18.9

Exhaustion 47 17.1

Low physical activity 19 6.9

Slowness 43 15.6

Weakness 129 46.9

Frailty status§(N=275)

Robust 81 29.5

Pre-frail 161 58.5

Frail 31 11.3

Frailty status★§

Robust 228 53.6

Pre-frail 161 37.9

Frail 34 8.0

★N = 425 including subjects with scored 1, 2, 7 of the

CCSHA_CFS_TV

§ There are two cases with missing data

Frailty StudyCommunity

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Factors Associated with Frailty by Factors Associated with Frailty by Multinomial Logistic RegressionMultinomial Logistic Regression

Fried Frailty Index

Pre-frail vs Robust Frail vs Robust

Odds ratio (95% CI) p-value Odds ratio (95% CI) p-value

Age(Years)

65-68 1 1

69-79 2.77(1.54 ~ 5.01) 0.001 7.66(2.22 ~ 26.38) 0.001

Education(Years)

≧ 7 1 1

< 7 1.13(0.57 ~ 2.26) 0.724 13.40(1.55 ~ 116.24) 0.019

0 1.71(0.81 ~ 3.60) 0.157 10.60(1.18 ~ 95.07) 0.035

Barthel Index score 0.93(0.85 ~ 1.03) 0.159 0.87(0.78 ~ 0.97) 0.013

Depression by PHQ9 3.64(1.31 ~ 10.11) 0.013 10.04(2.85 ~ 35.39) < 0.001

95% CI = 95% confidence interval.

age 65-68 as reference group; education equal or more than 7 years as reference group

‧

Frailty StudyCommunity

影響因子影響因子

臨床兩階段周全性老年醫學評估臨床兩階段周全性老年醫學評估

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主訴、現在史、過去史：疫苗、健康行為、手術、住院

目前用藥檢視 社會史：婚姻狀況、家庭情形、照顧者..

系統功能回顧：如跌倒、失禁

情緒狀況 營養評估 理學檢查、身高體重

一般功能評估: ◦ COOP/WONCA Chart;

◦ 簡式症狀量表(BSRS-5); ◦ WHO Quality of Life

日常生活功能評估 特殊功能評估：

◦ 老年虛弱評估◦ 器官系統功能評估 (MMSE.

GDS. MNA. ADL. IADL. DEEPIN)

實驗室檢驗、重要檢查報告 預立醫囑 評估與建議

年齡：80歲以上功能障礙老年症候群:如跌倒、失智、憂鬱、衰弱、失禁、功能下降…預計或已有高度醫療利用

篩檢

評估

CGA

Inclusion criteria: frail Inclusion criteria: frail vsvs nonnon--/pre/pre--frailfrail

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Inclusion criteria Alln=189n（%）

Non & prefrailn=153n（%）

Frail n=36 n（%）

p

Age≧80 70 (37.0) 52 (34.0) 18 (50.0) .073Disease

number≧5110 (58.2) 83 (54.2) 27 (75.0) .023

Polypharmacy≧8 29 (15.3) 19 (12.4) 10 (27.8) .021

Mobility impairment

19 (10.1) 9 (5.9) 10 (27.8) ＜.001

Functional decline 57 (30.2) 51 (33.3) 6 (16.7) .050Fall in recent 1

year52 (27.5) 38 (24.8) 14 (38.9) .089

收案條件

Frailty StudyOPD

Functional Interview: frail Functional Interview: frail vsvs nonnon--/pre/pre--frail frail

