老年人多重用药及评价工具的研究进展

我国老龄化问题日益严峻,这对老年人相关疾病的诊治提出了新的挑战.老年综合评估是老年医学的核心技术,是对老年患者的躯体功能、精神心理、社会环境、生活质量及多重用药等多方面进行的全面个体化评估.其中多重用药是老年人中一种常见的老年综合征,会增加老年人药物不良反应的发生风险,对老年人多重用药采取行之有效的评估和干预已成为亟待...     

21世纪我国老年医学发展方向

老年人具有基础疾病多、器官功能储备差、起病隐匿、多重用药等特点,老年医学除具有其综合性、全面性和个体化的特点外,还需注重维持老年人的能力和生活质量,对老年人提供全方位的健康服务。在中国,目前老年医学的发展还需要现代观念、政策及资金上的支持,建立独立的老年医学学科有其必要性及合理性。     

WHO/中国老年社区卫生服务研讨会纪要

WHO 中国老年社区卫生服务研讨会于 2 0 0 3年 10月15～ 19日在北京举行。WHO老年医学官员Dr .AlexKalache、WHO顾问Dr .OkRyunMoon和WHO驻华代表Dr .HenkBekedam、卫生部、全国老龄工作委员会办公室、各省市卫生厅局等负责老年卫生工作的同志以及许多老年医学专家参加会议。与会代表对当前加强我国社区老年卫生服务急需开展的活动或工作、社区老人卫生服务中疾病控制机构的切入点和结合点、进一步加强全国社区老年卫生服务 ,满足老年人的医疗保健需求、提高老年人生活质量、促进健康老龄化的实现和社区经济协调发展、中国社区老年…     

编者的话

赵紫阳同志在党的十三大报告中提出:“要注意人口迅速老龄化的问题,及时采取正确对策。”随着科学技术的进步,医疗水平的提高,生活条件的改善,人类的平均寿命也显著延长了,老年人在人口中的比例正在日益增加。老年人独特的组织结构、生理功能、病理演变、心理状态,己经逐渐地引起了世界各国医学工作者的重视,由此而形成了一门新兴的综合性的学科——老年医学。当前,老年医学的研究正方兴未艾。     

1000例老年人口腔颌面部肿瘤的回顾分析

随着人口结构日趋老龄化,肿瘤的发生率在老年人群中相应增高,治疗方法的选择上也有其特殊性,因此治疗老年肿瘤的问题较为突出[1,2].本文收集了近10年来老年口腔颌面肿瘤患者1 000例,探讨老年肿瘤病人的诊治和预防策略,为老年人口腔颌面部肿瘤的诊治和预防提供参考.     

重视整体医学背景下老年精神障碍研究

<正>当世界进入新的千年,中国也正式步入老龄化社会,年龄>65岁的人口数量和比例逐年增多,而且这一趋势还将持续至2050年。社会医疗支出相应增加,老年人的健康保健费用所占比重也增大。对老年医学而言,西方的发展模式已经从"疾病"走向"成功老龄化",更加注重生活质量和健康管理。根据老年人的特征提出"老年综合征"的概念,即更重视整体评估,而不是仅限于单个器官或系统疾病的程度。对于疾病的干预也不仅是治疗,更多应用照料、管理、康复、预防的方式,以提高老年人的     

对我国老年医学专科医师培养途径与模式的粗浅认识

随着我国进入老龄化社会,建立一支为之服务的老年医学医师队伍是保证老年人医疗健康服务的基础.但如何培养并建立起这支既能满足老年社会的基本医疗需求又能兼顾老年医学学科发展的队伍是摆在我们面前的重要任务.从内科高年住院医师中选拔高素质人才,进行现代老年医学相关专科培训,同时建立一支多学科老年医学临床工作团队,从临床上培养老年医学专科医师是一种可行的培养模式;另外建立导师制,从科研与个人职业发展方向两方面给予指导是培养高层次老年医学领军人才的可借鉴模式;将这些培养模式与社区医师培养相结合,使老年医学专科人才资源延伸到社区是快速培养我国老年医学医师队伍的可能方式.     

