1、1,Press Conference新聞發佈會,2,Challenges of Population Ageing on Disease Trends and BurdenPart III : Dementia 人口老化的挑戰 : 疾病趨勢與社會負擔研究系列 第三部份: 老年癡呆症,3,Dementia Prevalence Increases with Age 老年癡呆症患病率隨年齡上升,Fig. 1 Prevalence rate of dementia among community-dwellingHong Kong population, by age group, 2005-200
2、6圖一. 按年齡劃分的香港居於社區人口的老年癡呆症患病率, 2005-2006,Source: Elderly Commission, 2006,4,Subtype老年癡呆症的種類,Dementia can be classified into Alzheimers disease, vascular dementia, and other causes老年癡呆症主要可分為阿爾茨海默症、血管性老年癡呆症及其他較罕見的致病原因About one-third of the dementia cases in Hong Kong are associated with underlying card
3、iovascular disease在香港，約三分之一的老年癡呆症個案是由心血管疾病引起的(Chiu et al., 1998),5,An Ageing Population人口老化,The Hong Kong population is ageing香港正面對人口老化,Fig. 2 Number and proportion of people aged 65+ in Hong Kong, 1986-2036圖二. 香港 65 歲或以上人口數目及佔總人口比例, 1986-2036,Sources: (1)Website of the Census and Statistics Departm
4、ent, Hong Kong. (2) Hong Kong Population Projections 2007-2036.,6,Impact of an Ageing Population 人口老化的影響,Informal caregivers are an integral part of care非正式的照顧者是照顧過程中不可缺少的一環The support ratio in the oldest group (population aged 50-74: population aged 85+) has been decreasing高齡長者支援比例（50-74歲人口:85歲或以上人
5、口）一直下降Implying each informal caregiver is caring for more older people顯示每名非正式的照顧者要照顧愈來愈多的長者(Robine et al., 2007; Chau et al., 2007),7,Impact of an Ageing Population (contd) 人口老化的影響（續）,Even if there is no increase in the rate of dementia, the number of people who have dementia will increase due to mo
6、re older people即使老年癡呆症患病率沒有上升，僅因人口老化，已可預期未來患老年癡呆症的長者會增加The decrease in number of caregivers and more people with dementia raises questions about how to maintain care考慮到照顧者減少及老年癡呆症患者增加，必須解決如何提供照顧的問題,8,Burden of Disease 老年癡呆症造成的負擔,The costs of dealing with dementia include direct costs包括直接成本medical (e
7、.g. hospitalisation) 醫療開支（例如留院費用）long term care長期護理開支and indirect costs 及間接成本disability殘疾premature mortality提早死亡caregiver burden (psychological, physical and social)照顧者負擔(包括心理、生理及社交),9,CADENZA Project 流金頌計劃,“CADENZA: A Jockey Club Initiative for Seniors” conducted a study to 流金頌賽馬會長者計劃新里程完成了一項研究，以Ex
8、amine the trends in incidence, prevalence, mortality & associated disabilities of dementia over the past decade in Hong Kong檢視最近十年香港的老年癡呆症發病率、患病率、死亡率及相關殘疾的趨勢Project the burden of dementia 推算老年癡呆症帶來的負擔Investigate the implications for health & social services探究以上各項趨勢對醫療及社會服務的意義,10,Findings 研究結果,11,Pre
9、valence 疾病流行情況,An increasing trend in prevalence of dementia老年癡呆症個案正在上升 In 2005-2006, about 1 in 3 (32%) of community-dwelling population aged 85+ had dementia在2005-2006年，約每三名年齡為85歲或以上的社區人口中，便有一人患老年癡呆症（患病率為 32%） (Chiu et al., 1998; Lam et al., 2008),12,Prevalence Rate患病率,Sources:(1)Chiu et al., 1998
10、.(2)Elderly Commission, 2006.,Fig. 3 Prevalence rate of clinically-diagnosed dementia among peopleaged 70+ in Hong Kong, 1995 and 2005-2006圖三. 香港 70 歲或以上人口經臨床診斷的老年癡呆症患病率, 1995年及2005-2006年度,13,Assuming no increase in prevalence rates, the number of people aged 60+ with dementia will still increase fr