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Function review自報功能障礙

Alln=189 n (%）

Non & prefrailn=153

n（%）

Frail n=36

n（%）p

Imbalance 105 (55.6) 75 (49.0) 30 (83.3) ＜.001

Fall in recent 1 year 74 (39.2) 51 (32.7) 23 (63.9) .001

Depressive symptoms 55 (29.1) 33 (21.5) 22 (61.1) ＜.001

Memory impairment 147 (77.7) 112 (73.2) 35 (97.2) .002

Pain 140 (74.0) 108 (70.6) 32 (88.9) .024

Constipation 57 (30.2) 34 (22.2) 23 (63.9) ＜.001

Stool incontinence 22 (11.6) 9 (5.9) 13 (36.1) ＜.001

Urine incontinence 81 (42.9) 60 (39.2) 21 (58.3) .037

Swallowingdisturbance

29 (15.3) 18 (11.8) 11 (30.6) .005

Insomnia 77 (41.0) 60 (39.2) 18 (50.0) .237

Polypharmacy 152 (80.4) 121 (79.0) 31 (86.1) .339

Frailty StudyOPD

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Active problem 活動性疾病

All n=189 n（%）

Non & prefrailn=153n（%）

Frailn=36

n（%）p

Common chronic diseases

Cataract 122 (64.5) 92 (60.1) 30 (83.3) .009

Hypertension 159 (84.1) 131 (85.6) 28 (77.8) .247

Osteoarthritis 90 (47.6) 70 (45.7) 20 (55.5) .289

Diabetes Mellitus 79 (41.7) 60 (39.2) 19 (52.7) .138

Cerebrovascular accident 51 (27.0) 36 (23.5) 15 (41.6) .027

Hyperlipidemia 115 (60.8) 101 (66.0) 14 (38.9) .003

OsteoporosisParkinsonism

34 (18.0) 10 (5.3)

20 (13.1)3 (2.0)

14 (38.9)7 (19.4)

＜.001＜.001

Depression* 17 (9.0) 12 (7.8) 5 (13.9) .254

Anemia*Congestive heart failure DementiaCOPD

13 (6.9)7 (3.7)7 (3.7)

16 (8.5)

8 (5.2)4 (2.6)4 (2.6)

14 (9.2)

5 (13.9)3 (8.3)3 (8.3)2 (5.6)

.065

.102

.102

.486

Common chronic diseases: frail Common chronic diseases: frail vsvs nonnon--/pre/pre--frailfrail

*Examples for further analysis

Frailty StudyOPD

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Associated factors of frailty with logistic regression analysisAssociated factors of frailty with logistic regression analysis

Nonfrail-Frail* Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5

Risk factors OR(95%CI) OR(95%CI) OR(95%CI) OR(95%CI) OR(95%CI)

Age 1.07(1.00,1.3)

Mobility impairment 8.97(3.09,26.03)

14.03 (3.75,52.56)

Fall 2.46(1.07, 5.68)

3.15(1.07, 9.22)

Disease number≧5 3.99 (1.26,12.60)

Polypharmacy≧8 3.97(1.55,10.21)

4.19 (1.13,15.54)

Hyperlipidemia 0.34(0.16, 0.74)

0.23(0.06, 0.68)

Cerebrovascularaccident

2.55(1.13, 5.72)

Cataract 3.61(1.36, 9.58)

Constipation 6.19(2.84,13.50)

5.32 (1.99,14.38)

Pattern 1: Only using baseline demographic data to predict frailty; Pattern 2: Only using inclusion criteria data to predict frailty; Pattern 3: Only using chronic diseases condition data to predict frailty; Pattern 4: Only using self-reported functional review data to predict frailty; Pattern 5: Using baseline demographic data、inclusion criteria data、chronic diseases condition data and self-reported functional review data to predict frailty.

衰弱症相關因子衰弱症相關因子Frailty Study

OPD

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Example I Depressive mood with functional status 憂鬱情緒與身體功能

Frailty StudyOPD

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Example I Depressive mood with frailty by Fried criteria 憂鬱情緒與衰弱症指標

Frailty StudyOPD

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Example II Example II -- Functional indexes and Presence of Functional indexes and Presence of Anemia Status Anemia Status 貧血與貧血與衰弱症衰弱症

Anemia was defined using World Health Organization criteria as a hemoglobin level <13 g/dL for men or <12 g/dL for women.

Frailty StudyOPD

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The crossThe cross--sectional areas of the muscle on both thighs sectional areas of the muscle on both thighs were calculated by tracing around the image. were calculated by tracing around the image. Measurement by software was performed on both legs Measurement by software was performed on both legs simultaneously.simultaneously.大腿核磁共振攝影

MRI StudyOPD

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PearsonPearson’’s Correlations of MRIs Correlations of MRI--measured thigh muscle volumes with measured thigh muscle volumes with anthropometric measurements , BIA and physical function (N=69)anthropometric measurements , BIA and physical function (N=69)

Characteristic Correlation P value Age (yr) -.250 .039＊ Anthropometric measurement

Body height (cm) .645 .000＊ Body weight (kg) .772 .000＊

Body mass index (kg/m2) .453 .000＊ Waist size (cm) .384 .001＊

Thigh circumference (cm) .480 .000＊ Physical function

Physical activity (kcal) .037 .760 Grip strength (kg) -.077 .532

Quadriceps muscle power (kg) .467 .000＊ Up and go (sec) -.337 .005＊ Walk time (sec) -.347 .003＊

Bioelectrical impedance analysis Fat mass (kg) .150 .221

Free-fat mass (kg) .775 .000＊ Predictive muscle size (kg) .773 .000＊

＊P<0.05, indicating a significant variable in the two-tail Pearson correlation test. † categorical data (gender and Chair rise) were not analyzed.

