門診老年慢性腎臟病病人的衰弱與身體功能表現

Frailty and Physical Function Performance of Elderly Outpatients With Pre-Dialysis Chronic Kidney Disease

背景：慢性腎臟病（chronic kidney disease, CKD）在臺灣是嚴重的健康議題，65歲以上CKD病人透析人數逐年增加，及早辨識老年CKD病人之衰弱狀態對於延緩失能有其重要性。
目的：探討門診未透析老年CKD病人之衰弱狀況、身體功能表現及其風險因子。
方法：採橫斷性研究，以方便性取樣門診老年CKD病人共191位為研究對象；使用工具包括：病人基本資料、臨床衰弱量表、身體功能檢測（包含使用MicroFET 2肌力器、握力器、來回五次坐站所花費的時間）與三公尺計時起走花費時間評估跌倒風險。
結果：發現衰弱者占57.07%，衰弱會受到年齡（p < .001）、腎臟病嚴重度（p = .008）的影響。衰弱組之上下肢重點肌力與功能性肌力均明顯較差，且其跌倒風險較高。年齡、性別、身體功能（含手握力、肱二頭肌肌力、股四頭肌肌力、來回五次坐站所花費的時間、三公尺計時起走花費時間等）與衰弱程度有相關，為衰弱之重要風險因子，可解釋47.7%之總變異量。
結論：臨床醫護人員需重視老年CKD病人衰弱問題，透過篩檢確認腎臟病病人衰弱程度，並評估此族群之身體功能表現，提供合適的腎臟病自我管理方式及制定簡單的運動處方，以維護病人的健康。

Background: Chronic kidney disease (CKD) is a significant health issue in Taiwan, with the number of patients aged 65 and older receiving dialysis increasing annually. Early identification of frailty in older patients with CKD is crucial for delaying the onset of disability.
Purpose: This study was designed to explore the frailty status, physical function performance, and risk factors of older adult outpatients with CKD who have yet to receive dialysis.
Methods: A cross-sectional study was conducted on a total of 191 older adult patients with CKD in an outpatient care setting. The tools used to collect data included a basic patient information datasheet, clinical frailty scale, physical function performance instruments (a MicroFET 2 handheld dynamometer, grip strength dynamometer, and five-time sit-to-stand test), and the timed up and go test.
Results: Over half (57.07%) of the participants were rated as frail, with assignment to the frail group significantly influenced by age (p < .001) and CKD severity (p = .008). The frailty group exhibited significantly poorer upper and lower limb muscle strength and functional strength as well as a higher fall risk than the non-frail group. Age, gender, and physical function (including grip strength, biceps strength, quadriceps strength, five-time sit-to-stand time, and the average of three timed up and go test results) were all found to correlate with frailty severity and were important risk factors, explaining 47.7% of the total variance.
Conclusion: Frailty is a prevalent and critical issue among older adults with CKD. Clinical healthcare professionals should conduct routine frailty screening and physical function performance evaluations in this population. Implementing appropriate self-management strategies and prescribing simple, individualized exercise programs may help maintain health and prevent further functional decline in elderly CKD patients.