老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件

1、老年醫(yī)學(xué)的誤區(qū)老年醫(yī)學(xué)的誤區(qū)歐盟老年病醫(yī)生培訓(xùn)a) 基本照料和適宜服務(wù)b) 老年評(píng)估和治療 c) 老年康復(fù) d) 出院計(jì)劃 e) 長(zhǎng)期照料評(píng)估 f) 科研 g) 醫(yī)學(xué)教育 h) 老年服務(wù)的發(fā)展 i) 行政管理職責(zé) j) 國(guó)家健康服務(wù) k) 臨床質(zhì)控l) 專業(yè)發(fā)展（ 英國(guó)老年病學(xué)會(huì)老年學(xué)基礎(chǔ)知識(shí)常見老年病綜合癥：跌倒、瞻望、失禁、運(yùn)動(dòng)障礙老人常見疾病表現(xiàn)藥物治療老人康復(fù)計(jì)劃出院計(jì)劃和持續(xù)照料醫(yī)學(xué)教育科研與質(zhì)控倫理與法律問題老年病管理健康促進(jìn)（Joint Committee on Higher Medical Training，London）歐盟老年病醫(yī)生培訓(xùn)a) 基本照料和適宜服務(wù)英國(guó)老年病學(xué)會(huì)

2、2007年7月美國(guó)醫(yī)學(xué)會(huì) (AAMC)和 John A. Hartford Foundation 確認(rèn)老年病醫(yī)生掌握老年醫(yī)學(xué)知識(shí)最低標(biāo)準(zhǔn):認(rèn)知和行為疾病藥物管理自我管理跌倒平衡步態(tài)疾病疾病非典型表現(xiàn)舒緩治療住院病人照料健康促進(jìn)與管理計(jì)劃2007年7月美國(guó)醫(yī)學(xué)會(huì) (AAMC)和 John A. HINTERNATIONAL TRAINING PROGRAMME IN MEDICAL GERONTOLOGYUnited Nations Population Fund (UNFPA)4th 15th May 2009Imperial Hotel, Sliema, MaltaINTERNATIONAL

3、 TRAINING PROGRAM健康與長(zhǎng)壽老年生理疾病表現(xiàn)與評(píng)估老年社會(huì)學(xué)老年口腔問題譫妄營(yíng)養(yǎng)不良疼痛與臨終管理老人衛(wèi)生管理老年糖尿病睡眠障礙老年醫(yī)療誤區(qū)癡呆、卒中與治療老年人口學(xué)老年流行病學(xué)老年倫理褥瘡管理跌倒與骨折震顫與巴金森病老年護(hù)理老年用藥老年健康服務(wù)與政策健康服務(wù)的計(jì)劃與財(cái)務(wù)老年病培訓(xùn)內(nèi)容(聯(lián)合國(guó)老年研究所)健康與長(zhǎng)壽癡呆、卒中與治療老年病培訓(xùn)內(nèi)容(聯(lián)合國(guó)老年研究所)INIAs 2010 Training Programmes1526 FebruaryInternational Programme in Social Gerontology.0819 MarchInternatio

4、nal Programme in Economic and Financial Aspects of Ageing.1930 AprilInternational Programme in Medical Gerontology (Geriatrics).1122 OctoberInternational Programme in Policy Formulation, Planning, Implementationand Monitoring of the Madrid International Plan of Action on Ageing.29 November10 Decembe

5、rInternational Programme in Demographic Aspects of Population Ageing and itsImplications for Socio-Economic Development, Policies and Plans.October 2010 - June 2011International Post-Graduate Diploma/Masters in Gerontology and Geriatrics(European Centre for Gerontology, University of Malta).INIAs 20

6、10 Training Programme誤區(qū)一以為老人的實(shí)際年齡與生理年齡一樣Assuming all older people are alike, mistaking chronological age for physiological age誤區(qū)一以為老人的實(shí)際年齡Heart diseaseTrying to deliver care by oneself.30% of 85 years are deaf in at least one earSexual knowledge, attitudes and activity of older people in Taipei, Tai

