研究背景
老年健康問題的特性，為多重病因、表現不典型，並涉及身體、心理、社會及功能等面向，以及認知功能衰退、憂鬱、衰弱、跌倒、營養不良、用藥、失眠等老年病症候群問題。在臨床上可透過周全性老年醫學評估(簡稱CGA)，經全面性地評估與跨專業的共同處置，可改善生活品質、降低失能與死亡風險，但缺點是須由受過訓練的專業人員執行且耗時。所以本研究期望從預防的角度出發，統整篩檢指標架構並擬定題目，結合周全性評估和篩檢方便的優點，設計出簡單合適且有效，能讓老年人與家屬或照顧者可自行填寫的「老年健康狀況篩檢問卷」，以此擴大篩檢，從無症狀的群體中及早發掘可能有潛在老年健康問題者。

研究方法
研究分三階段進行。第一階段為綜合老年健康篩檢指標性面向研擬問卷，進行專家效度審查後制定「老年健康狀況自我篩檢問卷」做為研究工具。第二階段採用橫斷式研究方法(cross-sectional study)，2020年06月至2021年01月於某大學醫院老年科門診與病房，針對年齡65歲以上、預定進行CGA之高齡患者進行收案，邀請老年人或家屬照顧者填寫篩檢問卷。第三階段為追蹤填寫問卷後的第12個月和第24個月的存活與死亡情形。最後綜合篩檢問卷、CGA評估結果、臨床醫師診斷資料與追蹤情形，進行統計分析。建構研究工具部分採取專家效度審查、信度分析、探索性因素分析，並與CGA評估資料比對相關係數。基本人口學與追蹤情形，以描述性統計、卡方檢定、t檢定、二元邏輯式迴歸分析各健康面向問題與死亡之相關性。以ROC曲線及Youden’s index驗證與死亡相關之最佳切點，Kaplan-Meier資料分析篩檢問卷總分與死亡風險之相關性。

研究結果
建構研究工具之專家校度審查，各題I-CVI值皆達滿分1分，整體信度Cronbach’s α係數為0.893，皆達優良量表的標準，最終制定14個老年健康面向、總計25題之篩檢問卷。因素分析結果將整體問卷面向歸類老年健康問題和感官兩大類。與CGA的相關性分析結果，整體組的相關係數範圍為0.256至0.803，尿失禁、跌倒和日常生活功能相關性較高(0.695至0.803)。為使問卷能篩檢出健康風險程度，最終選定低分與高分的二切點分別為「14、28」，以此結果設定三個等級分數範圍：正常：< 14分；有風險：14~27分；高風險：≧28分。追蹤24個月存活與死亡情形，邏輯式迴歸分析結果顯示年齡越高、問卷總分越高、需要他人照顧者，以及社會功能、日常生活功能、行動能力差，頻繁發生跌倒與尿失禁、營養不良和認知功能較差，皆是顯著影響死亡因子，尤其行動能力差(OR：7.74, 95% CI：2.31-26.0)更是為影響死亡最重要危險因子。最終以Cox迴歸分析三個不同分數組別：< 14分、14~27分、≧28分對存活時間的影響程度，在控制年齡與性別後，結果顯示14~27分組(HR：6.87, 95% CI：1.59-29.77)和≧28分組(HR：13.52, 95% CI：3.00-60.94)比<14分組對死亡風險影響更加顯著。

研究結論
研究結果顯示，透過老年健康狀況自我篩檢問卷詢問，除了能發現現存老年健康問題，問卷總分也可預測其存活風險以及找出影響死亡的危險因子。相較於CGA評估，本問卷無需經過訓練，僅需自我填答或代填，執行時間較短，約5-15分鐘內即可完成。期望未來能在社區，以此問卷先做為篩檢老年健康問題的第一步，當得分接近14分時，建議轉至專業人員進行CGA評估，並提供適當的醫療照護計畫和預防措施，以降低老年人的健康風險，也能進而減輕專業人員工作負荷與醫療院所的成本。若接近28分時，顯示已有多個健康問題且程度較為嚴重，除CGA評估外，在擬定照護計畫並積極執行介入時，也應納入預立醫療計畫的討論。

The study explores geriatric health issues, proposing a comprehensive Elderly Health Self-Screening Questionnaire for self-administration. Utilizing a three-phase approach, the study integrates expert validation, cross-sectional analysis, and longitudinal tracking to predict survival risks and identify mortality-influencing factors. Findings reveal a high correlation between the screening questionnaire and Comprehensive Geriatric Assessment (CGA) results, underscoring its potential as an early screening tool.

The finalized 25-question questionnaire, validated through expert review, demonstrates excellent reliability. Factor analysis categorizes it into general health and sensory dimensions. Notably, urinary incontinence, falls, and daily life functionality exhibit high correlations. Cutoff points are established to classify risk levels: Normal (< 14), At risk (14-27), and High risk (≥ 28).

Logistic regression indicates that factors like older age, higher questionnaire scores, dependency on caregivers, impaired social and daily life functionality, mobility issues, falls, urinary incontinence, malnutrition, and cognitive decline significantly impact mortality. Impaired mobility emerges as the most critical risk factor.

Cox regression, controlling for age and gender, underscores the 14-27 and ≥ 28 point groups' heightened mortality risk compared to < 14 points. The study concludes that the self-administered questionnaire, facilitating early detection, could be instrumental in community-based screening. Prompt Comprehensive Geriatric Assessments can then guide tailored medical care plans, mitigating mortality risk, and easing healthcare professional workloads while reducing institutional costs.

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