《老龄化与老年医学新进展》出版消息

《老龄化与老年医学新进展》一书,为华东医院上海市老年医学研究所、上海医科大学中山医院及中科院上海生命科学研究中心多位专家学者合作编著,近期内出版。内容强调衰老及老年认知功能障碍发病机制的综合性及综合性延缓措施的必要性;并收译最近一届世界老年学大会主题...     

老年患者术前评估中国专家建议(精简版)

正2015年中华医学会老年医学分会及解放军总医院老年医学教研室已制定并于《中华老年医学杂志》发表了《老年患者术前评估中国专家建议》,为便于广泛推广该建议,解放军总医院老年医学教研室联合《中华老年心脑血管病杂志》编辑委员会对该建议进行了精简,形成了以下老年患者术前评估专家建议精简版。1衰弱状态的评估按表1进行评估,可咨询老年专科医师以进一步评估[1]。     

加拿大老年医学科医生培训情况

目的 本文结合加拿大医科生的培训情况,介绍加拿大的老年医学培训.在加拿大,老年医学隶属于内科学的范畴,经加拿大皇家医师学会认证,有全国通用的老年医学专业资格证书.要成为老年科医生,在经过了大学本科和医学院培训并从事临床工作的基础上,还需参加2年的老年医学科培训.学习内容主要是有关衰老以及老年人特有的健康问题,包括衰弱、联合用药、认知损害、痴呆和功能损害.在老年医学专业培训的过程中,医生要学习如何对老年人进行综合性评估,并学习如何在住院部、门诊部、疗养所和老年人家中等多种医疗环境中及多学科组成的医疗团队中从事诊治工作.     

Physicians' judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy

INTRODUCTION: Elderly cancer patients are a very heterogeneous population. A comprehensive geriatric assessment (CGA) shall help to identify more precisely those patients who are fit, compared to those who are vulnerable or frail, when deciding on chemotherapeutical treatment. METHODS: In a prospective trial, 200 cancer patients treated in an out-patient setting were judged by their physician for their fitness for chemotherapy as fit, vulnerable or frail. A CGA was performed thereafter. We determined the feasibility of a CGA in an out-patient setting and the frequency of changes within the different assessment tools and compared physicians' judgement with the CGA results. RESULTS: Physicians judged 64.3% of their patients as fit, 32.4% as vulnerable, and 3.2% as frail. A CGA was completed by 97.5% of patients and lasted 20min per patients (range: 9-47min). 26.5% of all patients had no deficits in the CGA. The CGA identified a mean of 1.7 problems per patient, 1.3 in patients judged as fit, 2.3 in those judged as vulnerable, and 4.2 in those judged as frail. A CGA is more sensitive in classifying patients as fit compared to vulnerable or frail than physicians' judgement. CONCLUSION: A CGA is feasible and detects more elderly cancer patients as being unfit for chemotherapy than physicians' judgement. Further trials including disease and treatment related end-points are needed.     

Möglichkeiten und Grenzen der onkologischen Chemotherapie bei alten Patienten

The chronological age of a patient should not be a barrier to apply chemotherapy. Elderly patients can benefit from chemotherapy. Chronological age should not be a reason for diagnostic or therapeutic nihilism, as the age of a patient poorly characterizes their health situation. Data with high level of evidence on treatment of elderly patients with cancer are limited. A comprehensive geriatric assessment (CGA) describes the individual deficits and resources of a patient much better. Limitations in CGA are risk factors for increased toxicity and decreased treatment benefit. The currently available data demonstrate under- and over-treatment in elderly patients with cancer.     

