高齡病人儲備生理能量、內在能力和生理復原力之概念模型
高齡病人儲備生理能量、內在能力和生理復原力之概念模型
世界衛生組織(WHO)提出2021 -2030年為健康老化的十年，強調發展及維持功能是基於「內在能⼒」與環境之間的交互作用，故內在能力為健康老化的關鍵，定義為「個人可以利用的身體和心理能力」，包含行動能力、活力、心理能力、認知能力及感官能力 (視覺及聽覺)。然而，人生不可避免會遇到壓力事件（如疾病、外傷或喪親等），僅有內在能力尚且不足，還需具備從壓力事件恢復功能之生理復原力，才能達到健康老化的理想。基於老化理論，團隊提出了⼀個概念模型，探討儲備生理能量、內在能⼒和生理復原力之間的關係。模型指出⼈⼝因素（例如: 年齡、⼼理社會因素、健康⾏為和遺傳）透過儲備生理能量（例如:慢性疾病）作為生理復原力的先決因素，並假設儲備生理能量會透過內在能⼒而影響生理復原力，進而決定高齡病人預後。因此，規劃提升內在能力的介入措施，可做為高齡者生理復原力的重要因素；而提升生理復原力，則能增進正向健康結果及生活品質。
於台灣南部某醫學中心進行收案，共納入413位高齡病人，平均年齡為76.3歲，以女性居多佔52.5%，模型路徑顯示儲備生理能量(以老年病累積疾病評估量表[CIRS-G]評估)與內在能力(行動能力以凱茲日常生活活動功能[Katz ADL]評估、認知功能以簡易心智狀態問卷調查表[SPMSQ]評估)有顯著正相關(r=0.123, p<.01; r=0.904, p<.001)；此外，內在能力(行動能力、心理能力[以五題式老年憂鬱量表[GDS-5]評估]、認知能力)與生理復原力(以高齡者生理復原力量表[PRIFOR]評估)有顯著相關(r=0.343, p<.001; r=-0.383, p<.001; r=0.156, p<.01 )。探討內在能力與預後之關係，顯示只有行動能力與預後有顯著相關(p<.001)，包含衰弱(r=0.123, p<.01)及生活品質(r=0.77, p<.001)；而生理復原力與衰弱呈現負相關(r=-0.122, p<.01 )及生活品質呈現正相關(r=0.121, p<.01)。透過本研究確認影響健康老化的決定因素，有助於政策制定者提供有效的介入措施，以提升高齡病人的內在能力及生理復原力，進而增進正向健康結果。
1.高齡病人具備良好的內在能力，可以促進生理復原力。
2.規劃提升高齡病人的內在能力及生理復原力之介入措施，可改善出院預後。
【研究團隊】
團隊成員：胡芳文、岳芳如、方姿蓉、張家銘、林宗瑩
代表單位：護理學院
團隊簡介：胡芳文副教授帶領的研究團隊長期致力於高齡照護相關研究，主要研究方向包括老年病症候群(衰弱、肌少症)、內在能力、認知衰弱、急性高齡病人照護、生理復原力、嗅覺刺激、科技運用於高齡照護、及高齡照護教育。
研究聯繫Email：kokojhlin@gmail.com
【論文資訊】
論文出處：Hu, F. W., Yueh, F. R., Fang, T. J., Chang, C. M., & Lin, C. Y. (2024). Testing a Conceptual Model of Physiologic Reserve, Intrinsic Capacity, and Physical Resilience in Hospitalized Older Patients: A Structural Equation Modelling. Gerontology, 70(2), 165-172.
全文下載：https://pubmed.ncbi.nlm.nih.gov/37995668/
Testing a Conceptual Model of Physiologic reserve, Intrinsic Capacity, and Physical Resilience in Hospitalized Older Patients: A Structural Equation Modelling
Testing a Conceptual Model of Physiologic reserve, Intrinsic Capacity, and Physical Resilience in Hospitalized Older Patients: A Structural Equation Modelling
The WHO declared the Decade of Healthy Ageing (2021-2030), defining intrinsic capacity (IC) as "the amalgamation of an individual's physical and mental capacities, as well as their interaction with relevant environmental factors, which ultimately determine the person's functional ability." Intrinsic capacity aims to measure an individual's physiological reserve, including locomotor, vitality, psychological, cognition, and sensory (vision and hearing). However, individuals will inevitably encounter stress events (i.e., illness, trauma, or bereavement). Intrinsic capacity alone is not enough; physical resilience, which is the ability to recover function after such stress events, is also needed to achieve the ideal of healthy aging. Based on aging theory, we proposed a conceptual model to explore the relationships between physiological reserve, intrinsic capacity, and physical resilience. The model indicates that demographic factors (i.e., age, psychosocial factors, health behaviors, and genetics) influence physical resilience through physiological reserve (i.e., chronic diseases) as a determinant. It also hypothesizes that physiological reserve impacts physical resilience via intrinsic capacity. Therefore, enhancing intrinsic capacity can not only improve physical resilience but also increase positive health outcomes and quality of life in older patients.
The study was conducted at a medical center in southern Taiwan, the mean age of the 413 patients was 76.34 ± 6.72 (52.5% female). The model showed a significant correlation between physiological reserve (assessed using the Cumulative Illness Rating Scale for Geriatrics [CIRS-G]) and intrinsic capacity (locomotor assessed using Katz Activities of Daily Living [Katz ADL], cognition assessed using the Short Portable Mental Status Questionnaire [SPMSQ]) (r=0.123, p<.01; r=0.904, p<.001). Additionally, intrinsic capacity (locomotor, psychological [assessed using the Five-Item Geriatric Depression Scale[GDS-5], cognition) was significant with physical resilience (assessed using the Physiological Resilience Index for the Elderly [PRIFOR]) (r=0.343, p<.001; r=-0.383, p<.001; r=0.156, p<.01). Exploring the relationship between intrinsic capacity and clinical outcomes revealed that only locomotor was significant with clinical outcomes (p<.001), including frailty (r=0.123, p<.01) and quality of life (r=0.77, p<.001). Physical resilience was correlated with frailty (r=-0.122, p<.01) and correlated with quality of life (r=0.121, p<.01). This study provides the determinants of healthy aging, which could help policymakers implement interventions to enhance intrinsic capacity and physical resilience in hospitalized elderly patients.
Application and Highlights:
1.Hospitalized older patients with better intrinsic capacity can enhance physical resilience.
2.Improving intrinsic capacity and physical resilience in hospitalized older patients can reverse frailty and increase quality of life.
Research Team Members: Fang-Wen Hu, Fang-Ru Yueh, Tzu-Jung Fang, Chia-Ming Chang, Chung-Ying Lin
Representative Department: College of Nursing
Introduction of Research Team: Our research team has long been devoted to studies related to elderly care, with primary research directions including geriatric syndromes (frailty, sarcopenia), intrinsic capacity, cognitive frailty, acute care for elders, physical resilience, olfactory stimulation, technology application in elderly care, and geriatric care education.
Contact Email: kokojhlin@gmail.com
Publication: Hu, F. W., Yueh, F. R., Fang, T. J., Chang, C. M., & Lin, C. Y. (2024). Testing a Conceptual Model of Physiologic Reserve, Intrinsic Capacity, and Physical Resilience in Hospitalized Older Patients: A Structural Equation Modelling. Gerontology, 70(2), 165-172.
Full-Text Article: https://pubmed.ncbi.nlm.nih.gov/37995668/
