中老年HIV感染者孤獨感、復原力及社會支持對衰弱前期之相關性與預測分析

Abstract

背景與目的：隨高效能抗反轉錄病毒治療普及，HIV感染者（People Living with HIV，PLWH）逐漸邁入中老年階段，衰弱成為影響健康老化的重要議題。衰弱前期為衰弱進程可逆的早期階段，臨床上常被忽略，但預後風險顯著，過往研究多聚焦生理層面，心理社會因子尚未被充分探討。為此，本研究旨在探討台灣中老年PLWH之孤獨感、復原力與社會支持對衰弱前期的影響與預測力。 方法：本研究採橫斷式設計，以方便取樣方式招募165位40歲以上PLWH，進行問卷調查與身體測量。研究量表包含Fried衰弱表現型指標、人口學基本資料、中文版UCLA孤獨量表第3版、復原力量表臺灣中文版（RS-25）及中文版醫療社會支持量表（MOS-SSS）。 結果：參與者平均年齡為48.5歲(SD=8.5)，47.9%處於衰弱前期。衰弱前期與感染HIV年數長、慢性共病、高血壓、服用降壓藥物以及曾有發病經驗呈顯著相關。孤獨感與衰弱前期呈正相關（rs=0.234, p<0.01），復原力（rs=-0.157, p<0.05）與社會支持（rs=-0.208, p<0.01）則呈負相關。羅吉斯迴歸顯示，高孤獨感者進入衰弱前期的勝算為2.14倍（95% CI:1.149-3.986, p=0.016），而高復原力（OR=0.30, 95% CI:0.120-0.748, p=0.010）和高社會支持（OR=0.51, 95% CI:0.277-0.955, p=0.035）則為顯著保護因子。此外，感染年數每增加一年，衰弱前期勝算增加約5%（95% CI: 1.003-1.098, p=0.036），有慢性共病（OR=1.91, 95% CI: 1.026-3.570, p=0.041）、高血壓（OR=3.30, 95% CI:1.415-7.709, p=0.006）、長期服用降壓藥（OR=3.31, 95% CI:1.361-8.024, p=0.008）以及曾有發病經驗（OR=2.47, 95% CI:1.103-5.527, p=0.028）為進入衰弱前期之風險預測因子。 結論：孤獨感為衰弱前期的風險因子，而復原力與社會支持具保護效果。研究結果可作為中老年PLWH進入衰弱前期的風險評估指引，及早辨識高風險個案，並適時介入預防衰弱之策略以延緩衰弱進程，促進健康老化。

Background and Purpose: With the widespread use of highly active antiretroviral therapy, people living with HIV (PLWH) are increasingly entering middle and older adulthood, making frailty a crucial issue affecting healthy aging. Pre-frailty is a reversible early stage of frailty that is often overlooked in clinical practice, despite its significant prognostic implications. Previous studies have primarily focused on physical factors, while psychosocial factors remain underexplored. Therefore, this study aimed to examine the effects and predictive power of loneliness, resilience, and social support on pre-frailty among middle-aged and older PLWH in Taiwan. Methods: This cross-sectional study recruited 165 PLWH aged 40 and above through convenience sampling. Data were collected via questionnaire and physical assessment. Instruments included the Fried frailty phenotype, demographic questionnaire, the Chinese version of the University of California-Los Angeles Loneliness Scale Version 3, the Taiwanese version of the Resilience Scale (RS-25), and the Chinese version of the Medical Outcomes Study Social Support Survey (MOS-SSS). Results: The participants had a mean age of 48.5 years (SD = 8.5), with 47.9% classified as pre-frailty. Pre-frailty was significantly associated with longer duration of HIV infection, chronic comorbidities, hypertension, antihypertensive medication use, and a history of AIDS diagnosis. Loneliness was positively correlated with pre-frailty (rs = 0.234, p < 0.01), whereas resilience (rs = -0.157, p < 0.05) and social support (rs = -0.208, p < 0.01) were negatively correlated. Logistic regression analysis showed that individuals with high loneliness were more likely to be pre-frail (OR = 2.14, 95% CI: 1.149-3.986, p = 0.016). High resilience (OR = 0.30, 95% CI: 0.120-0.748, p = 0.010) and high social support (OR = 0.51, 95% CI: 0.277-0.955, p = 0.035) were significant protective factors for pre-frailty. Additionally, each additional year since HIV diagnosis increased the odds of pre-frailty (OR = 1.05, 95% CI: 1.003-1.098, p = 0.036). Having chronic comorbidities (OR = 1.91, 95% CI: 1.026-3.570, p = 0.041), hypertension (OR = 3.30, 95% CI: 1.415-7.709, p = 0.006), long-term use of antihypertensive medication (OR = 3.31, 95% CI: 1.361-8.024, p = 0.008), and a history of AIDS diagnosis (OR = 2.47, 95% CI: 1.103-5.527, p = 0.028) were identified as significant risk factors for pre-frailty. Conclusion: Loneliness is a risk factor for pre-frailty, while resilience and social support serve as protective factors. These findings provide guidance for risk assessment of pre-frailty among middle-aged and older PLWH, facilitating early identification of high-risk individuals and timely implementation of preventive interventions to delay frailty progression and promote healthy aging.