Professional Documents
Culture Documents
2557
1
2
13
21
37
47
59
71
79
89
10
11
12
(Geriatric assessment)
..
(comprehensive geriatric assessment)
1.
2. (basic activity of daily living - BADL)
(instrumental activity of daily living - IADL)
3. (dementia; cognitive impairment)
4. (incontinence)
5. (fall)
6. (malnutrition)
7. (depression)
R-A-M-P-S
R - Reduced body reserve
A - Atypical presentation
13
geriatric syndromes
big Is
Instability
Immobility
Incontinence
Intellectual impairment
(delirium) (dementia)
Iatrogenesis
Inanition
M - Multiple pathology
P - Polypharmacy
(heterogeneity)
4
14
1. (physical assessment)
( get-up-and-go test )
( Mini-Nutritional Assessment : MNA
) bigs I (visual acuity)
1.
5D deafness () dysphasia () depression ()
delirium () dementia ()
2.
otoscope (ear wax impaction)
(presbycusis)
(hearing aids)
3.
4. motor aphasia
5. (recent memory)
6.
7.
15
1.
1.
80
ADL
BADL IADL
1. polypharmacy
2.
geriatric syndromes
bigs I
1. (vital signs)
1.1
10 / 5 .
10 10 .
16
atrial ibrillation
50
- 2
(postprandial hypotension)
(postural hypotension)
end organ damage pseudohypertension white coat hypertension
1.2
atrial ibrillation
2.
: parkinsonism, hypothyroidism, anemia, depression
: (visual acuity) fundoscopy
17
: periodontal disease
: range of motion cervical spondylosis thyroid, jugular
venous pressure , carotid bruit transmitted cardiac murmur
70 S4 acute ischemic
heart disease
: elasticity chest wall, crepitation
2 - 3 atelectasis
: ibrocystic disease nipple retraction
nipple
candidiasis
: spinous process compression fracture vertebrae, kyphosis, scoliosis
buttock, sacrum, trochanter
: anterior superior iliac spine multiple vertebral collapse
: (PR)
vibratory sense , frontal lobe releasing signs palmomental, grasping, glabella, snout relex
18
3. (Social assessment)
(carer caregiver)
bed-blocker
(nosocomial infection) (elderly abuse)
4. (functional assessment)
()
2. (Instrumental ADL)
(multidisciplinary team
approach)
90
delirium, dementia
19
1. . . : ., .
2 : ; 2554. 1-14.
2. . . : .,
I. : ; 2552. 753-773.
3. Hodkinson, HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and
Ageing. 1972;1(4): 2338.
4. Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE. Stroke rehabilitation: analysis of repeated Barthel index measures.
Arch Phys Med Rehabil. 1979;60:14-7.
20
..
21
22
23
24
25
26
27
28
29
30
4.6
(late age-related maculopathy) (optic atrophy)
(corneal opacity)
Snellens chart 5
6.116
16.3 12.5
2.7 8 4.317
presbycusis
otoscope audiometry
4.7
83.6
(varices) 18
4.8 ( 6 )
3.3 10
5 - 10 19
(subdural hematoma)
USPSTF (Mini-Mental State Examination : MMSE)
(cognitive impairment)
14 MMSE
31
4.9
7 1320
SIG: E-CAPS Sleep (), Interest ( ) Guilt
( ) Energy ( ) Concentration () Appetite (
) Psychomotor agitation and/or retardation ( )
Suicidality ()
1 - 2 (2Q)
2
2
1
9 (9Q) Thai Geriatric Depression Scale (TGDS)
4.10
(hypothyroidism)
Thyroid Stimulating Hormone (TSH)
(subclinical hypothyroidism) TSH
radioactive iodide
4.11
()
phenytoin, carbamazepine phenobarbital
(malabsorption)
USPSTF 65 60 - 65
9 National Osteoporosis Foundation
65 70 50-69
21 .. 2553
65 70 22
85
32
.. 2553
(clinical risk factors), Osteoporosis Self Assessment Tool for Asians (OSTA)
index, Khon Kaen Osteoporosis Score (KKOS), nomogram for osteoporosis Fracture Risk Assessment
Tools (FRAXTM)22 OSTA index 0.2 x ( - ) -4
OSTA index ( -4 -1)
65
5 2
4.12 ( 4 )
anticholinergic
(immobility)
1
get-up-and-go test
3
(orthostatic hypotension)
1.
