周全性老年評估個案報告：84歲女性憂鬱症合併自殺

Comprehensive Geriatric Assessment of an Elderly Woman with Geriatric Depression Disorder Complicated with Suicide: A Case Report

高湘涵(Hsiang-Han Kao) ； 王牧羣(Mu-Cyun Wang) ； 林志學(Chih-Hsueh Lin)

《台灣老年醫學暨老年學會雜誌》 16卷1期 (2021/02) Pp. 43-61

https://doi.org/10.29461/TGGa.202102_16(1).0004

摘要

台灣的老化指數於民國108年9月已達到117.62（65歲以上人口占14歲以下人口之百分比，指數越高，代表高老齡化情況越嚴重），於2018年台灣已進入「高齡社會」，65歲以上人口突破14％。老年人的生理、心理與社會問題於臨床照護上都需要被關注。而老年憂鬱因為診斷不易很容易被忽視，尤其在照顧急性病房的患者時，往往只專注於急性問題而忽略心理社會問題的評估。有憂鬱症狀的老年人比例為8－16％，而且老年憂鬱症常會與慢性疾病、認知功能障礙及失能有關，也會增加死亡率及對生活品質產生負面的影響。本文之個案為一位84歲的女性，過去病史有高血壓及高血脂症、輕度失智及憂鬱症，此次被家人發現意識嗜睡而來急診，診斷為吸入性肺炎及Benzodiazepine（BZD）藥物過量。入院後，除了使用抗生素針對其感染問題治療外，並施以老人周全性評估，經由會談後，了解個案是因自殺意圖而服用過量的BZD，進一步了解其社交網絡、家庭支持系統及其因為生理性問題所導致的挫敗感及無價值感。經由介入後，個案不只於住院中完成感染治療療程，也能在出院後利用相關資源在社區中得到妥善的照護，對個案整體的照顧更加全面，也期望能藉由此次的評估，由多方面控制其憂鬱症狀，減少與憂鬱症相關的老年病症候群。此個案的臨床發現與先前文獻相符合，顯示老年憂鬱與其他老年病症候群（包含老人衰弱、認知功能障礙及心血管疾病）具有雙向關係，而其不典型的症狀，則需要臨床醫師的細心與耐心評估，唯有清楚了解老年病症候群的特性並妥善安排後續處置，才能在高齡社會中，共同創造年長者及其照顧者的福祉。

關鍵字

周全性老年評估 ； 老年憂鬱症 ； 老人自殺 ； 老年認知功能障礙

並列摘要

Taiwan has reached to ＂aging society＂ in 2018, whichthe population over 65 years old was more than 14%. In caring of the elderly, the physical, psychological, and social problems need to be noticed. Elderly depression should not be ignored even though the difficulty of diagnosis. Especially for the patient care in acute wards, it tends to focus only on acute problems but ignore the psychosocial problems. The importance of elderly depression is that the proportion of elderly with depression symptoms is 8-16%, and it is often associated with chronic diseases, cognitive dysfunction and disability. It also increases mortality and has a negative impact on quality of life. The case is an 84-year-old woman with history of hypertension, hyperlipidemia, mild dementia, and depression. She was found drowsiness by her family and diagnosed with aspiration pneumonitis and benzodiazepine (BZD) overdose. After admission, in addition to antibiotics treatment for infection, the comprehensive geriatric assessment was also done. After the interview, we realized that she took overdose BZD for committing suicide. We also understood her social network, family support system, and the frustration and worthlessness caused by hermedical illness with the assessment according to the findings of comprehensive geriatric assessment. In the hospitalization, not only the infection control completed but also related resources of long-term care after discharge were arranged. The situation of this case is consistent with the previous studies, showing that elderly depression has a two-way relationship with other geriatric syndrome, including disability, cognitive dysfunction, and cardiovascular disease. Because of the atypical symptoms of elderly depression, clinicians should providecareful and patient assessment. As the cliniciansunderstand the characteristics of the geriatric syndrome and arrange related assessment and treatment, the elderly and their family or caregiver can have the welfare in this aging society.

並列關鍵字

compressive geriatric assessment ； geriatric depression ； suicide in elderly ； dementia