7、wan聽力問題 25-30%不了解老人住院會(huì)出現(xiàn)許多潛在問題開車,游泳和駕船時(shí)戒酒,戒藥Ancoli-Israel S, et al.71-74 years 1%1999;22(Suppl 2):S347-S353.HypertensionAndrogen Deficiency in Aging Males (ADAM)85%的尿失禁病人是女性(3) 不了解非藥物治療疼痛方法的效果和老人的態(tài)度Ancoli-Israel S, Roth T.25% of prescription drugs嚴(yán)重視力障礙 (差于20/200)75 years = 40%沒有足夠重視運(yùn)動(dòng)或身體活動(dòng)的重要性實(shí)際年齡、

8、生理年齡與心理年齡不同年齡段男女性別差異能否以年齡決定老年醫(yī)療服務(wù)模式Heart disease實(shí)際年齡、生理年齡與心理年齡老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件老年婦女的實(shí)際狀況是85歲以上老人中僅有36%是男性85%的尿失禁病人是女性75%住護(hù)理院老人是婦女80%婦女患有骨質(zhì)疏松者80%獨(dú)居老人是婦女90%已婚婦女存活時(shí)間超過配偶老年婦女的實(shí)際狀況是85歲以上老人中僅有36%是男性Activities of Daily LivingAlexopolous, G.b) 老年評(píng)估和治療Ancoli-Israel S, et al.Hartford Foundation 確認(rèn)老年病醫(yī)生掌握老年醫(yī)學(xué)知識(shí)最低標(biāo)

9、準(zhǔn):聽力問題 25-30%Nadol, NEJM, 1993不同年齡段男女性別差異門診抑郁癥患者費(fèi)用高于其他患者43% to 52%International Post-Graduate Diploma/Masters in Gerontology and Geriatrics開車,游泳和駕船時(shí)戒酒,戒藥（Joint Committee on Higher Medical Training，London）85%的尿失禁病人是女性h) 老年服務(wù)的發(fā)展疾病過程Parkinsons diseaseIgnoring the importance of nutritionIgnoring the imp

10、ortance of nutrition能否以年齡決定老年醫(yī)療服務(wù)模式推薦適宜照料的環(huán)境和設(shè)施United Nations Population Fund (UNFPA)Depression: Burden誤區(qū)二 不了解老年病表現(xiàn)不典型Not being aware that many common diseases can present atypicallyActivities of Daily Living誤區(qū)二 老年病特點(diǎn)病理表現(xiàn)多樣性、多病因特征、無報(bào)道過的疾病臨床癥狀不典型，沒有特異性表現(xiàn), 隱伏性發(fā)作,易漏診伴有智能障礙、肢體活動(dòng)障礙、抑郁癥、營(yíng)養(yǎng)不良、慢性肝腎功能障礙、骨質(zhì)疏松

11、、慢性疼痛、大小便失禁和褥瘡等綜合癥多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)豐富的社會(huì)閱歷形成特有的價(jià)值觀和世界觀不同的文化背景、宗教信仰、社會(huì)、子女的極度關(guān)注老年病特點(diǎn)病理表現(xiàn)多樣性、多病因特征、無報(bào)道過的疾病誤區(qū)三關(guān)注治愈疾病而不是管理慢病Focusing on curing disease rather than managing chronic diseases which cant be cured誤區(qū)三關(guān)注治愈疾病而不是老年醫(yī)學(xué)的目的照料與治療促進(jìn)功能改善，提高生存質(zhì)量三級(jí)預(yù)防臨終關(guān)懷老年醫(yī)學(xué)的目的照料與治療老年病管理健康促進(jìn) 疾病預(yù)防 疾病過程 治愈或轉(zhuǎn)慢性過程 功能康復(fù)

12、舒緩治療 臨終關(guān)懷 死亡照料 HomeDead老年病管理健康促進(jìn)HomeDead 個(gè)案管理Case management疾病管理Disease/care management自我管理Self-care support/ managementLevel 1 （65%） 單一慢病患者Level 2 （30%） 重病患者Level 3（5%） 多重疾病患者基礎(chǔ)預(yù)防老年病管理 個(gè)案管理疾病管理Level 1 （65%）Level 2誤區(qū)四用一元化解釋老年病因Assuming that there is always just one etiology responsible for illness i