(immunization)
(chemoprophylaxis) (screening)
2.
3.
4.
33
34
35
36
...
37
38
39
40
41
42
43
44
45
46
..
65 75 0.3 1.6
75 6
24.1 12.1 1
10.1 20 6
50
1
58
27
2
1. /
(accidental fall)
47
(spontaneous fall)
(predisposing factor)
"" ""
(precipitating factor)
2. spontaneous fall
1.
(cerebellar disease) normal pressure hydrocephalus deconditioning state
2. (postural hypotension)
3. (macular degeneration)
4.
(vasomotor syncope)
5.
6. cognitive impairment
48
1.
2.
3.
4. (hallux valgus)
5.
6. hyponatremia, hypokalemia
(delirium)
49
( : Timed
Up and Go Test (TUGT) (Falls Risk Assessment tool) )
Romberg
(proprioceptive sense)
postural relex
"startle reaction"
1-2
(dorsilexion)
basal ganglia
get-up-and-go test
3
postural hypotension
timed get-up and go test 10
29 (frail)
15
(gait assessment)
- Frontal lobe gait frontal apraxia
magnetic gait
(shufling and hesitant step)
(frontal lobe) normal pressure hydrocephalus
(vascular dementia)
- Spastic gait hemiparesis hemiplegia
(lexed hip, extended knee, plantar-lexed foot)
(circumduction)
visual neglect (hemianopia)
50
51
52
53
3
1. (Primary prevention)
3
2. (Secondary prevention)
4
3. (Tertiary prevention)
2.
3.
54
.. 2551
55
56
57
58
..
(protein energy malnutrition)
sarcopenia (hypoalbuminemia)
(postural hypotension)
(cognitive function)
(pharmacokinetics)
sulfonylurea
1 - 2
15 23 62
85
(body mass index : BMI) 18.5 ./2
13-27 16-39
20-39 60 - 69 70 - 79 80
59
60 69
5 - 24
11 - 39 18 - 54 60 - 69 70 - 79 80
4
1.
(xerostomia)
80 80
2.
3.
(bereavement)
(wandering)
60
4.
4.1
. digoxin, theophylline, luoxetine
. opioids
. anticholinergic, sympathomimetic
. metronidazole, metformin, angiotensin-converting enzyme inhibitor, calcium-channel blocker,
. digoxin, theophylline, opiate,
(nonsteroidal anti-inlammatory agent)
. theophylline, sertraline
4.2
4.3
(denture)
(xerostomia) anticholinergic
4.4 (chronic inlammatory bowel disease)
4.5
(, ephedrine) essential tremor, pheochromocytoma
4.6
4.7
5 3
61
(anthropometry)
Mindex () Demiquet ()
- (body mass index : BMI)
BMI =
/2
- Mindex
Mindex =
- Demiquet
Demiquet = /2
()2
/
(demispan )
(demispan )2
2
1.
(kyphosis) (scoliosis)
2.
(demispan)
Mindex Demiquet (demispan) suprasternal notch
metacarpophalangeal joint
(extensor surface)
62
3.5
5 () 3
10
(Body mass index : BMI) 18.5 ./2
Mindex Demiquet Mindex (
) Demiquet () 55.95 ( 56) . 75.6 ( 76)
.2
(anthropometry)
hemoglobin
prealbumin, transferrin, retinol-binding protein, insulin-like growth factor-1 ibronectin
(total cholesterol) 156 ./.
63
64
65
1. (Primary prevention)
2. (Secondary prevention)
3. (Tertiary prevention)
1.
2. (Demispan)
3.
4.
(Life style modiication)
5.
1
66
1
Mini-Nutritional Assessment (MNA)
15
(internet) http://www.mna-elderly.com/forms/MNA_thai.pdf
4 (anthropometry)
6 < 11
> 12
17 23.5 17
96 98 positive
predictive value 97 meta-analysis
MEALS - ON - WHEELS
(Mnemonics)
67
1.
MNA, MEALS ON - WHEELS
2.
(nasogastric tube)
(Parenteral nutrition)
3. (orexigenic drug)
megestrol acetate
HIV
(luid retention) (lushing) deep vein thrombosis adrenal
insuficiency cyproheptadine
anticholinergic
(Benign prostatic hypertrophy)
4. (antidepressant)
mirtazapine
62
68
5.
1. , , .
