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课程第一章
认识衰老和肌少症
内容
何谓健康老龄化?
Image source from : https://www.hkhs.com/en/our-business/elderly-housing
Image source from : https://www.futuregen.solutions/2016/08/16/the-shameful-case-of-elder-abuse-in-society/ &
内在能力和机能
健康老龄化：增强内在能力/延缓衰退
从健康老龄化到衰老 传统科学方法
对长者使用传统方法的局限性 (1)
对长者使用传统方法的局限性 (2)
动物研究知识
https://www.scmp.com/lifestyle/health-wellness/article/3153010/ & https://www.science.org/content/article/
➡（形成） 衰老综合症 衰老综合症
衰老以两种方式呈现
老龄和衰老
衰老的关键概念
关键概念(储备下降)
衰老的关键概念
衰老的影响
衰老的关键概念 衰老为"……的临床状态。多个生理系统的储备和功能下降……"
不要与以下情况混淆
• 残疾/自理能力受限
残疾和衰老 个案一
• 基线：独立
个案二
• 基线：右膝骨关节炎，习惯缓慢行走
两人都无法在没有辅助设备的情况下行走（类似的残疾)
• 导致残疾的机制是否相似? 残疾和衰老…… 对个案一而言
对个案二而言
• 若只有单一风险因素（膝关节炎、脑血管病变、腿长差异），他仍可能设法通过代偿机制行走
关键概念 (衰老≠残疾)
衰老有多普遍?
(Woo et al., 2015)
筛查衰老 - 谁需要筛查? 如何筛查? 如何筛查?
衰老表型 (Fried et al., 2001)
衰老指数 (Rockwood et al., 2005)
临床衰老量表 (Rockwood et al., 2005)
临床衰老量表 (Chong et al., 2021)
Image source from : https://www.jamda.com/article/S1525-8610(21)00203-6/fulltext 衰老量表 (Morley) 
埃德蒙顿衰老量表 
Image source from : https://ihub.scot/improvement-programmes/community-care/electronic-frailty-index-efi/ 如何在不同的工具中进行选择?
谁需要筛查?
为什麽要筛查衰老?
预防压力下的併发症
➡ 与医院相关之併发症
为什麽要筛查衰老?
完善管理计划 (示例)
完善管理计划 
为什麽要筛查衰老?
为什麽要筛查衰老?
现在让我们去讨论肌少症 
肌少症和衰老 
肌少症的定义
(Chen et al., 2020) 肌少症有多常见?
(Woo et al., 2015) 肌少症风险问卷
肌少症社区筛查 (流程)
(Chen et al., 2020) 临床环境中筛查的触发因素
(Chen et al., 2020) 诊断出肌少症 / 衰老后该怎麽办 回顾三者的关係
(Cruz-Jentoft et al., 2019) 回顾三者的关係
(Bentov et al., 2019)
诊断出肌少症和 / 或衰老后该怎麽办?