Undernutrition in elderly patients with cancer: target for diagnosis and intervention

In recent years, geriatricians and oncologists have worked together to evaluate elderly patients with cancer before and during treatment, to estimate the balance between the efficacy and safety of chemotherapy and to upgrade treatment in this population according to their comorbidity and physiological status. The clinical and biological factors of this population need to be assessed in multidisciplinary comprehensive geriatric assessment (CGA) in order to optimize treatment without inducing major adverse effects. We reviewed the nutritional aspects of this evaluation that highlight the impact of undernutrition on poor survival. In this paper we briefly describe tumoral cachexia (molecular and physiological), the impact of undernutrition on cancer prognosis (predictive factors), therapeutic effects of cancer on nutritional status, nutritional indicators (biological, anthropometric) and undernutrition in the elderly (specific needs of this population). The potential for nutritional intervention in geriatric oncology with regard to CGA is explored.     

术后腹腔化疗对老年结直肠癌患者生存质量的影响

目的评价老年结直肠癌患者手术后腹腔化疗对生存质量的影响。方法调查1998年1月至2002年12月期间52例60岁以上进行术后腹腔化疗的患者的生存质量GLQI指数,并与同期、同年龄段44例静脉化疗患者和40名健康老年对照组进行比较。所有病人于术前和术后6个月期间调查患者的生存质量。结果老年结直肠癌患者手术前的生存质量GLQI指数明显低于正常老年人群(P<0.05)。而两组患者手术前的生存质量GLQI指数无显著差异(P>0.05)。腹腔化疗组患者手术后6个月期间的生存质量GLQI指数高于静脉化疗组患者,其差异存在统计学意义(P<0.05)。腹腔化疗组患者手术后3月、4月、5月和6月的生存质量GLQI指数与正常老年人群无显著差异(P>0.05);而静脉化疗组患者手术后3月、4月、5月和6月的生存质量GLQI指数仍低于正常老年人群(P<0.05)。结论针对老年结直肠癌患者的生理特点,手术后采用腹腔化疗,不仅有利于提高手术后的生存期;而且有助于提高患者的生存质量,是老年结直肠癌患者手术后首选的理想化疗方式。     

腹腔化疗对老年进展期胃癌患者术后细胞免疫的影响

目的探讨老年胃癌患者手术后腹腔化疗对免疫功能的影响。方法对我院1997年1月至2002年12月60岁及以上接受胃癌根治性手术并进行腹腔化疗的49例患者前后细胞免疫检测,并与我院同期接受胃癌根治性手术并单独行静脉化疗的37例患者进行比较,以健康老年人作为正常对照组。所有患者于化疗前1d和化疗后7d早晨空腹时静脉采血,正常对照组于体检当日早晨空腹时静脉采血,测定血清中NK细胞和T细胞亚群。结果老年胃癌患者手术后CD4 和NK细胞水平明显低于正常对照组;老年胃癌患者化疗后CD4 、CD4 /CD8 和NK细胞水平低于化疗前,静脉化疗组化疗前后的差异具有统计学意义(P<0.05),而腹腔化疗组病人化疗前后的差异无统计学意义(P>0.05)。结论针对老年胃癌患者手术后的免疫特性,宜采用对细胞免疫抑制较轻的腹腔化疗方式进行化疗。     

Chemotherapy for colorectal carcinoma in the elderly

With nearly 50 % of all colorectal cancers being diagnosed in patients at the age of 70 or above colorectal cancer is a disease of the elderly. In an adjuvant setting, fit elderly patients can receive the same benefit from cytotoxic therapy as younger patients with an only slightly increased toxicity. In a palliative setting, the treatment of elderly patients with respect to clinical endpoints such as response, time to progression or overall survival is as effective as in their younger counterparts. In clinical studies, older patients are generally underrepresented and among the elderly patients involved in clinical studies there is a bias towards particularly fit patients. Therefore it is not possible to extrapolate the results of many randomized trials to all elderly patients. A Comprehensive Geriatric Assessment (CGA) should be applied to detect the diversities in the geriatric population. Based on this assessment elderly patients classified as suitable for chemotherapy should be enrolled into clinical trials for colorectal cancer.     

