(older person s ability to function independently in the physical, mental and social activities of daily life)[1] (comprehensive geriatric assessment CGA) (frail elderly) [3,4] CGA [2,3] CGA (1) (2) (3) (4) (5) [5] CGA 8 ( ) ( ) ( ) [2] CGA Title: Comprehensive Geriatric Assessment Authors: Chia-Ming Chang, Chih-Neng Tsai; Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital Key Words: geriatric assessment, the aged 364 Formosan J Med 23 Vol.7 No.3
23 7 3 365 CGA [2] ( ) [2] [2-4] ( ) [3] ( ) [4] ( ) [2] CGA [2] CGA ( ) ( ) [2] CGA CGA ( ) ( ) (problem oriented) (in-depth) [6-8] CGA[4] [2] Rubenstein
[2,3] ( ) Snellen 2 1 Katz 2-4 Lawton 3-5 / - 1 Tinetti 5-15 5-15 2 (15 ) 3-6 / 2 1 Stuck ( ) CGA (activity of daily living ADL) (instrumental [9] activity of daily living IADL) (advanced activity of daily living AADL) ADLs [3,9] ADL IADLs IADLs ( ) AADLs AADLs [2] ( ) 366 Formosan J Med 23 Vol.7 No.3
1 5 15 1 5 5 1 5 5 15 1 5 ( ) 5 5 ( ) 5 5 1 ( ) 5 1 5 1 5 ( ) 1 5 ( ) ( ) [8] ADLs IADLs Katz Index (Barthel Index ADL ) ADL Katz Index [4,5] ADL IADL 23 7 3 367
Lawton IADL Fillenbaum IADL [1] ADLs IADLs [8] timed up and go test [8] 88% 94%[2] ADL [7] Romberg ADL [8] (semi-tandem [1] stand) (tandem stand) Short Form 36 (Minimum Data Set) Functional (Functional Independence Measure) Reach Test 15 [2,8] 75 3 4 Tinetti 7 3% [1,3] ( ) (get-up and go test)[8] 5 368 Formosan J Med 23 Vol.7 No.3
( ) [1] [8] Folstein (Mini-Mental Status Examination, MMSE) ( ) 3 Snellen 24 21 16 ( ) 1 7 2 3 15 [1] Pfeiffer Short Portable Mental Status Questionnaire [2,8] (SPMSQ) SPMSQ MMSE DSM-IV 5 82 9 37 8 ( ) [1] SPMSQ 27 [1] [1] Inouye 1-12 ( 11 2 ) Confusion Assessment Method [7,8] (1) (2) (3) (4) [7] (Mini-Cog assessment) Geriatrics At Your Fingertips 23 7 3 369
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15 GDS Yesavage GDS Zung (Zung Self-Rating Depression Scale) 77 82 65 [1] 89 [1] Beck Depression Inventory for Primary Care( BDI-PC) Center for Epidemiological Studies ( CASI: Depression Scale ( CES-D) Cognitive Assessment Screening Instrument ) (protein-energy malnutrition) 15 (Clinical Dementia Rating) 5 Hachinski Ischemic Score [1] 1 2 ( ) 12 ( ) 5 1 [6] [8] Yesavage [8] [body mass index (Geriatric Depression Scale GDS)( ) BMI ( ) ( ) ] [1] BMI 22 GDS BMI 84 95 3 GDS 15 GDS [1] 7 15 3 DSM- GDS 72 5 57 15 GDS 25 35 ( ) 23 7 3 371
(Geriatric Depression Scale) ( ) 1 1. * 2. 3. 4. * 5. 6. 7. 8. * 9. * 1. 11. 12. * 13. 14. 15. = ( 79% 76%[6] ) ( ) ( ) [11] [6] ADL ADL [4] [8] 372 Formosan J Med 23 Vol.7 No.3
(Social Dysfunction Rating Scale) Duke Zarit Burden Interview Caregiver Strain Index[11] 1. Anonymous: Functional assessment. In: Gallo JJ, Reichel W, Anderson LM, eds. Handbook [8] of Geriatric Assessment. 2nd ed. Maryland: Aspen Publishers. 1995:69-13. 2. Reuben DB: Principles of geriatric assessment. In: Hazzard WR, Blass JP, Ettinger WH Jr, eds, Principles of Geriatric Medicine and Gerontology. 4th ed. New York: McGraw-Hill, 1999:467-81. 3. Anonymous: Comprehensive geriatric assessment. In: Abrams WB, Beers MH, Berkow R, eds. The Merck Manual of Geriatrics. 2nd ed. New Jersy: MERCK, 1995:224-35. 4. Anonymous: Evaluating the geriatric patient. In: Kane RL, Ouslander JG, Abrass IB, eds. Essentials of Clinical Geriatrics. 4th ed. New York: McGraw-Hill, 1999:43-73. 5. Palmer RM: Geriatric assessment. In: Robbins JM, ed. Primary Podiatric Medicine. WB Saunders. 1994:365-85. 6. Moore AA, Siu AL: Screening for common problems in ambulatory elderly: Clinical confirmation of a screening instrument. Am J Med 1996;1:438. 7. Sherman FT: Functional assessment: easy-to-use screening tools speed initial office work-up. Geriatrics 21;56:36-4. 8. Fleming KC, Jonathan JM, Weber DC, et al: 23 7 3 373
Practical functional assessment of elderly persons: a primary-care approach. Mayo Clin Proc 1995;7:89-91. 9. Anonymous: National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc 1988; 36:342-7. 1. Anonymous: Mental status assessment. In: Gallo JJ, Reichel W, Anderson LM, eds. Handbook of Geriatric Assessment, 2nd ed. Maryland, Aspen Publishers, 1995:11-68. 11. Anonymous: Social assessment. In: Gallo JJ, Reichel W, Anderson LM, eds. Handbook of Geriatric Assessment, 2nd ed. Maryland, Aspen Publishers, 1995:15-26. 374 Formosan J Med 23 Vol.7 No.3