目的：衰弱問題是近年來老年學研究新興的議題，目前多數國外研究已證實衰弱是失能、住院、入住機構、死亡等不良預後的預測因子，為了防範老年健康狀態的惡化，早期偵測老年人衰弱問題更顯重要。國外研究報告的衰弱盛行率約介於4~27%，與衰弱相關之危險因子涵蓋個人基本特質及健康狀況等。由於老年衰弱的概念與評估尚屬發展階段，目前國內僅有一篇全國性電話調查及以北部都會區門診病人之調查，尚無偏遠社區性的資料。本研究進行台灣偏遠社區老年男性衰弱盛行率及相關危險因子調查，期盼能找出適當的測試方式並充實台灣本土資料。
方法：於2010年7月針對台灣南部高雄縣田寮鄉大於65歲老年男性共1033位進行橫斷性全鄉篩檢田野研究，調查其衰弱盛行率與相關因子。經排除臥床、行動不便、溝通障礙者，共計414位參加檢查，參與回覆率為60.8%。每位受測者皆接受面對面結構式問卷之詢問並蒐集相關危險因子，包括年齡、社經地位、獨居與否、慢性疾病數目、自評健康狀況、日常生活功能、跌倒史、骨折史、手術史、骨質疏鬆症、糖尿病等。同時進行空腹血液生化檢測、骨密度檢測、身體質量指數(BMI)、腰圍、下肢肌肉力量與平衡等身體功能測試。衰弱之盛行率使用三種切點判定比較，分別為Fried於2001年提出判定衰弱的五項指標(符合一至二項指標為衰弱前期，大於等於三項指標為衰弱) 切點判定、以Fried衰弱概念但使用田寮受測者測試結果最低20%之表現為切點及詢問法判定切點等三種方法。
結果：本研究最終取得404位完整受測者資料，平均年齡為74.55± 6.14歲。三種切點判定之衰弱盛行率以Fried切點、田寮最低20%切點及詢問法之無衰弱/衰弱前期/衰弱盛行率分別為49.7%/41.6%/8.7%；51.3% / 37.1% / 11.6%；79.4%/ 18.1%/ 2.5%。另外使用Fried切點及田寮最低20%切點以單變項分析相關危險因子，除了社經地位僅在Fired切點為顯著相關，其餘皆可得相同結果：衰弱與年齡、獨居、日常生活功能失能或工具性日常生活功能依賴、共病症數、骨質疏鬆症及糖尿病呈現正相關，而自覺健康狀況、身體質量指數、30秒坐站測試與30秒開眼單足立測試呈現負相關。以邏輯斯複迴歸分析，發現身體質量指數≧25公斤/公尺2、自覺目前健康狀況不好、工具性日常生活功能依賴或日常生活功能失能(僅Fried切點呈現顯著)、30秒坐站次數偏低為衰弱之獨立危險因子。
結論：本研究結果顯示以測試法評估田寮鄉之衰弱盛行率為8.7%~11.6%。而身體質量指數較低、日常生活功能失能或依賴、自覺目前健康狀況不好及下肢肌力較差之老年男性容易有衰弱問題。由於不同測試法獲得幾乎相同之相關危險因子，在考量標準國際化之推廣性下，建議未來衰弱研究使用Fried於2001提出之切點作為衰弱判定即可，臨床建議可以使用手握力及走路速度作為快速篩檢方式。而詢問法測得之衰弱盛行率及危險因子與其他兩者有較大差異，現階段不建議使用，但詢問法之價值仍需未來長期追蹤研究來證實。

Objective: Frailty is one of the emerging gerontological issues and well recognized to be a predictor of disability, hospitalization, institutionalization, or death in the next few years. Therefore, it’s very important to early detect the frail elders to avoid rapid decline of health condition. The prevalence of frailty reported by foreign countries is around 4-27%. As the concept and assessment of frailty is just beginning, only one nationwide telephone survey and one urban study had been reported in Taiwan. None of the study had been focused on the older population living in the rural community in Taiwan. This study was designed to evaluate the appropriate assessment and enrich the information of frailty in Taiwan.
Methods: Subjects were sampled from 1033 aged 65 and over males lived in the Tianliao District of Kaohsiung City in July, 2010. People who are bed-ridden, impaired walking, or communication disorder were excluded. Participants completed the structural questionnaires, including demographics and general health information, by face to face interview. Physical function examination, fasting blood sampling and bone mineral density measured by DXA were obtained for each subject. All the three methods by either Fried criterion (proposed by Fried in 2001, satisfied 1-2 criteria was pre-frailty, 3 or more criteria was frailty), the lowest 20% of Tianliao’s cutoff or inquiry cutoff were used to evaluate the prevalence of frailty and the associated risk factors.
Result: Of the 404 subjects, the average age is 74.55± 6.14 y/o, the prevalence of the non-frailty/ pre-frailty/ frailty are 49.7%/ 41.6%/ 8.7% by Fried criterion, 51.3%/37.1%/11.6% by Tianliao’s cutoff and 79.4%/18.1%/2.5% by inquiry cutoff method. Subjects who are older, disability or dependent, living alone, having co-morbidities, osteoporosis and diabetes are more likely being frail. BMI, self-report health status, socioeconomic status, lower extremities muscle strength and balance are negatively correlated with frailty. Multiple logistic regression analysis showed that BMI ≧25 kg/m2, poor self-report health status, disability or dependent and lower extremities muscle strength are independent factors for frailty.
Conclusion: The prevalence of frailty among older male lived in remote community is around 8.7~11.6% in Taiwan. The BMI≧25 kg/m2 might be a protective factor for frailty, and people with poor self-report health status, disability or dependent and poor lower extremities muscle are more likely to be frail. For unifying the frailty definition and being comparable with international studies, the Fried criterion was recommended to assess frailty in Taiwan. We recommend using hand grip strength and walking speed to screen frailty quickly. The prevalence and associated risk factors derived from the inquiry method is quite discrepant for practical usage and warranted for further study.

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