13、n an older patient誤區(qū)四用一元化解釋老年病因老年病的特點(diǎn)慢病急性發(fā)作多病共存非典型發(fā)作老年病的特點(diǎn)慢病急性發(fā)作老年醫(yī)學(xué)原則以病人為本多學(xué)科模式病人主動(dòng)參與老年醫(yī)學(xué)原則以病人為本誤區(qū)五沒有認(rèn)真評(píng)估聽力和視力Not carefully evaluating hearing and vision誤區(qū)五沒有認(rèn)真評(píng)估聽力和視力聽覺損害發(fā)病率:65-74 years = 24%75 years = 40%國(guó)家衛(wèi)生干預(yù)研究:30% of community-dwelling older adults30% of 85 years are deaf in at least one earNa

14、dol, NEJM, 1993Moss Vital Health Stat, 1986.聽覺損害發(fā)病率:Nadol, NEJM, 1993Depression: CostsAssuming all older people are alike, mistaking chronological age for physiological ageNot being aware of the many potential problems that often develop when an older person is hospitalized保持健壯的骨骼，肌肉和關(guān)節(jié)Sexual knowle

15、dge, attitudes and activity of older people in Taipei, Taiwan營(yíng)養(yǎng)不良 20%Journal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008Ignoring the importance of nutritiona) 基本照料和適宜服務(wù)J Am Geriatr Soc.(3) 不了解非藥物治療疼痛方法的效果和老人的態(tài)度Geriatric Depression Scale性生活與教育水平,低壓力和日?；顒?dòng)程度有關(guān)Not pay

16、ing enough attention to the devastating effects of extremes in hot or cold weatherRestless Legs多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)尿失禁 30%多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)Assuming all older people are alike, mistaking chronological age for physiological ageNot being aware of the many potential problems that often develop

17、when an older person is hospitalized不同年齡段男女性別差異視覺損害嚴(yán)重視力障礙 (差于20/200)71-74 years 1%90 years17%patients17%視力障礙發(fā)病率71-74 years 7%90 years39%Nursing home patients19%Salive ME Ophthalmology, 1999.Depression: Costs視覺損害嚴(yán)重視力障礙 (差誤區(qū)六不了解老人住院會(huì)出現(xiàn)許多潛在問題Not being aware of the many potential problems that often dev

18、elop when an older person is hospitalized誤區(qū)六不了解老人住院會(huì)出現(xiàn)許多潛在問題老人常見疾病發(fā)病率抑郁15%步態(tài)不穩(wěn) 8-19%聽力問題 25-30%視力問題 26%性功能障礙 25-50%營(yíng)養(yǎng)不良 20%尿失禁 30%認(rèn)知障礙 12%虐待老人 3-10%老人常見疾病發(fā)病率抑郁15%誤區(qū)七以為臥床休息是老年患者恢復(fù)的良好方式Assuming that bedrest is a beneficial intervention in the ill older person誤區(qū)七以為臥床休息是老年患者恢復(fù)的良好方式老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件Fernandez

19、 H. Mount Sinai School of MedicineFernandez H. Mount Sinai Schoo長(zhǎng)期臥床并發(fā)癥褥瘡骨吸收體位性低血壓肺炎血栓性靜脈炎和血栓栓塞尿失禁便秘肌肉攣縮長(zhǎng)期臥床并發(fā)癥褥瘡Dr. Blooms 老年病人住院的十條誡律盡早讓病人下床活動(dòng)簡(jiǎn)化藥物方案盡早去除靜脈和其它導(dǎo)管避免束縛評(píng)估和監(jiān)測(cè)智能和認(rèn)知狀況Bloom P. Mount Sinai School of MedicineDr. Blooms 老年病人住院的十條誡律盡早讓病人下床6) 譫妄是急癥表現(xiàn)，鎮(zhèn)靜藥慎用7) 催眠藥不要過量8) 關(guān)注抑郁癥9) 注意營(yíng)養(yǎng)，補(bǔ)充營(yíng)養(yǎng)素10) 在住院時(shí)

20、決定出院標(biāo)準(zhǔn)，與病人和家屬共同決定治療方案和提前遺囑。Bloom P. Mount Sinai School of MedicineDr. Blooms 老年病人住院的十條誡律6) 譫妄是急癥表現(xiàn)，鎮(zhèn)靜藥慎用Bloom P. Mount誤區(qū)八對(duì)醫(yī)源性疾病沒有認(rèn)識(shí)Being unaware of the high prevalence of iatrogenesis: problems caused by health professionals誤區(qū)八對(duì)醫(yī)源性疾病沒有認(rèn)識(shí)老人占有的醫(yī)療服務(wù)40% of acute hospital beds60% of federal health dollar

