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課程第一章
認識衰老和肌少症
內容
何謂健康老齡化?
Image source from : https://www.hkhs.com/en/our-business/elderly-housing
Image source from : https://www.futuregen.solutions/2016/08/16/the-shameful-case-of-elder-abuse-in-society/ &
內在能力和機能
健康老齡化：增強內在能力/延緩衰退
從健康老齡化到衰老 傳統科學方法
對長者使用傳統方法的局限性 (1)
對長者使用傳統方法的局限性 (2)
動物研究知識
https://www.scmp.com/lifestyle/health-wellness/article/3153010/ & https://www.science.org/content/article/
➡（形成） 衰老綜合症 衰老綜合症
衰老以兩種方式呈現
老齡和衰老
衰老的關鍵概念
關鍵概念(儲備下降)
衰老的關鍵概念
衰老的影響
衰老的關鍵概念 衰老為"……的臨床狀態。多個生理系統的儲備和功能下降……"
不要與以下情況混淆
• 殘疾/自理能力受限
殘疾和衰老 個案一
• 基線：獨立
個案二
• 基線：右膝骨關節炎，習慣緩慢行走
兩人都無法在沒有輔助設備的情況下行走（類似的殘疾)
• 導致殘疾的機制是否相似? 殘疾和衰老…… 對個案一而言
對個案二而言
• 若只有單一風險因素（膝關節炎、腦血管病變、腿長差異），他仍可能設法通過代償機制行走
關鍵概念 (衰老≠殘疾)
衰老有多普遍?
(Woo et al., 2015)
篩查衰老 - 誰需要篩查? 如何篩查? 如何篩查?
衰老表型 (Fried et al., 2001)
衰老指數 (Rockwood et al., 2005)
臨床衰老量表 (Rockwood et al., 2005)
臨床衰老量表 (Chong et al., 2021)
Image source from : https://www.jamda.com/article/S1525-8610(21)00203-6/fulltext 衰老量表 (Morley) 
埃德蒙頓衰老量表 
Image source from : https://ihub.scot/improvement-programmes/community-care/electronic-frailty-index-efi/ 如何在不同的工具中進行選擇?
誰需要篩查?
為什麼要篩查衰老?
預防壓力下的併發症
➡ 與醫院相關之併發症
為什麼要篩查衰老?
完善管理計劃 (示例)
完善管理計劃 
為什麼要篩查衰老?
為什麼要篩查衰老?
現在讓我們去討論肌少症 
肌少症和衰老 
肌少症的定義
(Chen et al., 2020) 肌少症有多常見?
(Woo et al., 2015) 肌少症風險問卷
肌少症社區篩查 (流程)
(Chen et al., 2020) 臨床環境中篩查的觸發因素
(Chen et al., 2020) 診斷出肌少症 / 衰老後該怎麼辦 回顧三者的關係
(Cruz-Jentoft et al., 2019) 回顧三者的關係
(Bentov et al., 2019)
診斷出肌少症和 / 或衰老後該怎麼辦?
