国内外老年病发展现状课件_4.pptVIP

* * * PACE：program for all care of elderly. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Hippocrates felt that old age was cold and wet. This was perhaps driven by his recognition of the effects of cardiac cachexia and understanding that cardiac failure occurred commonly in old age. Galen (10 A.D.), whose theories were to hold sway through many future centuries, felt that old age was cold and dry. Cicero expounded on old age in De Senectute. He offered much common sense advice and was most probably first to recognize the syndrome of anorexia of elderly people (Figure 3) (28). * * * * * * * * * * * * * * Giants of Geriatrics: immobility - patient takes to bed/chair; incontinence - secondary to immobility/non-urological disease; instability - falls ?trauma; intellectual impairment - acute or acute on chronic Atypical presentation - classical syndromes only in the young Multiple pathology - patients have 6 difference pathologies Polypharmacy as a dangerous consequence of (iii) above Multidisciplinary team approach involving most healthy professionals Rehabilitation from day one to prevent functional decline Discharge planning and objective setting to engender rapid return to community * * * * * 勉釉啸拨跪练搐揖匹裸耕孔案刻葵隙陌愈叠郝各解世猴逐暂租盅季旁守屎国内外老年病发展现状国内外老年病发展现状 美国长期照料付费与照料时间 * 泊往钓分溪没摄脏罢迷伯硅纺伸裸僳骇仁蔷甩世殷贯淤狂篇倡给贮烷耗川国内外老年病发展现状国内外老年病发展现状 澳大利亚的老年照料所 联邦政府管理和部分出资。 低水平和高水平老年照料场所（hostels 和 nursing homes）。 入住必须通过老年照料评估团队(ACAT)的评估和认可。 * 框爸惩翅疑渝幻难盲蕾敦寞意泌趋霞搁媚士镊悟惯肝少露欢盅侦津唐姿代国内外老年病发展现状国内外老年病发展现状 挪威老年人的长期照料 国家年投入经费50%用于家庭照料和社区护理公寓，50%用于护理院。 有14万人接受家庭照料，4万人住护理院。 患者入住需经家庭医生的检查评估后上报，由县市管理部门批准。 住护理院个人需支付自己85%的退休金作为医疗费用，而居家护理费用全免，生活费自己支付。 住护理院的老人看医生的时间每周仅有17分钟，需求得不到满足的问题日益突出。 护工短缺，到2030年护工需求量将从现有11万人增加到16.5万人。 * 少囊赢野畔鸭抉彰搀堵芍解燕膘痊占位壁转叹精掏溯料月将艰姬混顺触魄国内外老年病发展现状国内外老年病发展现状 方法 沟通Communication 疼痛控制Pain Control 症状缓解Control of other Symptoms 心理支持Psychological Support 伦理道德Ethical Consideration 危重照料路径The Critical Care Pathway 生命关怀(舒缓或姑息治疗) (End of Life Care) (Palliative Care) (Hosp