21、90% of nursing home beds25% of prescription drugs老人占有的醫(yī)療服務(wù)40% of acute hospital醫(yī)源性疾病藥物相互作用及副反應(yīng)住院治療并發(fā)癥譫妄跌倒功能損害過度診斷和治療醫(yī)源性疾病藥物相互作用及副反應(yīng)開車,游泳和駕船時(shí)戒酒,戒藥International Programme in Medical Gerontology (Geriatrics).85%的尿失禁病人是女性Not being aware of the many potential problems that often develop when an older per

22、son is hospitalized推薦適宜照料的環(huán)境和設(shè)施29 November10 December60% of federal health dollar住院抑郁癥患者費(fèi)用高于其他患者47% to 51%推薦適宜照料的環(huán)境和設(shè)施Ignoring the importance of nutritionAssuming all older people are alike, mistaking chronological age for physiological age門診抑郁癥患者費(fèi)用高于其他患者43% to 52%聽力問題 25-30%多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)3

23、0% of 85 years are deaf in at least one earSexual knowledge, attitudes and activity of older people in Taipei, Taiwan以為臥床休息是老年患者恢復(fù)的良好方式Journal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008營(yíng)養(yǎng)不良 20%步態(tài)不穩(wěn) 8-19%and Monitoring of the Madrid International Plan of Action on

24、 Ageing.誤區(qū)九以為選用藥物和使用計(jì)量對(duì)老人和成人是相同的Assuming that the choice and dosing of medications is the same in older persons as in younger adults開車,游泳和駕船時(shí)戒酒,戒藥誤區(qū)九以為選用藥物和使用計(jì)量對(duì)老老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件老人藥效改變Pharmacodynamic Alterations受體數(shù)量和功能的改變靶器官反應(yīng)程度改變自我調(diào)節(jié)機(jī)制改變- 體位控制- 直立循環(huán)反應(yīng)- 體溫調(diào)節(jié)- 內(nèi)臟平滑肌功能老人藥效改變Pharmacodynamic Alterat藥物不良反應(yīng)與

25、用藥數(shù)量的關(guān)系藥物不良反應(yīng)與用藥數(shù)量的關(guān)系老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件常見藥物副作用疲倦,嗜睡,反應(yīng)下降 便秘,腹瀉或失禁 食欲下降 混亂跌倒 抑郁或失去興趣 虛弱 震顫 幻覺 焦慮或興奮 暈厥 性欲下降 皮疹 常見藥物副作用疲倦,嗜睡,反應(yīng)下降 誤區(qū)十沒有認(rèn)識(shí)和適當(dāng)?shù)闹委熞钟舭YNot recognizing and not properly treating depression誤區(qū)十沒有認(rèn)識(shí)和適當(dāng)?shù)闹委煻唐谟洃浐烷L(zhǎng)期記憶異常25% of prescription drugs65-74 years = 24%（Joint Committee on Higher Medical Training

26、，London）死亡照料30% of 85 years are deaf in at least one earAssuming all older people are alike, mistaking chronological age for physiological ageJournal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008Hypertension4% 老人有適應(yīng)障礙(Blazer et al, 1987)營(yíng)養(yǎng)不良 20%Not recognizing and n

27、ot properly treating depressionSexual knowledge, attitudes and activity of older people in Taipei, TaiwanAllen R, et al.足量的鈣(特別是婦女最大獨(dú)立最小依賴Maximization of independenceMinimization of dependenceJournal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan20081930 AprilJournal of

28、Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008OKeefe ST, et al.b) 老年評(píng)估和治療Assuming all older people are alike, mistaking chronological age for physiological age癡呆、抑郁和譫妄DementiaDepressionDelirium短期記憶和長(zhǎng)期記憶異常癡呆、抑郁和譫妄DementiaDepDepression: Burden65歲以上老人發(fā)病率為1%: 女性中1.4%,男性中0.4