心理衰老
認知衰老 認知衰老的概念
社交衰老
干預措施
更好的是 ... 提高復原能力
推薦閱讀 Professional training materials of Cadenza Training programme
參考資料 Asgar, A. W., Ouzounian, M., Adams, C., Afilalo, J., Fremes, S., Lauck, S., … Webb, J. G. (2019). 2019 Canadian cardiovascular society position statement for Transcatheter aortic valve implantation. Canadian Journal of Cardiology, 35(11), 1437-1448. doi:10.1016/j.cjca.2019.08.011 Bentov, I., Kaplan, S. J., Pham, T. N., & Reed, M. J. (2019). Frailty assessment: From clinical to radiological tools. British Journal of Anaesthesia, 123(1), 37-50. doi:10.1016/j.bja.2019.03.034 Center for Perioperative Care. (2021). Guideline for perioperative care for people living with frailty undergoing elective and emergency surgery. British Geriatrics Society. Retrieved from Chen, L., Woo, J., Assantachai, P., Auyeung, T., Chou, M., Iijima, K., Jang, H. C., Kang, L., Kim, M., Kim, S., Kojima, T., Kuzuya, M., Lee, J. S., Lee, S. Y., Lee, W., Lee, Y., Liang, C., Lim, J., Lim, W. S., … Arai, H. (2019). Asian working group for Sarcopenia: 2019 consensus update on Sarcopenia diagnosis and treatment. Journal of the American Medical Directors Association, 21(3), 300-307.e2. https://doi.org/10.1016/j.jamda.2019.12.012 Chong, E., Tham, A., Chew, J., Lim, W. S., Tan, H. N., Ang, H., & Chan, M. (2021). Brief aids to guide clinical frailty scale scoring at the front door of acute hospitals. Journal of the American Medical Directors Association, 22(5), 1116-1117.e2. doi:10.1016/j.jamda.2021.02.005 Chong, E., Lim, A., Mah, F., Yeo, L., Ng, S., & Yi, H. (2022). Assessing the psychosocial dimensions of frailty among older adults in Singapore: A community-based cross-sectional study. BMJ Open, 12(2), E047586. Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., & Cederholm, T. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(4), 601-601. doi:10.1093/ageing/afz046 Dent, E., Lien, C., Lim, W. S., Wong, W. C., Wong, C. H., Ng, T. P., Woo, J., Dong, B., De la Vega, S., Hua Poi, P. J., Kamaruzzaman, S. B., Won, C., Chen, L., Rockwood, K., Arai, H., Rodriguez-Mañas, L., Cao, L., Cesari, M., Chan, P., … Flicker, L. (2017). The Asia-Pacific clinical practice guidelines for the management of frailty. Journal of the American Medical Directors Association, 18(7), 564-575. https://doi.org/10.1016/j.jamda.2017.04.018 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., …Vellas, B. (2019). Physical frailty: ICFSR international clinical practice guidelines for identification and management. The journal of nutrition, health & aging, 23(9), 771-787. https://doi.org/10.1007/s12603-019-1273-z Fitten, L. J. (2015). Psychological frailty in the aging patient. Nestlé Nutrition Institute Workshop Series, 45-54. https://doi.org/10.1159/000382060 Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., … McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. doi:10.1093/gerona/56.3.m146 Kelaiditi, E., Cesari, M., Canevelli, M., Abellan van Kan, G., Ousset, P. -., Gillette-Guyonnet, S., … Vellas, B. (2013). Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The journal of nutrition, health & aging, 17(9), 726-734. doi:10.1007/s12603-013-0367-2 Lee, J. S., Auyeung, T., Leung, J., Kwok, T., & Woo, J. (2014). Transitions in frailty states among community-living older adults and their associated factors. Journal of the American Medical Directors Association, 15(4), 281-286. doi:10.1016/j.jamda.2013.12.002 MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266-272. https://doi.org/10.1016/j.gerinurse.2016.02.014 Michel, J., & Sadana, R. (2017). "Healthy aging" concepts and measures. Journal of the American Medical Directors Association, 18(6), 460-464. https://doi.org/10.1016/j.jamda.2017.03.008 Mijnarends, D. M. (n.d.). Sarcopenia: A rising geriatric giant. doi:10.26481/dis.20160413dm Rockwood, K. