Shinkai Shoji, Watanabe Naoki, Yoshida Hiroto, Fujiwara Yoshinori, Amano Hidenori, Lee Sangyoon, Nishi Mariko, Tsuchiya Yumiko
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.
Nihon Koshu Eisei Zasshi. 2010 May;57(5):345-54.
Early detection of older persons at high-risk with an effective screening tool is a prerequisite for strategies to optimize care among the community-dwelling elderly. We have focused on risks regarding the likelihood of developing homeboundedness, falls, and poor nutrition, and proposed an original 18 item-scale called "the Kaigo-Yobo Checklist" as a questionnaire-based screening tool. This study examined the reliability and validity of this scale using a longitudinal cohort of community-dwelling elderly.
Among 1039 older persons aged 70 years and over living in Kusatsu Town, Gunma Prefecture in 2001, 916 persons (88.2%) responded to the baseline interview survey including assessment with the 18-items of "the Kaigo-Yobo Checklist". Using these data, we performed the following analyses: (1) elimination of improper items according to pass and non-response rates; (2) internal reliability analysis based on Cronbach's alpha and Good-Poor approaches; (3) partial correlation analysis with IADL scores (Instrumental Self-Maintenance subscale of TMIG-Index of Competence) treated as external criteria. Further, we collected individual records under the long-term care insurance system in Kusatsu Town from April 2000 to November 2005, and determined the predictive value of the checklist for onset of certification of long-term care insurance over 4 years (2001-2005) with the trend test and logistic regression models.
(1) Three among 18 items did not show pass rates of 75% to 95% with a non-response rate under 1%. Thus we excluded these three items from the original checklist, yielding a 15 item-scale with 15 points for full marks, i.e., a modified version of "the Kaigo-Yobo Checklist". (2) The Cronbach's alpha was 0.79, and Good-Poor analysis determined that the high-score group (> or =2 points) had a higher mean score for all items of the checklist compared to the low-score group ( < or =1 point) (P < 0.001). (3) The partial correlation coefficient between the checklist score and the IADL score was -0.64 (P < 0.001). (4) The baseline checklist score was positively and linearly associated with the risk of developing a state in need of care during the 4-year follow-up; the adjusted odds ratio for the increment of 1 point was 1.21 (95% confidence interval, 1.10-1.33) [1.24 (1.11-1.38) when deceased or moving-out cases were excluded from the analysis].
The modified version of "the Kaigo-Yobo Checklist" had concurrent and predictive validity, and good reliability as a questionnaire-based scale for screening high-risk older persons.
使用有效的筛查工具早期发现高危老年人是优化社区居家老年人护理策略的前提。我们关注了发展为居家不出、跌倒和营养不良可能性的风险，并提出了一种名为“介护预防检查表”的原创18项量表作为基于问卷的筛查工具。本研究使用社区居家老年人的纵向队列检验了该量表的信度和效度。
2001年在群马县草津町居住的1039名70岁及以上老年人中，916人（88.2%）回应了基线访谈调查，包括使用“介护预防检查表”的18项进行评估。利用这些数据，我们进行了以下分析：（1）根据通过率和无应答率剔除不合适的项目；（2）基于克朗巴哈系数和优劣分析进行内部信度分析；（3）将IADL评分（TMIG能力指数的工具性自我维持子量表）作为外部标准进行偏相关分析。此外，我们收集了草津町2000年4月至2005年11月长期护理保险系统下的个人记录，并通过趋势检验和逻辑回归模型确定该检查表对4年（2001 - 2005年）长期护理保险认证发病的预测价值。
（1）18项中有3项未显示75%至95%的通过率且无应答率低于1%。因此，我们从原始检查表中剔除了这3项，得到一个15项量表，满分15分，即“介护预防检查表”的修订版。（2）克朗巴哈系数为0.79，优劣分析确定高分组（≥2分）与低分组（≤1分）相比，检查表所有项目的平均得分更高（P < 0.001）。（3）检查表得分与IADL得分的偏相关系数为 -0.64（P < 0.001）。（4）基线检查表得分与4年随访期间发展为需要护理状态的风险呈正线性相关；每增加1分的调整比值比为1.21（95%置信区间，1.10 - 1.33）[当分析中排除死亡或迁出病例时为1.24（1.11 - 1.38）]。
“介护预防检查表”的修订版具有同时效度和预测效度，作为筛查高危老年人的基于问卷的量表具有良好的信度。