Non-Hodgkin's lymphoma in the elderly

With rising age the incidence of non-Hodgkin's lymphoma (NHL), together with the fact that the proportion of people older than 65 years in Western populations will double during the next 40 years, poses the challenge to adequately meet the needs of elderly patients. After a general introduction on cancer in the elderly, a review is given concerning aspects of epidemiology and prognostic factors of NHL. Therapeutic strategies, including the use of hematopoietic growth factors, for the elderly with aggressive NHL are discussed. The future role for so-called comprehensive geriatric assessment (CGA) to appropriately determine treatment possibilities is emphasized. Much scientific work has to be performed before the true value of CGA instruments can be acknowledged. Screening instruments are discussed and the role for specially trained oncology nurses in the assessment process is stipulated.     

中国与加拿大合作开展健康与衰老研究的情况介绍

Improving health care in later life is crucial, especially under the impact of world population ageing. It provides challenges and opportunities for health and ageing research, and global co-operations and joint commitments among different countries are needed. Supported by the Canada-China Joint Health Research Initiative Program, the Canada China Study in Ageing and Longevity is the first research of the kind to compare the process of ageing and health changes between Canadian and Chinese. The collaboration sets up a data and knowledge sharing agreement between the participate partners. The initial proposal was for the " Quantification of health status changes in China and in Canada: an evaluation of a stochastic model of health transition". As the project evolves, however, the focus is expanding to develop a quantative method to assess frailty in elderly Chinese people, corresponding to information collected in Canada in Comprehensive Geriatric Assessments (CGAs). The Canadian team has established the Frailty Index and a stochastic ageing model, which despite mathematically simplicity, can capture characteristic health statue changes. The model will be applied to study Chinese datasets and parameters will be compared between different countries. In additional, a new version of the Frailty Index, based on a CGA (the FI-CGA) will be developed, tested and modeled. Through various research activities, the collaborative research will allow quantification not only of the impact of ageing, but also of the impact of a feasible intervention on improving public health in different social settings.     

Comprehensive Geriatric Assessment for outpatients is important for the detection of functional disabilities and depressive symptoms associated with sensory impairment as well as for the screening of cognitive impairment

Background:   The Comprehensive Geriatric Assessment (CGA) for inpatients is very useful to improve the outcomes of elderly patients. However, most of the elderly patients are provided their care by general practitioners in primary care settings without comprehensive assessment. Concise and practical assessment is necessary for the detection of geriatric problems and sufficient care in the outpatient clinic.
Methods:   The CGA was introduced in the outpatient clinic for elderly people in Kyoto University Hospital and 309 patients participated in the study, where cognitive impairment, depressive symptoms, activities of daily living, and self-reported hearing and visual impairment were assessed.
Results:   In the patients studied, the most prevalent chief complaint was memory loss (19%). Among the patients complaining of memory loss, two-thirds of the patients were diagnosed as cognitively impaired by the Mini-Mental State Examination. Multiple logistic regression analysis showed that hearing and visual impairment was significantly associated with functional disabilities and that hearing impairment was significantly associated with depressive symptoms.
Conclusions:   Thus, the CGA for outpatients is useful for the detection of functional disabilities and depressive symptoms by asking about their sensory impairment as well as for the detection of cognitive impairment in elderly patients. Therefore, concise and practical assessment should be introduced in the primary care settings to improve the quality of life of elderly people.     

Advances in the systemic treatment of cancers in the elderly

Cancer is a disease of the elderly. More than 50% of all cancers and deaths occur in people over 65 years. Older cancer patients are less likely to be referred to centers or to be given adequate chemotherapy. The elderly are under-represented in Phase I and II trials. Some of this hesitancy to give chemotherapy is related to the increased presence of co-morbid conditions in the elderly. Toxicity is another concern. This review summarizes data from literature on the effectiveness, outcome, and toxicity of chemotherapy in selected tumors. Information is presented on age related effects. In addition, a summary of new agents and biologics is presented that needs to be looked at for age related effects. Some comments are made on the pharmacokinetic impact of physiologic changes in the elderly on chemotherapy drugs. As the world's population ages, we need to include the elderly in trials to get data on age related effects. Most of the information presented shows that effective chemotherapy can be given safely to the elderly and the outcomes and toxicity are equivalent for many of the common solid tumors.