29、% 發(fā)病(Weissman et al 1988). 2% 老人有精神抑郁4% 老人有適應(yīng)障礙(Blazer et al, 1987)15%老人有抑郁癥狀但沒達(dá)到診斷標(biāo)準(zhǔn) (Koenig and Blazer, 1992).住院老人: 最高到 40% 護(hù)理院: 12-16%之間 (Weissman et al, 1991).Depression: Burden65歲以上老人發(fā)病率為Depression: Costs住院抑郁癥患者費(fèi)用高于其他患者47% to 51%門診抑郁癥患者費(fèi)用高于其他患者43% to 52%Wayne J. Katon; Elizabeth Lin; Joan Russo

30、; Jurgen Unutzer. Arch Gen Psychiatry 2003 60: 897-903 使原有疾病惡化使免疫力降低增加自殺頻率增加看醫(yī)生時(shí)間Alexopolous, G. Lancet 2005; 365: 261-70. Depression: Costs住院抑郁癥患者費(fèi)用高于其他誤區(qū)十一過度診斷或未能診斷癡呆Over-diagnosing or under-diagnosing dementia誤區(qū)十一過度診斷或輕度認(rèn)知障礙與癡呆診斷標(biāo)準(zhǔn)Mild cognitive impairment (MCI) v. Dementia CriteriaMCI主訴記憶問題記憶力減退

31、無精神錯(cuò)亂一般認(rèn)知功能正常正常 ADLsDementia短期記憶和長(zhǎng)期記憶異常加上下面一條 :語言功能下降抽象思維下降感知下降判斷力下降人格改變無譫妄ADLs 下降輕度認(rèn)知障礙與癡呆診斷標(biāo)準(zhǔn)Mild cognitive i誤區(qū)十二忽略營(yíng)養(yǎng)的重要性Ignoring the importance of nutrition誤區(qū)十二忽略營(yíng)養(yǎng)的重要性誤區(qū)十三低估尿失禁的發(fā)病率和不良影響Underestimating the prevalence and negative impact of urinary incontinence誤區(qū)十三低估尿失禁的發(fā)病率老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件誤區(qū)十四未能作出疼痛診

32、斷和不適當(dāng)治療Under-diagnosing and inadequately treating pain誤區(qū)十四未能作出疼痛診斷影響疼痛管理的因素(1) 沒有進(jìn)行疼痛評(píng)估 (2) 老人藥物治療存在潛在風(fēng)險(xiǎn) (3) 不了解非藥物治療疼痛方法的效果和老人的態(tài)度影響疼痛管理的因素(1) 沒有進(jìn)行疼痛評(píng)估 誤區(qū)十五以為老人沒有性需求Assuming that older people are not sexually active誤區(qū)十五以為老人沒有性需求Sexual knowledge, attitudes and activity of older people in Taipei, Taiw

33、an 調(diào)查412 男性和 204女性,年齡大于65歲 35.7%有性生活 頻率為21.4次 (SD 16.9)/每年 (range: 1120). 性生活與教育水平,低壓力和日常活動(dòng)程度有關(guān) Journal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008Sexual knowledge, attitudes anBeing unaware of abuse of older individuals by family and others: physical, emotional,

34、economic, and socialIgnoring the importance of nutrition癡呆病人照料者比其他照料者:Activities of Daily LivingMoss Vital Health Stat, 1986.Not paying enough attention to the devastating effects of extremes in hot or cold weather開車,游泳和駕船時(shí)戒酒,戒藥4th 15th May 2009促進(jìn)功能改善，提高生存質(zhì)量a) 基本照料和適宜服務(wù)OKeefe ST, et al.尿失禁 30%Arch G

35、en Psychiatry 2003 60: 897-903Performance Orientated Assessment of Mobility沒察覺家庭的、肉體的、情感的、經(jīng)濟(jì)的和社會(huì)方面對(duì)老人的虐待不同的文化背景、宗教信仰、社會(huì)、子女的極度關(guān)注Fernandez H.Assuming that sleep problems are a normal part of aging4th 15th May 2009門診抑郁癥患者費(fèi)用高于其他患者43% to 52%75 years = 40%Peptic ulcer誤區(qū)十六對(duì)氣候變化沒有足夠關(guān)注Not paying enough atten

36、tion to the devastating effects of extremes in hot or cold weatherBeing unaware of abuse of olde老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件誤區(qū)十七以為睡眠障礙是衰老的正常現(xiàn)象Assuming that sleep problems are a normal part of aging誤區(qū)十七以為睡眠障礙是衰老的Ancoli-Israel S, Roth T. SLEEP. 1999;22(Suppl 2):S347-S353. Ancoli-Israel. SLEEP. 2000;23:S23-S30. Ancol