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495. doi:10.1503/cmaj.050051 Rockwood, K., & Mitnitski, A. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(7), 722-727. doi:10.1093/gerona/62.7.722 Woo, J., Leung, J., & Morley, J. E. (2015). Validating the SARC-F: A suitable community screening tool for Sarcopenia? Journal of the American Medical Directors Association, 15(9), 630-634. doi:10.1016/j.jamda.2014.04.021 Woo, J., Yu, R., Wong, M., Yeung, F., Wong, M., & Lum, C. (2015). Frailty screening in the community using the FRAIL scale. Journal of the American Medical Directors Association, 16(5), 412-419. doi:10.1016/j.jamda.2015.01.087 World Health Organization (2020). Healthy ageing and functional ability. Retrieved from https://www.who.int/newsroom/questions-and-answers/item/healthy-ageing-and-functional-abilit Xue, Q. (2011). The frailty syndrome: Definition and natural history. Clinics in Geriatric Medicine, 27(1), 1-15. doi:10.1016/j.cger.2010.08.009 Ye, L., Elstgeest, L. E., Zhang, X., Alhambra-Borrás, T., Tan, S. S., & Raat, H. (2021). Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: A cross-sectional study of urban health centres Europe (UHCE). BMC Geriatrics, 21(1). https://doi.org/10.1186/s12877-021-02364-x Yu, R., Tong, C., Ho, F., & Woo, J. (2020). Effects of a Multicomponent frailty prevention program in Prefrail community-dwelling older persons: A randomized controlled trial. Journal of the American Medical Directors Association, 21(2), 294.e1-294.e10. https://doi.org/10.1016/j.jamda.2019.08.024 - 第一章完結 - 課程第二章
衰老及肌少症之營養干預
一、以補充營養來預防身體衰老及肌少症
預防衰老及肌少症 - 營養
1. 攝取足夠能量
2. 最佳蛋白質攝取量
3. 維他命D
4. Omega-3脂肪酸
5. 地中海飲食
二、以營養逆轉肌少症/身體衰老
1. 保持理想體重
2. 最佳蛋白質攝取量
3. 維他命D
4. 地中海飲食 對已確立的衰老，治療效果不明
個案1 陳先生70歲，體重60公斤，身高160厘米，每週做兩次太極，沒有慢性病
答案:
1. BMI 23.4，屬於長者的正常範圍，陳先生沒有超重
請重溫課程5 老唔惱 – 耆妙飲食: 食得耆福獲取更多資訊。 參考資料 Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., … Boirie, Y. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group. Journal of the American Medical Directors Association, 14(8), 542-559. Doi:10.1016/j.jamda.2013.05.021 Bruyère, O., Cavalier, E., Buckinx, F., & Reginster, J. (2017). Relevance of vitamin D in the pathogenesis and therapy of frailty. Current Opinion in Clinical Nutrition & Metabolic Care, 20(1), 26-29. Doi:10.1097/mco.0000000000000334 Coelho-Junior, H. J., Marzetti, E., Picca, A., Cesari, M., Uchida, M. C., & Calvani, R. (2020). Protein intake and frailty: A matter of quantity, quality, and timing. Nutrients, 12(10), 2915. Doi:10.3390/nu12102915 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Arai, H., Kritchevsky, S. B., Guralnik, J., … Vellas, B. (2018). International clinical practice guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management. The journal of nutrition, health & aging, 22(10), 1148-1161. Doi:10.1007/s12603-018-1139-9 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., … Vellas, B. (2019). Physical frailty: ICFSR international clinical practice guidelines for identification and management. The journal of nutrition, health & aging, 23(9), 771-787. Doi:10.1007/s12603-019-1273-z Huang, Y., Chiu, W., Hsu, Y., Lo, Y., & Wang, Y. (2020). Effects of omega-3 fatty acids on muscle mass, muscle strength and muscle performance among the elderly: A meta-analysis. Nutrients, 12(12), 3739. Doi:10.3390/nu12123739 Kojima, G., Avgerinou, C., Iliffe, S., & Walters, K. (2018). Adherence to Mediterranean diet reduces incident frailty risk: Systematic review and meta-analysis. Journal of the American Geriatrics Society, 66(4), 783-788. Doi:10.1111/jgs.15251 Morley, J. E. (2012). Undernutrition in older adults. Family Practice, 29(suppl 1), i89-i93. Doi:10.1093/fampra/cmr054 