社區型健走運動與生活品質相關性之探討—以衰弱為中介變項

Abstract

研究背景與目的：目前臺灣為老化速度最快的國家之一，可預期人口老化伴隨著失能風險提高，將為家庭及社會帶來沈重的照護與財務負荷，因此尋找有效維持健康與延緩失能的運動模式為當務之急。過去研究顯示長者衰弱會提高失能的風險，並會有較差的健康相關生活品質，兩項指標皆會導致不良的健康結果。健走運動為長者最常見且喜愛的運動項目，臺北市南港區社區型健走運動已經推廣十年以上，但是社區型健走運動和長者衰弱的相關性也未獲驗證，對於健康相關生活品質並無一致結論，因此本研究目的為探討健走運動、衰弱與健康相關生活品質之相關性，並進一步觀察衰弱在健走運動及健康相關生活品質當中，是否存在中介效果。 研究方法：本研究採橫斷性問卷調查，並以立意取樣的方式於臺北市南港社區進行收案，訪問參與南港區健走計畫的100位長者，以及至各社區關懷據點、社區篩檢場域訪問271位以上一般社區長者。研究以面訪方式評估基本人口學特質，並使用Fried’s Frailty Phenotype衰弱評估量表、歐洲健康相關生活品質(EuroQuol-5Dimensions)衡量長者衰弱與健康情況。在控制其他變項之後，以複迴歸分析比較是否參與社區型健走運動，在於衰弱程度及健康相關生活品質之差異，並進一步驗證衰弱的中介效果。 研究結果：相對於未參加社區型健走運動的一般社區長者，健走隊成員的衰弱指標分數偏低(=-0.199, p = 0.053)，進入衰弱前期(OR=0.55, p =0.023)、衰弱階段(OR=0.216, p = 0.049)的風險顯著偏低，並有程度上的差異；在健康相關生活品質的方面，研究結果發現健走隊長者自評健康分數EQ-5D VAS顯著偏高(=5.277, p < 0.001)，但在生活品質EQ-5D方面無顯著差異。本研究亦發現衰弱程度越嚴重其整體健康相關生活品質顯著較差(=-5.410, p < 0.001)，進一步探討三者之間相關性，發現衰弱為參與社區型健走運動、自評健康分數之間的顯著部分中介變項(partial mediation)，參與健走老年人若有其他相關因子造成衰弱，則會對老年人的生活品質有負面的影響。 結論：本研究探討相對低成本的社區型健走運動模式成效，結果顯示參與健走運動相較於未運動的一般民眾有更低的衰弱風險，值得進行大規模的推廣，但針對運動頻率，建議須至少達到每周150分鐘以上的累積運動時數，對於健康相關生活品質提升幅度可較為明顯。衰弱和較差的健康相關生活品質顯著相關，並會改變健走與生活品質的關聯性，由此再次驗證衰弱為值得重視的議題，因為即使長者有參與社區型健走運動，若有其他相關因子導致長者衰弱，可能會減弱改善健康相關生活品質的幅度，進而降低健走運動的成效，故建議政府增加民眾對於衰弱議題的健康意識，重視衰弱預防以達到延緩失能的目的。

Background: Taiwan is one of rapidly aging countries in the world and faces many challenges of promoting older adults’ physical function. The risk of disability increases as the population aging and may result in heavy financial and care burden on both family and Taiwanese society. It is imperative to initiate effective health promotion programs to maintain older adults’ independence and prevent frailty and even disabilities. Previous studies revealed that frail older adults have higher risk of disability and poor health related quality of life. Both frailty and low quality of life could lead to poorer health outcomes. Walking exercise is the most common and preferable physical activity among Taiwanese elderly. Nangang communities in Taipei City have long history of promoting community-based walking programs. However, very few studies have investigated the relationships between community-based walking exercise and frailty status in Taiwanese older adults. Therefore, the purpose of the study is to evaluate the community-based walking programs in Taipei cities and examine the relationships between community-based walking exercise, frailty, and health-related quality of life; and we will further observe the mediating effect of frailty between walking exercise and health-related quality of life. Methods: This study was a cross-sectional design survey study. The study subjects were the community-dwelling older adults who lived in Nangang communities in Taipei City. We have recruited 100 older adults participating in neighborhood walking programs and 271 older adults from Nangang communities. The Fried’s Frailty Phenotype Scale, European Health-Related Quality of Life (EuroQuol-5 Dimensions) were used as measurements for all participants. With covariates controlled, we used multiple logistic regression and multiple linear regression analyses to evaluate the effect of community-based walking program in frailty and health-related quality of life, and test the mediation effect of frailty between walking exercise and health-related quality of life. Results: Compared with the general community elders, the community-dwelling elderly who have participated in the community-based walking exercise had lower frailty score (β=-0.199, p = 0.053), and were significantly associated with lower risk of becoming pre-frail (OR=0.55, p =0.023) and frail (OR=0.216, p = 0.049). In terms of health-related quality of life, the elderly in the walking exercise group had better self-rated health (β= 5.277, p < 0.001). This study has also found that frailty has strong negative correlation with poor health-related quality of life (p < 0.001). Further analysis showed frailty as an inconsistent mediator of the relation between walking exercise and self-rated health. Conclusion: The results indicated that community-based walking exercise could maintain health, but it is recommended that walking group should engage in physical activities for at least 150 minutes per week in order to improve health related quality of life. Although the results showed that the community elders could benefit from community-based walking exercise, they may still perceived lower quality of life if they developed frailty conditions. Therefore, it is suggested that the government should raise the public awareness and understandings about frailty, which will also be recommended to be included for future studies assessing the effects of older adults’ walking exercise on quality of life.