體位測量

身體功能体

生物電阻分析:體脂儀

MRI StudyOPD

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Thigh muscle volume prediction formulaThigh muscle volume prediction formula

換算公式Thigh Muscle volume (cm3, by MRI) = 4226.3－42.5 × Age (year)－955.7 × gender (male=1,female=2)+ 45.9 × body weight (kg) + 60.0 × thigh circumference (cm)

r2 = 0.745, P < 0.001Standard Error of the Estimate = 581.6cm3

MRI StudyOPD

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PearsonPearson’’s Correlations of predicted thigh muscle s Correlations of predicted thigh muscle volumes with BIA and physical function (N=189)volumes with BIA and physical function (N=189)

Characteristic Correlation P value Physical function

Quadriceps muscle power (kg) .481 <.001＊ Up and go (sec) -.113 .128

5m Walk time (sec) -.136 .066

Bioelectrical impedance analysis Predictive muscle mass (kg) .889 <.001＊

＊ P<0.05, indicating a significant variable in the two-tail Pearson correlation test.

預測大腿肌肉量與身體功能和體脂儀之結果一致。

MRI StudyOPD

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Thigh muscle volume, strength and gait speed in Thigh muscle volume, strength and gait speed in three Frail Groups by Fried criteria (N=189)three Frail Groups by Fried criteria (N=189)

Fried Robust(n = 46)

Pre-frail(n = 106)

Frail(n = 37)

pPost-hoc

Female 24 (52.2%) 52 (49.1%) 22 (59.5%) .551

Age 74.9 ± 6.6 77.6 ± 6.1 79.0 ± 4.8 .006 R<PF,F

Estimated Muscle Volume (cm3)

5048.4 ± 969.1 4984.6 ± 1044.7 4619.8 ± 758.2 .097

Muscle Index 27.05 ±4.98 24.05 ±5.79 24.83 ±5.83 .011 R>PF

Appendicular Muscle Mass (kg) 17.0 ±4.0 17.0 ±4.1 15.2 ±2.7 .049

Thigh Muscle Strengtha (nt) 139.5 ± 24.6 122.9 ± 31.1 118.1 ± 25.5 .001 R>PF,F

Up-Go Test (sec) 8.8 ± 2.4 13.0 ± 8.0 21.5 ± 13.9 .000 R<PF<F

5m Walk (sec) 4.04 ± 0.93 6.47 ± 3.88 11.42 ± 10.55 .000 R<PF<F

Muscle Index = 1000* (muscle strength/muscle volume) 預測大腿肌肉量與衰弱程度之檢定

MRI StudySarcopenia

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11--yr follow up Frailty prediction yr follow up Frailty prediction

Predicting Variables

Dependent Age Muscle Index Up and Go Model Variables beta p beta p beta p R2

Frailty Score .220 .004 -.222 .003 .370 .000 .243

WONCA-COOP -- -- -.181 .019 .338 .000 .137

WHOQOL

Physical -- -- -- -- -.236 .004 .049

Psychological -- -- -- -- -.190 .021 .030

Note: -- variable did not enter in the model

預測大腿肌肉量預測一年後衰弱指數

MRI StudySarcopenia

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Association of different biomarkers with FrailtyAssociation of different biomarkers with Frailty

Fulop T et al: aging frailty and age-related diseases. Biogerontology 2010

生物指標

Biomarker

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Comparison of various cytokines with frail statusComparison of various cytokines with frail status細胞激素

Biomarker

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Characteristics of study participants with insufficient vitamin D status 維生素D 缺乏Characteristics(categorical) Total 25(OH)D<20 (N=66) 25(OH)≧20 (N=147) p-value Gender(female) 126(59.2) 49(74.2) 77(52.4) 0.003

Fried Frailty Indicators robust 73(34.3) 12(18.2) 61(41.5) < 0.001 prefrail 119(55.9) 41(62.1) 78(53.1) frail 21(9.9) 13(19.7) 8(5.4) Timed Up and Go(sec) 0.001 0-10 129(60.6) 30(45.5) 99(67.3)