心理衰老
认知衰老 认知衰老的概念
社交衰老
干预措施
更好的是 ... 提高復原能力
推荐阅读 Professional training materials of Cadenza Training programme
参考资料 Asgar, A. W., Ouzounian, M., Adams, C., Afilalo, J., Fremes, S., Lauck, S., … Webb, J. G. (2019). 2019 Canadian cardiovascular society position statement for Transcatheter aortic valve implantation. Canadian Journal of Cardiology, 35(11), 1437-1448. doi:10.1016/j.cjca.2019.08.011 Bentov, I., Kaplan, S. J., Pham, T. N., & Reed, M. J. (2019). Frailty assessment: From clinical to radiological tools. British Journal of Anaesthesia, 123(1), 37-50. doi:10.1016/j.bja.2019.03.034 Center for Perioperative Care. (2021). Guideline for perioperative care for people living with frailty undergoing elective and emergency surgery. British Geriatrics Society. Retrieved from Chen, L., Woo, J., Assantachai, P., Auyeung, T., Chou, M., Iijima, K., Jang, H. C., Kang, L., Kim, M., Kim, S., Kojima, T., Kuzuya, M., Lee, J. S., Lee, S. Y., Lee, W., Lee, Y., Liang, C., Lim, J., Lim, W. S., … Arai, H. (2019). Asian working group for Sarcopenia: 2019 consensus update on Sarcopenia diagnosis and treatment. Journal of the American Medical Directors Association, 21(3), 300-307.e2. https://doi.org/10.1016/j.jamda.2019.12.012 Chong, E., Tham, A., Chew, J., Lim, W. S., Tan, H. N., Ang, H., & Chan, M. (2021). Brief aids to guide clinical frailty scale scoring at the front door of acute hospitals. Journal of the American Medical Directors Association, 22(5), 1116-1117.e2. doi:10.1016/j.jamda.2021.02.005 Chong, E., Lim, A., Mah, F., Yeo, L., Ng, S., & Yi, H. (2022). Assessing the psychosocial dimensions of frailty among older adults in Singapore: A community-based cross-sectional study. BMJ Open, 12(2), E047586. Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., & Cederholm, T. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(4), 601-601. doi:10.1093/ageing/afz046 Dent, E., Lien, C., Lim, W. S., Wong, W. C., Wong, C. H., Ng, T. P., Woo, J., Dong, B., De la Vega, S., Hua Poi, P. J., Kamaruzzaman, S. B., Won, C., Chen, L., Rockwood, K., Arai, H., Rodriguez-Mañas, L., Cao, L., Cesari, M., Chan, P., … Flicker, L. (2017). The Asia-Pacific clinical practice guidelines for the management of frailty. Journal of the American Medical Directors Association, 18(7), 564-575. https://doi.org/10.1016/j.jamda.2017.04.018 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., …Vellas, B. (2019). Physical frailty: ICFSR international clinical practice guidelines for identification and management. The journal of nutrition, health & aging, 23(9), 771-787. https://doi.org/10.1007/s12603-019-1273-z Fitten, L. J. (2015). Psychological frailty in the aging patient. Nestlé Nutrition Institute Workshop Series, 45-54. https://doi.org/10.1159/000382060 Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., … McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. doi:10.1093/gerona/56.3.m146 Kelaiditi, E., Cesari, M., Canevelli, M., Abellan van Kan, G., Ousset, P. -., Gillette-Guyonnet, S., … Vellas, B. (2013). Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The journal of nutrition, health & aging, 17(9), 726-734. doi:10.1007/s12603-013-0367-2 Lee, J. S., Auyeung, T., Leung, J., Kwok, T., & Woo, J. (2014). Transitions in frailty states among community-living older adults and their associated factors. Journal of the American Medical Directors Association, 15(4), 281-286. doi:10.1016/j.jamda.2013.12.002 MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266-272. https://doi.org/10.1016/j.gerinurse.2016.02.014 Michel, J., & Sadana, R. (2017). "Healthy aging" concepts and measures. Journal of the American Medical Directors Association, 18(6), 460-464. https://doi.org/10.1016/j.jamda.2017.03.008 Mijnarends, D. M. (n.d.). Sarcopenia: A rising geriatric giant. doi:10.26481/dis.20160413dm Rockwood, K. