Longitudinal Changes of Physical and Psychological Function and Predictors of Frail Status in Community-dwelling Elderly

• Main Authors: Huei Tzu Hsu, 徐會詞
• Other Authors: P. S. Lin
• Format: Others
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/53708857614271443472

碩士 === 長庚大學 === 物理治療學系 === 102 === Background: Frailty, a geriatric syndrome, is a state of age-related physiologic vulnerability that is characterized by reduced functional reserve and high susceptibility to adverse health outcomes, including disability, dependency, falls, need for long-term care, and mortality. The aims of this study are to investigate the changes of physical and psychological function in elderly with different level of frailty and to identify physical and psychological factors which could predict the occurrence of frailty status 3 years later in older adults. Method: Three hundred and fifty-two non-frail, pre-frail and frail community-dwelling older adults were recruited via convenient sampling from the elderly community and medical clinic of north Taiwan, with baseline mean age 77.4 ±6.5. Physical and psychological functional tests, including 30-s chair stand test (CST), knee extensor strength (KES), functional reach test (FR), timed-up-and-go test (TUG), mini-mental state examination (MMSE) and geriatric depression scale (GDS), were measured annually for 2 years. Generalized estimating equation (GEE) was used to analyze the annual changes of all the variables. Logistic regression analysis were used to describe the associations between baseline physical and psychological factors and the future developing of pre-frail or frail status in the 140 baseline non-frail elderly. Result: There were significant differences between the 3 frailty groups in education level (p=0.03), number of comorbidity (p=0.015), regular exercise habit (p<0.001), KES (p=0.007), 30-s CST (p<0.001), TUG (p<0.001), and FR (p=0.01) at baseline ANOVA analyses. The GEE analyses demonstrated that all participants showed significant performance decline in KES (β= -6.86, p<0.001), 30-s CST (β=-1.38, p=0.013), FR (β=-3.05, p=0.001), TUG (β=1.16, p=0.001) and GDS (β=-0.625, p=0.001) in the 2-year period. At the end of 2- year follow up, frail (β=2.33, p=0.046) and pre-frail (β=1.64, p=0.018) group showed significantly more decline than non-frail group in 30-s CST. In the results of logistic regression, FR was the only test that significantly predicted development of the frail and pre-frail status in 2-year period. For every 1 cm increase in FR measured in baseline, the risk of being in frail status decreased 0.86 times (Relative risk (RR) =0.86, 95%CI= 0.76~0.97, p=0.013). Conclusion: The results of this study suggest that lower extremity muscle strength, balance and emotional status significantly declined annually in community-dwelling elderly. Frail older adults had poorer performance in most physical and psychological tests than non-frail ones. Balance ability decline might be the first sign in elderly who will develop frail status. Muscle endurance and balance tests decline in elderly were highly related to development of frail status.