. : ; 2542.
2. , .
. : ; 2542.
3. , .
. : ; 2542.
4. , .
. : ; 2543.
5. . . : .
. 4 : ; 2556. 369397.
6. Assantachai P. Anthropometric aspects and common health problems in older adults. In: Preedy VR, ed. Handbook of
Anthropometry: Physical Measures of Human Form in Health and Disease. London: Springer; 2012. p. 14151434.
7. Assantachai P, Yamwong P, Lekhakula S. The study of alternative anthropometric measurements for the Thai elderly:
mindex and demiquet. Asia Paciic J Clin Nutr. 2006;15:521-7.
8. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us ? J Nutr Health Aging.
2006;10: 466-85.
9. Wilson M-MG, Morley JE. The diagnosis and management of protein energy undernutrition in older persons. In: Morley JE,
Miller DK, editors. Annual Review of Gerontology and Geriatrics Focus on Nutrition. New York: Springer; 1995. p. 110-42.
69
70
\}} 1
\\\ j k n | \ j k
n
.
s)
}p
j so
|
(Dementia)
'B`h`iod(
x x
x }x
y|z |
|)
xz
}x |\|
|x}
(
'x
(
x}x
x
x
xy
}
|x
zz
x
x
|
(visuospatial:
)
|xz z x
|x
| 'qdnpjnkodg9
( x
}
z
z z
y}
x
x
z x
z
}
}
| x
| z~
~}|
z
}z x|
|
|
}x
|
|
xz
x\
| | zz
z
|x
|
|
z z
y
xzz
z|z
y|
|
x
}xx |
1
3
}
x
|
z | | zz
cognitive function: ()
1.
n
o {n j\z jy }o n
n .j l#,$
(the cognitive impairment should be acquired )
0- x ^jbidodq` api^odji9 | \| x
2. (impair of multiple domains of cognitive function )
'oc` ^jbidodq` dhkdmh`io ncjpg_ ]` ^lpdm`_ (
3. (no impair of arousal )
1- x | 'dhkdm ja hpgodkg` _jhdin ja ^jbidodq` api^odji (
2-
(dementia) The Diagnostic and
} | 'ij dhkdm ja mjpng (
2
64
71
cognitive impairment cognition
6 (perceiving) (remembering)
(imagining) (thinking) (reasoning) (judgment)
72
(Alzheimers disease : AD)
degenerative change 3-5% 65
35-40% 85 7 AD/DAT
45
3
(1-3 ) short term memory
AD/DAT
construction
(instrumental activities of daily living IADL) /
irritability sadness, apathy
rigidity awareness depression separation
motor system, EEG CT scan
(2-10 )
self hygiene (
() ) ()
(IADL)
motor system-restlessness, EEG CT scan
(3-12 )
/ /
() 2-20
8-10
AD/DAT
(visuospatial)
73
AD/DAT ( )
AD/DAT
Degenerative Vascular dementia
reversible dementia complete ( dementia drugs, depression, metabolie, toxic and vitamin deiciency, normal pressure hydrocephalus
Test Folstein mini-mental state (MMSE) 9
cognitive function ( orientation, recall, registration, language
visuospatial ability) ( 3) MMSE score = 30
27-30 (Normal)
25-26 (Possible dementia)
10-20 (Mild-moderate dementia)
6-9 (Moderate-severe dementia)
< 6 (Severe dementia)
-
-
-
1. ()
( counseling )
2.
ABC
A = ADL (Activity of Daily living) :
B = Behavioral and psychological symptom of dementia :
C = Cognition :
B C ()
74
75
Sleep disturbances
cognitive function
1 reversible dementia
76
77
j nn
0(
1(
2(
3(
4(
5(
6(
7(
8(
72
78
5
(anticoagulant) (antiplatelet)
1 3
4 (delirium)
10-15
Gurwitz nursing home
6 ()
3
5
anticholinergic7
79
(delirium)
14
anticholinergic 8
Edward
(hazard)
9 6 1
1 ( 9)
80
10
(deinite diagnosis)
deinite diagnosis
11
11,12 2
(provider-based strategies) (system-based strategies)
13 (provider-based strategies)
1. (high risk drugs)
(inappropriate
medications for older persons)14,15 2 3
81
2.
3.
4. (interaction)
5.