11-20 81(38.0) 33(50.0) 48(32.7) ＞ 20 3(1.4) 3(4.5) 0

Fall history in one year 57(26.8) 20(30.3) 37(25.5) 0.468

Disturbing pain 65(30.5) 34(51.5) 31(21.4) < 0.001 Depression 31(14.6) 25(37.9) 6(4.1) < 0.001 Self-reported memory impairment 119(56.4) 43(65.2) 76(52.4) 0.084 characteristics(continuous)

Age(Years) 71.1(3.9) 71.3(4.0) 71.0(3.9) 0.603

Body mass index (kg/m2) 25.3(3.5) 24.6(3.8) 25.7(3.3) 0.034 Number of comorbidity 3.4(2.0) 3.8(2.2) 3.1(1.9) 0.045 MMSE 25.1(3.7) 24.4(4.1) 25.4(3.5) 0.113

Barthel Index score 98.5(4.2) 98.0(5.7) 98.8(3.3) 0.735

Vitamin D insufficiency = 25-hydroxyvitamin D < 20 ng/mL; Depression including mild, moderate, moderately severe

depression by PHQ9 (Patient Health Questionnaire 9 assessment); MMSE: Mini-mental State Examination. P indicates t-test for continuous variables, and the χ

2 or Fisher exact test for categorical variables.

Vitamin D insufficiency Prevalence rate :31%

Vit DCommunity

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Frailty Level with the Frequency of Recent 1 year Admission, Emergency Visit and Fall Analysis

Item預後項目

Robust (N=39)

Pre-frail(N=87)

Frail(N=27)

Linearity p

Adjusted p

Post-hoc

Ad time 0.10 ± 0.31 0.21 ± 0.46 0.56 ± 1.05 .002 .006 1＜3

ER time 0.10 ± 0.31 0.29 ± 0.68 0.81 ± 1.39 .000 .001 1＜3

Ad+ER time 1.14 ± 0.38 1.72 ± 1.06 3.70 ± 2.36 .001 .001 1＜3

Fall time 0.41 ± 0.68 0.89 ± 1.86 1.22 ± 1.95 .053 .134

Frailty outcome

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Comparison of Geriatric Assessment between Baseline and 1year Follow-up Analysis

Baseline After 1yr follow-up

Item Frail group Mean (SD) Mean (SD) t p

自評功能 (WONCA)

Robust 14.13 (1.66) 13.90 (1.45) 1.120 0.270

Pre-frail 15.36 (2.72) 15.60 (2.88) -0.850 0.398

Frail 18.11 (3.76) 19.52 (4.94) -1.455 0.158

簡式症狀 (BSRS-5)

Robust 3.56 (2.90) 2.82 (2.25) 2.069 0.045

Pre-frail 3.46 (3.51) 2.93 (3.38) 1.500 0.137

Frail 4.96 (4.42) 5.15 (5.39) -0.288 0.776

簡式智能評估 (MMSE)Robust 28.05 (2.41) 27.72 (2.51) 1.242 0.222

Pre-frail 26.09 (3.86) 25.63 (4.31) 2.031 0.045

Frail 21.30 (5.88) 21.00 (6.03) 0.365 0.718

老年憂鬱症狀 (GDS)

Robust 2.21 (2.14) 2.18 (2.21) 0.091 0.928

Pre-frail 3.38 (3.53) 3.23 (3.46) 0.517 0.606

Frail 7.93 (4.60) 7.00 (4.38) 1.335 0.194

迷你營養評估 (MNA)

Robust 26.78 (1.89) 26.51 (1.91) 1.452 0.155

Pre-frail 26.18 (1.80) 25.65 (2.25) 2.653 0.010

Frail 22.72 (2.38) 22.46 (2.98) 0.373 0.712

巴氏 (Barthel)

Robust 99.87 (0.80) 99.74 (1.12) 1.000 0.324

Pre-frail 97.87 (5.37) 97.36 (5.75) 1.085 0.281

Frail 89.07 (17.76) 82.78(26.25) 2.185 0.038

工具日常生活功能(IADL)

Robust 6.69 (1.56) 6.28 (1.50) 2.343 0.024

Pre-frail 5.66 (1.81) 5.39 (1.85) 1.983 0.051

Frail 4.41 (2.04) 3.78 (2.36) 2.148 0.041

Frailty outcome

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Frailty level with the score changes of quality of life (QOL) between baseline and after 1 year follow-up analysis

