老年症候群與多重用藥

隨著台灣邁入高齡社會，老年人的醫療與健康問題也日益重要，多重器官與系統的退化、生理儲備能力的下降再加上多重共病，導致各種老年症候群（geriatric syndrome）的發生，不僅增加臨床照顧的複雜度，也造成病人與家屬極大的生活負擔。在疾病與老年症候群的交互影響之下，多重用藥（polypharmacy）的議題也漸漸受到重視，為了避免藥物不良反應與潛在不適當用藥引發的各種問題，臨床醫師可以使用不同的評估工具，審慎地檢視病人的藥物清單，透過劑量調整與簡化藥物提升藥物使用的品質，減少病人接受藥物治療的風險，實現處方優化（deprescribing）的價值與好處。本文透過一位近期意識狀態改變的個案，詳細描述臨床評估與功能性回顧的過程，完整呈現周全性老年評估介入後的情況，透過周全性老年評估不僅能有效釐清個案的臨床問題與老年症候群，更能藉由多元團隊成員的合作訂定個人化的治療計畫。希望這樣的分享可以給予老年醫學臨床實務上的幫助，增加醫療資源運用的效率，也提高病人與家屬的照顧品質。

關鍵字

周全性老年評估；老年症候群；多重用藥

並列摘要

As Taiwan is becoming an aged society, the medical conditions and health concerns of the elderly have come to assume increasing importance. Degeneration of multiple organs and systems, loss of physiological reserve, and multimorbidity give rise to various geriatric syndromes among the elderly, not only aggravating the complexity of medical care but also imposing great burden on patients and their families. Due to the interactions of diseases and geriatric syndromes, medical professionals have directed greater attention to the issue of polypharmacy recently. In order to prevent adverse drug effects and potential inappropriate medication, physicians make use of different assessment tools to review drug list thoroughly. Physicians also adjust dosage and simplify prescriptions to improve quality of medicine usage, decrease related risks of pharmaceutical treatments, and ultimately achieve the value and benefits of deprescribing. In this case report, we present a case of recent consciousness disturbance. We describe the processes of clinical assessment and functional reviews in detail and show the results with the intervention of CGA. Through CGA, our multidisciplinary team not only clarified the patient's clinical problems and geriatric syndrome but also developed personalized treatment plans. By sharing such a clinical experience, we hope to improve the clinical practice of geriatric care, raise the efficacy of medical resource utilization and enhance quality of care for elderly patients and their families.

並列關鍵字

compressive geriatric assessment ； geriatric syndrome ； polypharmacy

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