6. (non-adherence)
82
83
(system-based strategies)
Medication Reconciliation (MR)
16
(
, /, , OPD) 17 MR
55 4
84
: medication reconciliation OPD review PIM
2
: medication reconciliation OPD IPD
review PIM 2 3
medication reconciliation (MR)
MR OPD 4
MR MR form
MR IPD 24
MR form admit
PIM 2 PIM 3
review potentially inappropriate medications Beers
criteria14
85
86
87
88
90
(YJ+X;(JT.eJ+cAYRNY@"["(YJ<JN/cL^T;
91
92
@0"
5@
@0"
5@
@0"
5@
93
: Sne en ha t
: Snellen Chart
94
1.
1.1
/
1
2
2 ................................................................................................................
........................................................................................................................................................
1.2
1.3 /
.......................................................
2.
10 /
"
"
95
1-5 1
96
14
1 1
2 1 2 1
3
4
97
: Abbreviated Mental Test (AMT)
98
: MMSE-Thai 2002
: MMSE-Thai 2002
99
3- 8bbTbX] ]` :PZRcZPbX] 5 z y} #0 l $
x z y} | lz y 3-0
| lz {\ y 3-1
3-0 yz y} 0// | x 6 x
----------------------- ------------ ------------ -------------- "
xz y x z| ' |z x ( | 4 z|
0+ 1 2 z| z z | y 3-1
3-1 ' ~( }x z z ' +( | z
' +(
x |}x | x z x ,
,,, z ' +( x | |z 'z(
----------------------- ------------ ------------ --------------- "
0/4
100
101
2 (2Q)
102
(2 )
9 (9Q)
103
: Timed
104
:
:
( M : od Mass nde )
(BMI : Body Mass Index)
105
106
107
(ADL)
108
109
110
111
z } . n r
0
x | . x |x y xy x| x
/
0
1 z x
0( |
"
"
1( x
"
"
/ ||y
0 y y| ||y
z } /
0
\n
, } x | xx 3-4 x x
/
0
} j
/
0
} | | z |
/
0
| | | 3-4 }
/ x 6
0 6 y.
| z |y|x | y y }
/
0
006
112
"7" "
113
114
z|x x
.
| | |zx x z |
z|x|
zyxy |xy
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
x |y x z x
xy 'Q`mqd^` kgi( x | ' - - ( |
x x | |x z
| x |z y x |x }- y z y x
xz x xy | x |xx z|x|
zyxy |xy y| } |{ |
| z x | x y|z xy| x
x xzy }x | x |y x |\\
} | { | | } | | | zx x z |
|zx } |
- zx xz|x| zyxy | xy
- |zx
- - x }
} xx |y
x
y xy
- - | x x
| x x
x
- - | z
x
|
} |{ | |
- - ~ x }
z
|
z
- - x z
x|
x x
} |{ | |
- - - } x
z
x x
z } |x
z |x |z
x x
- - -
z
- - - x --01/
115
- - - x z
z
- - - x |
z |x |z
z
- - - -
| |xx
- --- | - z
} |x
- y}|
- - x |
- - x}
|
- x| |
- x| | x
- x| |x
- x| | y | |
|
- |x x | x
} |{ | |
- | }}
|
} |{ | |
- | }
|
} |{ | |
- | }
} |{ | |
- | } ~
} |{ | |
- |}
} |{ | |
- | z
} |{ | |
- | x
} |{ | |
x x
x x
x x
x x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x x
x x
x x
x x
x x
x x
x x
- | x --010
116
- | x
- - x
- |
} |{ | |
} |{ | |
} |{ | |
x
x
x
yx
x
yx
x
yx
- } |
- x xy | xy
- x x |z yx y | x
y
- |
-
- z |z|x| zyxy | xy
- |zx
- - | z
x
x x
} |{ | |
- - ~ x }
z
|
z
- - - x z
x x
z
- - - x |
z |x |z
x x
z
- - - -
| |xx
x x
- --- | -
z
x x
} |x
- |
x|y}-
x x
x x
- | }
} |{ | |
- | } ~
x x
} |{ | |
- |} --011
117
- |}
} |{
} |{
} |{
} |{
} |{
} |{
- | z
- | x
- | x
- | x
- |
x x
| |
x x
| |
x x
| |
| |
| |
| |
- } |
- } xy | xy
- x zy xy |
- | x | zx x
-
| |
|
- -
012
118
x
x
x
yx
x
yx
x
yx
2557
119
120