Radd-Vagenas, S., Duffy, S. L., Naismith, S. L., Brew, B. J., Flood, V. M., & Fiatarone Singh, M. A. (2018). Effect of the Mediterranean diet on cognition and brain morphology and function: A systematic review of randomized controlled trials. The American Journal of Clinical Nutrition, 107(3), 389-404. Doi:10.1093/ajcn/nqx070 Silva, R., Pizato, N., Da Mata, F., Figueiredo, A., Ito, M., & Pereira, M. G. (2017). Mediterranean diet and musculoskeletal-functional outcomes in community-dwelling older people: A systematic review and meta-analysis. The journal of nutrition, health & aging, 22(6), 655-663. Doi:10.1007/s12603-017-0993-1 Stajkovic, S., Aitken, E. M., & Holroyd-Leduc, J. (2011). Unintentional weight loss in older adults. Canadian Medical Association Journal, 183(4), 443-449. Doi:10.1503/cmaj.101471 Van Duong, T., Chiu, C., Lin, C., Chen, Y., Wong, T., Chang, P. W., & Yang, S. (2020). E-healthy diet literacy scale and its relationship with behaviors and health outcomes in Taiwan. Health Promotion International, 36(1), 20-33. Doi:10.1093/heapro/daaa033 Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., … Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47. Doi:10.1016/j.clnu.2018.05.024 Woo, J. (2016). Body mass index and mortality. Age and Ageing, 45(3), 331-333. Doi:10.1093/ageing/afw042 - 第二章完結 - 課程第三章
衰老及肌少症之運動干預
結構化運動計劃
➡ 對身體機能、認知和心理健康均有正面影響
請到課程4 老唔惱 – 防跌耆妙法，路遙皆可達獲取更多防跌的資訊 多種類的運動計劃
世衛組織關於身體活動和
建議
體能活動金字塔
圖片來源 : https://www.elderly.gov.hk/tc_chi/healthy_ageing/ 運動時理想心率圖表
進行運動時的提示和建議
長者活力體能訓練方案
長者活力體能訓練方案評估
如欲獲取更多資訊，請瀏覽 http://vivifrail.com/wp-content/uploads/2020/12/pasaporte-SANITARIO-CHIV4.pdf.
圖片及資料來源 : http://vivifrail.com/wp-content/uploads/2020/12/pasaporte-SANITARIO-CHIV4.pdf A級 殘疾人士
B級 衰老者
長者活力體能訓練（衰老） C級 衰老前期者
長者活力體能訓練（前期衰老） D級 健康者
長者活力體能訓練（健康者） 「長者活力體能訓練方案」
更多運動短片 強化肢體防跌倒
香港中文大學賽馬會老年學研究所賽馬會齡活城市計劃
參考資料 American Heart Association. (2021). Target heart rates chart. www.heart.org. https://www.heart.org/en/healthy-living/fitness/fitness -basics/target-heart-rates Casas-Herrero, A., Anton-Rodrigo, I., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Martinez-Velilla, N., Elexpuru-Estomba, J., Marin-Epelde, I., Ramon-Espinoza, F., Petidier-Torregrosa, R., Sanchez-Sanchez, J. L., Ibañez, B., & Izquierdo, M. (2019). Effect of a multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive decline: Study protocol for a randomized multicentre control trial. Trials, 20(1). https://doi.org/10.1186/s13063-019-3426-0 The Government of the Hong Kong Special Administrative Region. (2020). "Create your own exercise programme" - for both elders & caregivers. Elderly Health Service. Izquierdo, M., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Martínez-Velilla, N., Ramirez-Vélez, R., García-Hermoso, A., Casas-Herrero, A., Sinclair, A., & Rodríguez-Mañas, L. (2021, March 6). VIVIFRAIL: A multi-component physical training program to prevent weakness and falls in people over 70 years [web log]. Retrieved January 26, 2022, from https://blogs.bmj.com/bjsm/2021/03/06/vivifrail-a-multi-component-physical-training-program-to-prevent-weakness-and-falls-in-people-over-70-years/ Theou, O., Stathokostas, L., Roland, K. P., Jakobi, J. M., Patterson, C., Vandervoort, A. A., & Jones, G. R. (2011). The effectiveness of exercise interventions for the management of frailty: A systematic review. Journal of Aging Research, 2011, 1-19. https://doi.org/10.4061/2011/569194 World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. Retrieved from https://www.who.int/publications/i/ - 第三章完結-
測驗、回饋和證書 (只供英文版)
實用連結/ 資源 相關之流金頌培訓教材 聲明 本課程影片所提供的資訊只作教育用途，並不作為醫療建議或診斷，亦不能代替任何醫療決定。倘若有任何醫療上的問題或要作出任何醫療決定前，先諮詢你的醫療團隊並共同討論是重要的。由於本課程的影片只作教學用途，我們不會對你就影片而作出的任何決定及後果負上任何責任。任何情況下，捐助機構皆不會對任何人或法律實體因此載內容而作出或沒有作出的任何行為負上任何法律責任。 |
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