老年醫學科醫師在長期照護的角色

根據經建會的推估約8成以上的失能者是65歲以上的老年人。隨著人口老化，老年人口的失能增加率將快速增加，自2011年起25年內，65歲以上的老年人口失能率將增加2－3倍以上，其中女性失能人數與增加率均高於男性。而失能的老年人常伴隨營養不良、多重共病症、用藥不適當等複雜狀況。僅僅強調照護，非以積極主動的介入來防止功能的退化，顯然並非好的長期照護。老年醫學專科的訓練著重在處理複雜狀況、限制失能的程度並促進功能回復，正符合此類長期照護需求者的臨床需求。目前國內醫師參與長期照護的主要工作內容，最大部份仍然為健康評估與疾病診療。相較於美國綜合預算平衡法案（Omnibus Budget Reconciliation Act, OBRA）對於護理之家所需提供的醫事服務有詳細的規定，台灣的醫療法與醫師法並未明定醫師在長期照護機構下的職掌。我們認為應該給與老年醫學科醫師在長期照護體系下清楚的定位，方足以發揮其功能。除了健康評估與疾病診療之外，醫師應協同其他照護人員訂定整合式治療計畫，維持照護的連續性，偵測臨床不穩定狀況，完成病歷記錄書寫，協助品質改善計畫，並注意末期生命照護的特殊需求。目前正值長期照護服務發展的關鍵時刻，我們呼籲必須釐清老年醫學科醫師在長照中的定位與工作職掌，方可實現高品質的長期照護。

關鍵字

長期照護；醫師角色；老年醫學

並列摘要

According to the CEPD (Council for Economic Planning and Development) estimation, old people aged 65 years and over account for approximately 80% of the entire disabled population, and the percentage is expected to escalate with the accelerating pace of population aging. The prevalence of disability in the elderly population is projected to increase two to three times within the next 25 years, with women registering a higher percentage in both the prevalence and the incidence of disability. Disability in older people is often accompanied with malnutrition, multi-morbidity, and potential inappropriate medication. It is thus obvious that for long-term care to be effective, it must be able to provide active interventions in disability prevention. Geriatric medicine with its focus on managing complex medical conditions, mitigating disability, and promoting restoration of physical functions is perfectly capable of meeting the goals of effective long-term care.Currently in Taiwan, however, most of the geriatricans participating in long-term care tend to concentrate on health evaluation and disease treatment. Compared to the U.S. ORBA (Omnibus Budget Reconciliation Act), neither the Medical Care Act and the Physicians Law in Taiwan provides specific prescription on the roles and responsibilities of physicians in long-term care. We believe that defining clearly geriatricans responsibilities in long-term care can help enhance the quality and effectiveness of long-term care. In addition to health evaluation and disease treatment, physicians should collaborate with medical professionals in other disciplines to optimize their contributions to elderly patients by developing integrated medical care plans, ensuring continuity of care, detecting clinical instability, documenting comprehensive medical histories, assisting quality improvement, and attending to the special needs of end-of-life care.At this moment when long-term care is experiencing critical transitions, we urge all responsible authorities to clearly define the roles and responsibilities of geriatricans as the key to quality long-term care.

並列關鍵字

long-term care ； physician role ； geriatric medicine

國際替代計量

老年醫學科醫師在長期照護的角色

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