Baseline After 1yr follow-up

Item Frailty group Mean (SD) Mean (SD) t p

Robust 14.54 (2.02) 13.90 (1.57) 2.709 0.010

Physiological domain Pre-frail 14.13 (2.27) 13.84 (2.28) 1.348 0.181

身體 Frail 12.70 (1.94) 12.41 (2.47) 0.625 0.537

Robust 13.44 (2.10) 13.26 (2.04) 0.685 0.497

Psychological domain Pre-frail 13.02 (2.35) 12.55 (2.54) 1.990 0.050

心理 Frail 10.63 (2.91) 11.04 (3.67) -0.635 0.531

Robust 13.87 (2.41) 12.92 (1.61) 3.088 0.004

Social domain Pre-frail 13.23 (2.55) 12.82 (2.16) 1.667 0.099

社會 Frail 12.22 (3.33) 11.52 (2.75) 0.945 0.354

Robust 13.95 (2.37) 13.26 (1.57) 2.610 0.013

Social domain (Taiwan) Pre-frail 13.62 (2.15) 13.11 (1.77) 2.380 0.020

Frail 12.74 (3.56) 11.93 (2.50) 1.354 0.187

Robust 14.56 (1.65) 14.08 (1.44) 2.155 0.038

Environmental domain Pre-frail 15.01 (1.93) 14.61 (2.37) 1.624 0.108

環境 Frail 14.70 (1.98) 14.22 (2.39) 1.235 0.228

Environmental domain Robust 14.82 (1.54) 14.28 (1.40) 2.448 0.019

(Taiwan) Pre-frail 15.07 (1.87) 14.63 (2.25) 1.858 0.067

Frail 14.85 (1.96) 14.15 (2.40) 1.927 0.065

生活品質

Frailty outcome

First Stage Telephone Screen (N=2900)

Second Stage Hospital Screen

Eligible, N=548

Category 3 n = 236

Category 4 n = 224

Category 5 n = 69

Category 6 n = 19

Excluded, N=2352

Not-eligible (Category 1 n=206、Category 2 n=86、Category 7 n=5)

Refusal n=998, communication barrier n=43,

can’t reach after 3 attempts n=1004,

death n=6, institutionalized n=4

Randomization, N=159

Refuse, N=274

Refusal, N=38

Baseline assessment, N=121 (Enrolled)

Intervention Assessments, N=117

CHS_PCF evaluation, N=274

Robust n=80

Pre-frail n=161

Frail n=31

Missing n=2Excluded, N=115

Robust n=62

Other exclusion criteria n=52

Refusal, N=4

收案流程圖 社區老年人整合型照護計畫Community Intervention

受試者在介入前之比較受試者在介入前之比較社區老年人整合型照護計畫

Community Intervention

受試者在介入後衰弱症評估結果受試者在介入後衰弱症評估結果社區老年人整合型照護計畫

Community Intervention

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2020健康白皮書老年族群健康指標

衰弱及失能之防治跌倒及骨折之防治憂鬱症及自殺之防治復健及中風後失能之防治預立指示之簽署與執行

知識轉譯知識轉譯

40

目標與因應策略彙整表

2020健康國民白皮書:高齡化族群

目標 積極老化/預防失能指標 老人衰弱及失能之防治因應策略

1. 規劃老人衰弱防治策略，透過立法，整合各部會資源。

2. 研訂老人衰弱篩檢表，推廣自我篩檢、老人健檢、社區篩檢。

3. 結合縣市政府或社群團體，發展社區篩檢及社區運動，並透過社區志工、學生社團或學生服務，關懷社區老人。

4. 強化基層家庭醫師之老人照護。

5. 強化老年專科醫師之周全性老年評估

6. 加強老人及家屬/照顧者之衰弱察覺與照護。

7. 落實社區健康中心老人照護團隊服務。

8. 建立各層級老人照護制度、相關品管與財務規劃。

9. 加強老人衰弱相關研究，找出衰弱危險因數及有效介入。

知識轉譯

AcknowledgementAcknowledgement

Research team members Case managers 陳慶餘醫師 Chen, CY

陳晶瑩醫師 Chen,Crystal CY

嚴崇仁醫師 Yan, CR

劉文俊醫師 Liu, WC

郭旭格醫師 Kuo, HK

陳人豪醫師 Chen, JH

詹鼎正醫師 Chan, DC

張皓翔醫師 Cheng, HS

蔡兆勳醫師 Tsai, JS

吳治勳博士Wu, CH

呂貝蕾 Bei-Lei Lu

林妤嬪 Yu-Ping Lin

林美月Mei-Yeh Lin

張淑玲 Shu-Ling Chang

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Thank you for your attentionThank you for your attention

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