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495. doi:10.1503/cmaj.050051 Rockwood, K., & Mitnitski, A. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(7), 722-727. doi:10.1093/gerona/62.7.722 Woo, J., Leung, J., & Morley, J. E. (2015). Validating the SARC-F: A suitable community screening tool for Sarcopenia? Journal of the American Medical Directors Association, 15(9), 630-634. doi:10.1016/j.jamda.2014.04.021 Woo, J., Yu, R., Wong, M., Yeung, F., Wong, M., & Lum, C. (2015). Frailty screening in the community using the FRAIL scale. Journal of the American Medical Directors Association, 16(5), 412-419. doi:10.1016/j.jamda.2015.01.087 World Health Organization (2020). Healthy ageing and functional ability. Retrieved from https://www.who.int/newsroom/questions-and-answers/item/healthy-ageing-and-functional-abilit Xue, Q. (2011). The frailty syndrome: Definition and natural history. Clinics in Geriatric Medicine, 27(1), 1-15. doi:10.1016/j.cger.2010.08.009 Ye, L., Elstgeest, L. E., Zhang, X., Alhambra-Borrás, T., Tan, S. S., & Raat, H. (2021). Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: A cross-sectional study of urban health centres Europe (UHCE). BMC Geriatrics, 21(1). https://doi.org/10.1186/s12877-021-02364-x Yu, R., Tong, C., Ho, F., & Woo, J. (2020). Effects of a Multicomponent frailty prevention program in Prefrail community-dwelling older persons: A randomized controlled trial. Journal of the American Medical Directors Association, 21(2), 294.e1-294.e10. https://doi.org/10.1016/j.jamda.2019.08.024 - 第一章完结 - 课程第二章
衰老及肌少症之营养干预
一、以补充营养来预防身体衰老及肌少症
预防衰老及肌少症 - 营养
1. 摄取足够能量
2. 最佳蛋白质摄取量
3. 维他命D
4. Omega-3脂肪酸
5. 地中海饮食
二、以营养逆转肌少症/身体衰老
1. 保持理想体重
2. 最佳蛋白质摄取量
3. 维他命D
4. 地中海饮食 对已确立的衰老，治疗效果不明
个案1 陈先生70岁，体重60公斤，身高160厘米，每週做两次太极，没有慢性病
答案:
1. BMI 23.4，属于长者的正常范围，陈先生没有超重
请重温课程5 老唔恼 – 耆妙饮食: 食得耆福获取更多资讯。 参考资料 Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., … Boirie, Y. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group. Journal of the American Medical Directors Association, 14(8), 542-559. Doi:10.1016/j.jamda.2013.05.021 Bruyère, O., Cavalier, E., Buckinx, F., & Reginster, J. (2017). Relevance of vitamin D in the pathogenesis and therapy of frailty. Current Opinion in Clinical Nutrition & Metabolic Care, 20(1), 26-29. Doi:10.1097/mco.0000000000000334 Coelho-Junior, H. J., Marzetti, E., Picca, A., Cesari, M., Uchida, M. C., & Calvani, R. (2020). Protein intake and frailty: A matter of quantity, quality, and timing. Nutrients, 12(10), 2915. Doi:10.3390/nu12102915 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Arai, H., Kritchevsky, S. B., Guralnik, J., … Vellas, B. (2018). International clinical practice guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management. The journal of nutrition, health & aging, 22(10), 1148-1161. Doi:10.1007/s12603-018-1139-9 Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., … Vellas, B. (2019). Physical frailty: ICFSR international clinical practice guidelines for identification and management. The journal of nutrition, health & aging, 23(9), 771-787. Doi:10.1007/s12603-019-1273-z Huang, Y., Chiu, W., Hsu, Y., Lo, Y., & Wang, Y. (2020). Effects of omega-3 fatty acids on muscle mass, muscle strength and muscle performance among the elderly: A meta-analysis. Nutrients, 12(12), 3739. Doi:10.3390/nu12123739 Kojima, G., Avgerinou, C., Iliffe, S., & Walters, K. (2018). Adherence to Mediterranean diet reduces incident frailty risk: Systematic review and meta-analysis. Journal of the American Geriatrics Society, 66(4), 783-788. Doi:10.1111/jgs.15251 Morley, J. E. (2012). Undernutrition in older adults. Family Practice, 29(suppl 1), i89-i93. Doi:10.1093/fampra/cmr054 