周全性老年評估個案報告：多重慢性疾病併老年憂鬱及自殺行為

Comprehensive Geriatric Assessment of a Patient with Chronic Medical Disorders, Late-life Depression and Suicidal Behavior: A Case Report

吳雅婷(Ya-Ting Wu) ； 郭展宏(Chan-Hung Kuo) ； 許凱倫(Kai-Lun Sheu)

《台灣老年醫學暨老年學雜誌》 9卷4期 (2014/11) Pp. 198-211

https://doi.org/10.29461/TGG.201411_9(4).0005

摘要

據美國的研究統計，有8~16%的社區老人出現憂鬱症狀，甚至1~4%為重度憂鬱症，但是憂鬱症卻常被忽略診斷；另外一方面，老人常具有多種慢性病，而慢性病和憂鬱症常同時存在，老人憂鬱症不僅是會影響到治療順從性，同時也增加併發症及死亡率；此外，憂鬱症也增加老人自殺的危險性。本個案為一位七十四歲女性病人，患有糖尿病、高血壓、心臟衰竭併瓣膜性心臟病、持續性心房顫動和慢性C型肝炎等多重慢性疾病，於一年多前開始出現失眠的症狀，最近三個月減少社交活動，另外也伴隨著血糖控制惡化，但陸續的就診均著重在藥物劑量調整以達慢性病控制目標，直到這次出現自殺行為，透過跨領域的醫療團隊幫助病人與家屬建立全面的診斷、治療、預防及追蹤，同時也提醒適時的篩檢、診斷及治療憂鬱症，以促進身心健康及達成自殺防治。

關鍵字

周全性老年評估 ； 多重慢性疾病 ； 老年憂鬱

並列摘要

According to several studies published in the United States, the prevalence of depressive symptoms among elderly community dwellers ranges from approximately 8% to 16%, and that of major depression from 1% to 4%. Late-life depression, however, is often undetected or undertreated. The elderly usually have one or more chronic medical illnesses. Depression often coexists with poor adherence to prescribed medication regimens and is associated with increased morbidity and mortality in elderly patients with comorbid chronic medical conditions. Moreover, depression increases suicide risk. In this article, a 74-year-old woman with diabetes mellitus, hypertension, heart failure with valvular heart disease, persistent atrial fibrillation and chronic hepatitis C had been further troubled by insomnia for over one year, and social withdrawal was noted in the recent three months. Because of multiple physical illnesses and suicidal behavior, a comprehensive geriatric assessment was conducted and led to the diagnosis of late-life depression. Through interdisciplinary team assessment, we endeavored to develop an integrated plan for multi-intervention treatment and prevention.

並列關鍵字

comprehensive geriatric assessment ； chronic medical disorders ； late-life depression