37、i-Israel S, Cooke JR. J Am Geriatr Soc. 2005;53:S264-271. 老人睡眠障礙的影響注意力下降反應(yīng)力下降記憶下降動(dòng)作準(zhǔn)確力下降抑郁與焦慮可能誤認(rèn)為是癡呆嗜睡Ancoli-Israel S, Roth T. SLEEPAlzheimers DiseaseParkinsons diseasePsychiatric disordersStrokeArthritisProstate diseaseHeart diseaseRefluxPeptic ulcerRespiratory diseases HypertensionSleep apneaRest

38、less LegsREM Behavior DisorderRenal DiseaseDiabetesImmuneDiseases Conditions Associated With Sleep Disturbances in the ElderlyNocturiaAlzheimers DiseaseArthritisPr原發(fā)睡眠疾病發(fā)病率 疾 病 成人 老人 睡眠呼吸暫停 1%-8% 24%-40%周期性肢體運(yùn)動(dòng) 5% 30%-45%不寧腿綜合征 2%-15% 12%-30%Young T, Ancoli-Israel S, et al. SLEEP. 2001. Mant E, et a

39、l. Age and Ageing. 1992. Ancoli-Israel S, et al. SLEEP. 1993. Phillips BA, et al. SLEEP. 1994. Hoch CC, et .al. SLEEP. 1994. OKeefe ST, et al. Age and Ageing. 1994. Phillips B, et al. Arch Int Med. 2000. Allen R, et al. Arch Int Med. 2005.原發(fā)睡眠疾病發(fā)病率 疾 病 誤區(qū)十八沒有采取預(yù)防措施Not having enough time to do import

40、ant preventive measures誤區(qū)十八沒有采取預(yù)防措施美國(guó)預(yù)防服務(wù)工作小組（ USPSTF）: 65+老人干預(yù)攝用物質(zhì) 戒煙 開車,游泳和駕船時(shí)戒酒,戒藥運(yùn)動(dòng)和飲食 控制脂肪和膽固醇;保持熱量平衡; 保證谷物,蔬菜和水果 足量的鈣(特別是婦女 定期運(yùn)動(dòng)美國(guó)預(yù)防服務(wù)工作小組（ USPSTF）: 65+老人干預(yù)攝美國(guó)預(yù)防服務(wù)工作小組（ USPSTF）: 65+老人干預(yù)(contd)預(yù)防損傷 膝蓋肩膀護(hù)帶 摩托自行車頭盔 防跌倒 煙感器 設(shè)置熱水器低于50C 家庭成員進(jìn)行心肺復(fù)蘇訓(xùn)練口腔衛(wèi)生 定期看口腔醫(yī)生 含氟牙膏性行為 預(yù)防性傳染疾病美國(guó)預(yù)防服務(wù)工作小組（ USPSTF）: 65

41、+老人干預(yù)(營(yíng)養(yǎng)不良 20%伴有智能障礙、肢體活動(dòng)障礙、抑郁癥、營(yíng)養(yǎng)不良、慢性肝腎功能障礙、骨質(zhì)疏松、慢性疼痛、大小便失禁和褥瘡等綜合癥Conditions Associated With Sleep Disturbances in the Elderly護(hù)理院: 12-16%之間 (Weissman et al, 1991).沒有足夠重視運(yùn)動(dòng)或身體活動(dòng)的重要性Ancoli-Israel S, et al.Age and Ageing.9)/每年 (range: 1120).開車,游泳和駕船時(shí)戒酒,戒藥多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)多種藥物的應(yīng)用導(dǎo)致病情復(fù)雜化和增大新并發(fā)癥風(fēng)險(xiǎn)

42、最大獨(dú)立最小依賴Maximization of independenceMinimization of dependence71-74 years 1%Not paying enough attention to the devastating effects of extremes in hot or cold weather短期記憶和長(zhǎng)期記憶異常Alexopolous, G.（Joint Committee on Higher Medical Training，London）Moss Vital Health Stat, 1986.Restless LegsAndrogen Deficie

