老人衰弱之概念分析

A Concept Analysis of Frailty in the Elderly

衰弱一詞在老年護理，普遍被用來形容虛弱或有日常活動功能障礙的老年人，此概念雖與共病性和失能有相關，但並非相同的概念，有關此概念之真正意涵、影響因素與測量方式在文獻中缺乏較完整的釐清與整理，故本文以Walker和Avant（2005）所提方法進行老年衰弱之概念分析。先廣泛查證此概念定義，確認其定義性特徵，並以典型、邊緣、相關及相反案例來做說明，確認前因後果和列舉出常見的實證性參考指標。經分析結果顯示衰弱的定義性特徵為：（1）是一進展性的過程與狀況。（2）包含多面向的概念，個案出現身體衰弱及至少一項其他功能不足，包括生理、心理、認知及社會功能。（3）處於易受傷害及發生不良健康結果的狀況中，如生病、住院、死亡、跌倒、失能和入住機構。希望藉此概念分析結果增進護理人員對老年衰弱概念的瞭解，進而在護理實務中評估及運用此概念。

In gerontology nursing, the term ”frailty” is generally used in relation to the weak elderly or the elderly who have difficulties in activities of daily living. Although the concept of frailty is related to comorbidity and disability, these are different concepts. On its true meaning, influencing factors and measurements, there is a lack of clarification and organization in the literature. This paper applied the methodology outlined by Walker & Avant (2005) to analyze the concept of frailty in the elderly. The analytical procedures included a literature review of conceptual definitions of frailty, and identification of defining attributes. Using constructing model, borderline, related and contrary cases to explain the concept of frailty; and identifying its antecedents and consequences. Empirical referents are also outlined. Result shows that defining attributes of frailty are: (1) a progressive condition, (2) a multidimensional concept, apparent physical frailty and at least one other deficiency (including physiological, psychological, cognitive, and social function), (3) vulnerability to suffering from adverse health outcomes (e.g. illness, hospitalization, death, falls, disability and institutionalization). This analysis might improve nursing staff’s knowledge and understanding of the concept of frailty in the elderly, and enable nurses to apply the concepts in nursing practices.