The Validity and Reliability of Osteoporotic Fractures(SOF) scale：Cases of the Elderly Living in Community and Elderly Persons Living Alone in Taiwan

• Main Authors: Bei-Yu Hu, 胡倍瑜
• Other Authors: 陳雅美
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/4rdw5z

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 107 === Background and purpose：Disability have become a critical issue in Taiwan due to the rapidly growing aging population. In 2002, WHO introduced the concept of active aging as well as emphasizing the importance of disability prevention for the elderly. Taiwan’s Ten-Year Long-Term Care 2.0 policy has also expanded long-term care service to the older adults with frailty, in order to prevent further disability. However, the tools for measuring frailty remains controversial, especially in Taiwan. It is more common in the world to use Fried’s Frailty Phenotype index to measure frailty. However, Taiwanese governments use the Study of Osteoporotic Fractures index (SOF index) to assess the degree of frailty for the purpose of easy application. The purpose of this study was to assess and compare the tool properties of the SOF index and the Fried’s Frailty Phenotype index in general community-dwelling older adulating living in Nai-King communities in Taiwan. In addition, since previous studies have indicated that older adults living alone may be lack of social support, and therefore may be with poor mental health comparing to other community-dwelling older adults. Thus, the present study also intended to discuss whether there were different assessment results between the group of older adults living alone and community-dwelling older adults when using the two frailty scales. Method：This study was a cross-sectional survey study and the data was collected using purposive sampling. We collected 369 general community-dwelling older adults and 102 older adults who were living alone from Nangang District of Taipei City. All participants were above 65 years old. For data analysis, (1) Spearman’s Rank Correlation Coefficient was adopted to understand the association between frailty as measured by the Fried’s Frailty Phenotype index and the SOF index. (2) Area under the curve (AUC) analysis and multiple regression analysis were used to test respective models by measuring the predictive validity of fall and IADL disability from Frailty Phenotype index and SOF index. (3) Chi-square test and multiple logistic regression analysis were applied to evaluate the applicable index for elderly who lives alone. Results：Using the Fried’s Frailty Phenotype index, 10.6% and 57.7% of the overall participants were assessed as frail and prefrail respectively. Using the SOF index, 8.1% and 36.3% were assessed as frail and prefrail respectively. The Spearman’s Rank Correlation Coefficient showed moderate association (r = 0.510, p < 0.001) between the Fried’s Frailty Phenotype index and the SOF index. However, these two frailty indexes were inconsistent with their ability to predict fall and disability. Besides, this study also compares with the difference between the older adults who lived alone and the community-dwelling older adults. The result of AUC showed that the SOF predicted fall better (AUCSOF=0.657, AUC Fried’s Frailty Phenotype =0.642, p <0.001) and the Fried’s Frailty Phenotype index predicted IADL disability better (AUCSOF=0.657, AUC Fried’s Frailty Phenotype =0.642, p <0.001). With covariates included, using the Fried’s Frailty Phenotype index showed that older adults who were living alone had a higher risk of becoming prefrail (OR prefrail = 0.309, p <0.001) and frail (OR frailty = 0.092, p <0.001) when compared to the general community-dwelling older adults. However, using the SOF index showed that older adults who were living along had an equal risk of becoming prefrail (OR prefrail = 1.185, p = 0.707) and higher risk of becoming frail (OR frailty = 0.304, p < 0.001) comparing to the general community-dwelling older adults. Moreover, the AUC comparisons revealed Fried’s Frailty Phenotype index is more sensitive to predict the risk of fall and disability (AUC fall = 0.688; AUC disability =0.676). Therefore, people who live alone suitable for using Fried’s Frailty Phenotype index to evaluate their frailty status. Conclusions and recommendations：We found that the SOF index is a validated tool to evaluate frailty especially for general community-dwelling older adults in Taiwan. However, the Fried’s Frailty Phenotype index is more sensitive for the elderly who lived alone. Our study findings support the long-term care policy which used the SOF index to screen and measure frailty regulations by the Taiwanese governments. We recommend that the SOF index and indicators of slowness should be combined used for measuring the status of frailty among older adults who live in the community. In addition, we also recommend that the SOF index and indicators of slowness and weakness should be combined used for measuring the status of frailty among older adults who live alone. To support healthy aging and disability prevention is an important challenge for public health in Taiwan, with a good tool to t evaluate frailty status will greatly contribute to success.