狠狠撸

?? ????????????????? ????
?.??.???????? ??????????
????????? ?? ???????? ?.????????? ???????
?
????????????? ????????????
?

?????? ?????????????????????????????
?.?. 2513-2593
80+
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-09
0-04

0.1
0.2
0.4
0.6
0.9
1.1
1.3
1.7
2.2
2.7
3
3.1
3.8

???

0.2
0.3
0.5
????
0.7
0.9
1.1
1.4
1.7
2.2
2.7
3.1
3.3
3.9

5.2

???

7.4

80+
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-09
0-04

8.9
6

4

2

0

0.3
0.6
0.9
1.2

???

2

4

6

8

0.5
0.9
1.2
1.4
1.8

1.7
2.3

8

0

1

2

3

2

1

0

3

1

2

3

4

4

5

6

5

4

5

6

7

8

7

5
5.2
5

4

3

1

1

0

1

2

3

4

1.5

5

2

3

4

5

4

3.5

3

7

2.1

???

3.2
3.2
3.4

????

3
3
3.1
3.1
3.2
3.1
3
3
3
2.9
2.9
2.8

4
4.1
4.2
3.9
4

6

2.8

3.3
3.3

????

0

2

2.2
2.2

1

4.6

2.7
2.9

3.5
3.4
3.4
3.4
3.4
3.3
2

6

1.5

???

3

4
5.3
5.4
5.4

1.1

2.8

3.9
4.1
4.2
4
4.1
3.6
3.5
3.6
3.6
3.5
3.5

3.3

5.5
5.6
5.6
5.2
5.4

0.7

2.5

3.7
3.6
3.6
3.6
1

4

3.2
4.3
4.4
4.5
4.2
4.3

2

5

1.2

3.7

3

6

2.5

4

5.6

1.8

3.2

4.3
4.5
4.6
4.3
4.5

4

7

????

4.7

6.4
6.5
6.7

2.5

3.8
3.8
3.8
3.8

2.5

4.9

????

3.6

5

10

0.4
0.5
0.7
0.9
1.2
1.6
1.9
2

3.3

4

0.5
0.8

3

6

2.4
2.5
3.1

6.7
6.8
6.9

6.4

0.2
0.3
0.5
0.8
1.1
1.4
1.8
2

???

5.8

5.4

6.6

8

????

4.9

7.6
10

0.1
0.4
0.6
0.8
1
1.2
1.6
2

4

9.2
12

0.1
0.3
0.4
0.7
0.9
1.2
1.6
1.9
2.3
2.5
3.1

3
3
3.1
3.1
3.1
3
2.9
2.9
2.9
2.8
2.8
2.7
2.5

2

1.5

1

0.5

0

0.5

1

1.5

2

2.5

United Nations. Sex & Age Distribution of the World
Populations: The 1998 Revision, p. 784 – 785.

3

3.5

4

???????? ???????????
6
40 ????? ??????????1.5 ?? ??
?
?? ?????
?

50
40 ????? ??? 73 ? ???? ?????
?
?
?
?

????????????????
?
?????????????
?
??? 18
40 ?????
?
??? 32 ????? ?????
?
?
?
3%
40 ?????
?
??? 11% ???? ?????
?
?

“Geriatric Medicine” ????????? ?? ????????
“….
?
?
? ?? ???? ???
? ????? ???????? ???????????????????
?
British Geriatrics Society

????????? (Gerontology):

????? ???????? ??????????? ????? ???????????????
?
?
?????????
??????????
????????? ?????????
?
?

7

????????? ?
????????????? ?
???????????????????????
?
?

? ????????????????????????? ?
– Osteoarthritis, crystal-induced arthropathy
– Osteoporosis
? ???????????????????????????
– ????????????????? ? ?????????? ???????????????????????
– Circulatory disorders : ???????????????? ?????????????????
?
– Parkinson’s disease
–
Dementia
– ????????? ???????????? Delirium
– ??????????? ? Depression

RAMPS
–
–
–
–
–

Reduced body reserve ?????? ?????? ?????????
Atypical presentation
Multiple pathology ???????????????????????
Polypharmacy
??? ?????????????
Social adversity
??????? ???? ???

__?????? ?
? ???????? ?
Instability (Fall)
? ????? ???? ???????????????????? Immobility
?
Intellectual impairment
? ?????????????????
Incontinence
?
Inanition
? ?????????????? ????? ???? Iatrogenesis

???