Radd-Vagenas, S., Duffy, S. L., Naismith, S. L., Brew, B. J., Flood, V. M., & Fiatarone Singh, M. A. (2018). Effect of the Mediterranean diet on cognition and brain morphology and function: A systematic review of randomized controlled trials. The American Journal of Clinical Nutrition, 107(3), 389-404. Doi:10.1093/ajcn/nqx070 Silva, R., Pizato, N., Da Mata, F., Figueiredo, A., Ito, M., & Pereira, M. G. (2017). Mediterranean diet and musculoskeletal-functional outcomes in community-dwelling older people: A systematic review and meta-analysis. The journal of nutrition, health & aging, 22(6), 655-663. Doi:10.1007/s12603-017-0993-1 Stajkovic, S., Aitken, E. M., & Holroyd-Leduc, J. (2011). Unintentional weight loss in older adults. Canadian Medical Association Journal, 183(4), 443-449. Doi:10.1503/cmaj.101471 Van Duong, T., Chiu, C., Lin, C., Chen, Y., Wong, T., Chang, P. W., & Yang, S. (2020). E-healthy diet literacy scale and its relationship with behaviors and health outcomes in Taiwan. Health Promotion International, 36(1), 20-33. Doi:10.1093/heapro/daaa033 Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., … Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47. Doi:10.1016/j.clnu.2018.05.024 Woo, J. (2016). Body mass index and mortality. Age and Ageing, 45(3), 331-333. Doi:10.1093/ageing/afw042 - 第二章完结 - 课程第三章
衰老及肌少症之运动干预
结构化运动计划
➡ 对身体机能、认知和心理健康均有正面影响
请到课程4 老唔恼 – 防跌耆妙法，路遥皆可达获取更多防跌的资讯 多种类的运动计划
世卫组织关于身体活动和
建议
体能活动金字塔
图片来源 : https://www.elderly.gov.hk/tc_chi/healthy_ageing/ 运动时理想心率图表
进行运动时的提示和建议
长者活力体能训练方案
长者活力体能训练方案评估
如欲获取更多资讯，请浏览 http://vivifrail.com/wp-content/uploads/2020/12/pasaporte-SANITARIO-CHIV4.pdf.
图片及资料来源 : http://vivifrail.com/wp-content/uploads/2020/12/pasaporte-SANITARIO-CHIV4.pdf A级 残疾人士
B级 衰老者
长者活力体能训练（衰老） C级 衰老前期者
长者活力体能训练（前期衰老） D级 健康者
长者活力体能训练（健康者） 「长者活力体能训练方案」
更多运动短片 强化肢体防跌倒
香港中文大学赛马会老年学研究所赛马会龄活城市计划
参考资料 American Heart Association. (2021). Target heart rates chart. www.heart.org. https://www.heart.org/en/healthy-living/fitness/fitness -basics/target-heart-rates Casas-Herrero, A., Anton-Rodrigo, I., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Martinez-Velilla, N., Elexpuru-Estomba, J., Marin-Epelde, I., Ramon-Espinoza, F., Petidier-Torregrosa, R., Sanchez-Sanchez, J. L., Ibañez, B., & Izquierdo, M. (2019). Effect of a multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive decline: Study protocol for a randomized multicentre control trial. Trials, 20(1). https://doi.org/10.1186/s13063-019-3426-0 The Government of the Hong Kong Special Administrative Region. (2020). "Create your own exercise programme" - for both elders & caregivers. Elderly Health Service. Izquierdo, M., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Martínez-Velilla, N., Ramirez-Vélez, R., García-Hermoso, A., Casas-Herrero, A., Sinclair, A., & Rodríguez-Mañas, L. (2021, March 6). VIVIFRAIL: A multi-component physical training program to prevent weakness and falls in people over 70 years [web log]. Retrieved January 26, 2022, from https://blogs.bmj.com/bjsm/2021/03/06/vivifrail-a-multi-component-physical-training-program-to-prevent-weakness-and-falls-in-people-over-70-years/ Theou, O., Stathokostas, L., Roland, K. P., Jakobi, J. M., Patterson, C., Vandervoort, A. A., & Jones, G. R. (2011). The effectiveness of exercise interventions for the management of frailty: A systematic review. Journal of Aging Research, 2011, 1-19. https://doi.org/10.4061/2011/569194 World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. Retrieved from https://www.who.int/publications/i/ - 第三章完结-
测验、回馈和证书 (只供英文版)
实用连结/ 资源 相关之流金颂培训教材 声明 本课程影片所提供的资讯只作教育用途，并不作为医疗建议或诊断，亦不能代替任何医疗决定。倘若有任何医疗上的问题或要作出任何医疗决定前，先谘询你的医疗团队并共同讨论是重要的，我们不会对你就影片而作出的任何决定及后果负上任何责任。
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