社區長者身、心、社會衰弱量表之切點初探：以台北兩行政區為例

Pilot study on cutoff values of physical, psychological and social frailty indexes in Taiwan community-dwelling older people

目標：為提早篩檢長者延緩不良健康結果，探討身體（SOF+緩慢、SOF+握力）、心理 （TFI, Tilburg Frailty Indicator）、社會性衰弱指標（QSFS, Questionnaire to define Social Frailty Status），以及整合性衰弱指標（MSTQ, Modified SOF TFI QSFS Integrated Frailty Tool）合適台 灣族群的最佳切點。方法：收案對象為台灣北部城市兩個行政區的65歲以上長者（行政區一， n=471、行政區二，n=703），以AUC探討工具鑑別力，以約登指數找最適切點。結果：身體 指標「衰弱」≥2分，「前衰」=1分；心理指標「衰弱」≥3分，「前衰」=2分；社會指標「衰 弱」≥2分，「前衰」=1分。整合性衰弱指標「衰弱」≥4分，「前衰」=3分，鑑別力比單一衰 弱面向好。衰弱盛行率方面，行政區(二)身體衰弱（SOF+緩慢）盛行率11.6%；（SOF+握力） 14.5%；心理衰弱9.0%；社會衰弱20.0%；身（SOF+緩慢、SOF+握力）、心、社會整合量表衰 弱24.6%、25.5%。結論：本研究提供身體、心理、社會性衰弱指標之「衰弱」與「前衰」切點 做篩檢標準。身體（SOF+握力）、心理、社會及整合性衰弱指標鑑別力之敏感性比起（SOF+ 緩慢）略好。不過，仍建議依需求選擇適合量表。（台灣衛誌 2020；39(6)：671-685）

Objectives: Screening for frailty among older people to guard them against adverse health outcomes is a crucial task as the population ages. This study sought to find the most optimal cutoff values for physical (SOF-walking speed、SOF-handgrip), psychological (TFI, Tilburg Frailty Indicator), and social frailty indexes (QSFS, Questionnaire to define Social Frailty Status), and Modified SOF TFI QSFS Integrated Frailty Tool (MSTQ) in Taiwanese community-dwelling older people. Methods: The study used cross-sectional survey data in two secondary sets collected from two municipalities in Taipei, with 471 and 703 older adult participants, respectively. Spearman's rank correlation analysis was used to assess the association of three dimensions of frailty. Receiver operator characteristic curves were generated to determine the discriminant functions for these frailty indexes. Results: Modest associations were found between physical, psychological, and social frailty. The full integrated frailty indexes, which combined the three separate indexes, showed an improved discriminant function (cutoff values: frail ≥4, pre-frail = 3) relative to the single index. The cutoff values suggested for Taiwanese older adults was as follows: physical frailty (frail ≥2, pre-frail = 1), psychological frailty (frail ≥3, pre-frail = 2), and social frailty (frail ≥2, pre-frail = 1). Conclusions: Our findings supported the use of the full integrated frailty index and provided cutoff values to screen older community-dwelling people for frailty. The discriminate ability of the MSTQ was better to include SOF-handgrip comparing to include SOF walking speed as physical frailty. Researchers can select either one of the indexes as needed. (Taiwan J Public Health. 2020;39(6):671-685)