?????????

?hyperthyroidism apathy not agitated
?hypothyroidism ???????????? ? ???????
?
?????????????? ???? ??no guarding
?
no adrenergic
????????????
?????????? ????????
????? ????? ??????????

????
↓ ?-receptor sense
sedentary life
↓ interleukin I
weak rectus M.
↓ ?-receptor sense
sedentary life
↓ ??? ????

??????? Physical
??? ???????
Mental
??? ??? Social
?????????????????? ???????????? Function

?

?????????????

?
3 D’s : dysphasia, depression, deafness.
? ?????? ????????? ??? ??? ??????? ????????????????
?
? ???????? ? ????? ???????
?
?
motor aphasia
“??? ”
“??? ??? ”
? ????? ??????????????? ?????????????????????????
?
?
? ?????????????????? : dietary recall
?

?? ???????

?? ???????

?????????? ??????

???????? ???? ???
?????????

??????????????

??????????????
??????? ?

?????????? ??

?? ??????? ?????

??????????????

???????????
?????? ???????
?? ???????????????

????

????? ????????????

Mini-Nutritional Assessment (MNA)?
?
15
?

????????? ???????????????
? sensitivity 96%, specificity 98% !
? ?? 4 ?? ?? : anthropometry, dietary recall, clinical,
self assessment.
? http://www.mna-elderly.com/forms/MNA._thai.pdf

MiniNutritional
Assessment
(MNA)?
< 11 points

< 17 points

? Abbreviated mental test (AMT)
? Standard mental tests
? Thai Mental State Examination (TMSE)
? Chula Mental Test (CMT)
? Mini Mental State Examination-Thai 2002

????????!!

Abbreviated Mental Test
?
????
?
????
Scoring: 0-3 severe,
?
4-7 moderate,
8-10 normal
?
??
?
? ???
??
? ???????? ????
??
?
?
????????????? ??????????????????????
? ??????????? 20 ?? 1
??

Thai Mini-mental State Examination (TMSE)

????????????????? ????????????????
(Thai Geriatric Depression Scale : TGDS)

1.

?

2.

?

3.
4.

?
?

5.

?

6.
7.
8.

?
?? ?????? ??????????????????? ???
?

????????????????? ????????????????
(Thai Geriatric Depression Scale : TGDS)

9.
10.

???? ?????????
????? 0 – 12 ?????

?? ?????? ????????????????? ??
?

11. ?????? ?????????????? ????? ?????? ???? ?? ? ?
12.

?

13.
14.
15.

?
?
?

Social assessment - relationship in family
? ?????????? Caregiver : ?????????????????? ???
?
? ???????? ???????? Physical abuse
? ??????? : ?????? ????? ?????? ?? ??????????
????? ????????????? ??????????????? ???
????????? ??????????????
? ????????? : ??????????? ????????????
?
:
!!

Functional Assessment for Older People
????????????????????????????????????????????????
Activity of daily living (ADL)

1. Basic ADL
2. Instrumental ADL

Barthel Index of Activity of daily living

?
? ????
?
? ?? ????? ????????
? ???????
? ???????
?
? ????????
? ??? ????
?

Functional Status Assessment
(instrumental activity of daily living-ADL)
? ???????????????????? ??
? ??????? ???????
?
?
?
? ?????? ??

1) ???????????????
(2 ?? ?)
2)
3) ???????? ?????????
(VA, hearing)
4) ?????????? ???
5) Get-up-and-go test

?
?
?

? hypertension
postural hypotension
? under-nutrition
? disability, fall

?
?

? breast cancer
? fall, immobility

????????? ?????????????????? ?????????????????????? ?????
?
1)
2)
3)
4)
5)
6)

Pap smear
Fecal occult blood
Fasting blood glucose
Cholesterol
TSH
Osteoporosis screen

NB: PSA ??

?
?
?
?
?
?

? CA cervix
? CA colon
? DM
? dyslipidemia
? hypothyroidism
? fracture

Minimum Data Set (MDS)
1.
2.
3.
4.
5.

Cognition
Communication
Physical function
Continence
Psychosocial wellbeing
6. Mood & behaviour
7. Disease diagnosis

8.
9.
10.
11.
12.

Health condition
Oral / nutritional status
Skin & foot
Medication use
Special treatments &
procedures

狠狠撸

??????????????????Elder by healthcare provider

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