43、ncy in Aging Males (ADAM)Fernandez H.Psychiatric disorders關(guān)注疾病而忽視身體和認(rèn)知功能Paying too much attention to diseases and not enough attention to physical and cognitive functioning誤區(qū)十九營(yíng)養(yǎng)不良 20%關(guān)注疾病而誤區(qū)十九老年綜合評(píng)估 老年病評(píng)估是關(guān)于老人智能、情感、功能、社會(huì)、經(jīng)濟(jì)、環(huán)境，以及心理方面的全面評(píng)估，其目的是合理的利用醫(yī)療保健資源, 改善生活品質(zhì)，減少住院需求，促使其獨(dú)立生活。 老年病房常用評(píng)估量表，包括日常生活活動(dòng)量

44、表、簡(jiǎn)易智能狀態(tài)測(cè)驗(yàn)、老年人精神憂郁量表，跌倒評(píng)估表、吞咽困難及營(yíng)養(yǎng)評(píng)估表等。老年綜合評(píng)估 老年病評(píng)估是關(guān)于老人智能、老年人全面評(píng)估的目的 生物治療 功能康復(fù)改進(jìn)診斷的正確性 指導(dǎo)康復(fù)方法選擇推薦適宜照料的環(huán)境和設(shè)施 推測(cè)預(yù)后隨時(shí)監(jiān)測(cè)臨床變化 老年人全面評(píng)估的目的 生物治療 Table. Screening Tools for Geriatric Assessment Date Scale 1955 Barthel Index 1963 Activities of Daily Living 1969 Instrumental Activities of Daily Living 1975 Mi

45、ni-Mental Status Examination 1983 Geriatric Depression Scale 1984 Functional Independence Measurement (FIM) 1986 Get Up and Go 1986 Performance Orientated Assessment of Mobility 1994 Mini Nutritional Assessment 2000 Androgen Deficiency in Aging Males (ADAM) Table. Screening Tools for Ger最大獨(dú)立最小依賴Maxi

46、mization of independenceMinimization of dependence最大獨(dú)立最小依賴Maximization of inde誤區(qū)二十沒有足夠重視運(yùn)動(dòng)或身體活動(dòng)的重要性Not adequately emphasizing the importance of exercise or physical activity誤區(qū)二十沒有足夠重視運(yùn)動(dòng)或身體活動(dòng)的重要性老年醫(yī)學(xué)的誤區(qū)精實(shí)用版課件活動(dòng)方式：有氧運(yùn)動(dòng)加速心跳和呼吸，有益于心血管功能。強(qiáng)度和柔韌性運(yùn)動(dòng)可保持強(qiáng)壯的骨骼和肌肉。規(guī)律活動(dòng)的益處：增強(qiáng)體能保持健壯的骨骼，肌肉和關(guān)節(jié)增加肌肉的耐力和強(qiáng)度控制體重減少心血管病，結(jié)

47、腸癌和糖尿病的危險(xiǎn)因素控制血壓促進(jìn)心理健康和自信心減少壓抑和憂郁活動(dòng)方式：規(guī)律活動(dòng)的益處：誤區(qū)二十一我能治好老人的病Trying to deliver care by oneself.誤區(qū)二十一我能治好老人的病多學(xué)科團(tuán)隊(duì)模式多學(xué)科團(tuán)隊(duì)模式Parkinsons diseaseAncoli-Israel S, et al.老年病房常用評(píng)估量表，包括日常生活活動(dòng)量表、簡(jiǎn)易智能狀態(tài)測(cè)驗(yàn)、老年人精神憂郁量表，跌倒評(píng)估表、吞咽困難及營(yíng)養(yǎng)評(píng)估表等。Level 2 （30%）Alzheimers DiseaseFernandez H.29 November10 December門診抑郁癥患者費(fèi)用高于其他患者4

48、3% to 52%Allen R, et al.Being unaware of abuse of older individuals by family and others: physical, emotional, economic, and socialActivities of Daily LivingHypertensionArch Gen Psychiatry 2003 60: 897-9034th 15th May 2009Journal of Clinical Nursing Volume 17 Issue 4,Pages443-450, Published Online: 14Jan2008Assuming all older people are alike, mistaking chronological age for physiological age不寧腿綜合征 2%-15% 12%-30%1122 OctoberConditions Associated With Sleep Disturbances in the ElderlyMant E, et al.Ma