11、om 0.11 million (2010) to 0.28 million (2036)假設老年癡呆症患病率不變，可推算60歲或以上老年癡呆症患者數目將由 2010 年的 11 萬增加至 2036年的 28 萬Since the prevalence rates do seem to increase, the above projection is just a conservative estimate and the number of people with dementia will probably increase even faster由於老年癡呆症患病率可能有上升的趨勢，以
12、上的推算僅為保守估計，患者數目可能以更快的速度上升,Number of People with Dementia老年癡呆症患者的數目,14,Number of People with Dementia (contd)老年癡呆症患者的數目（續）,Fig. 4 Estimated number of people aged 60+ with dementiain Hong Kong, 2010 and 2036圖四. 推算2010 年及2036 年香港六十歲或以上人口的老年癡呆症患者的數目,2.6 times 2.6 倍,15,Incidence新個案,A study in 1991-1992 f
13、ound 2.6 new cases among 1,000 people aged 70+ in a year (self-reported data)一項 1991-1992 年的研究顯示每年每千名70歲或以上的人口中，便約有 2.6 個老年癡呆症新個案 (以自我報告計算)(Woo et al., unpublished data) There is not much information on the latest trends in new cases of dementia in Hong Kong 有關近年本港老年癡呆症新個案數目趨勢的資料不多,16,Mortality 死亡,A
14、n overseas study showed people aged 55+ with dementia had 2.4 times higher risk of dying compared to those without一項海外研究顯示，55歲或以上的老年癡呆症患者的死亡風險比非患者高 2.4 倍(Jagger et al., 2000),17,Mortality (contd)死亡（續）,In Hong Kong, dementia is the 10th most common cause of mortality among those aged 65+在香港 65 歲或以上的人
15、口中，老年癡呆症是第十號殺手In 2007, the death rate from dementia was 38 per 100,000 population aged 65+在 2007 年，每十萬名65歲或以上的人口中，便有約38人死於老年癡呆症The age-standardised mortality rate for dementia appears to have decreased in 2003 and remained stable afterwards老年癡呆症年齡標準化的死亡率在 2003 年下跌，此後一直保持平穩(Department of Health, 2008
16、),18,Mortality (contd)死亡 （續）,Source: Vital Statistics, Department of Health,Fig. 5 Age-standardised* death rates for dementia (per 100,000) among population aged 65+ in Hong Kong, 2001-2007圖五. 香港 65 歲或以上人口的老年癡呆症年齡標準化*死亡率（每十萬人）, 2001-2007,* The age-standardised death rates used the Hong Kong populati
17、on as of mid-2007 as the standard年齡標準化死亡率以香港在 2007 年的年中人口為標準人口計算,19,Mortality (contd)死亡 （續）,It should be noted that many people would have been recorded as dying from another cause which was itself a complication of dementia要注意的是即使被記錄的死亡原因並非老年癡呆症，該死者也可能死於由老年癡呆症引起的併發症,20,Life Expectancy 預期壽命,Despite
18、people with dementia having a higher risk of dying, they are expected to live for another 16 (male) to 22 (female) years at the age of 60 雖然老年癡呆症患者有較高的死亡風險，預計他們在60歲時男性仍可多活16年，而女性則多活22年,21,Disability殘疾,Caused by the disease itself as well as the social environment (such as not user-friendly environme
19、nt and social exclusion )不但由老年癡呆症本身引起，亦由社交環境(如不方便使用者的環境及社交排斥)引起People with dementia aged 70+ had higher risk of functional limitation than those without (15 to 157 times depending on the level of limitation)70歲或以上的老年癡呆症患者較非患者有較高活動功能限制的風險(視乎不同程度的限制，風險為15至157倍)(Woo, Ho, & Yu et al., 1998),22,Long Term
20、 Care長期護理,Dementia has higher probability:老年癡呆症與以下情況有顯著關係for caregiver to opt for residential care照顧者較傾向選擇讓長者接受院舍護理(Chau et al., 2010)for older people to stay in long term institutional care長者入住長期護理院舍的機會較高(Woo et al., 2000) .but many people with advanced dementia do not receive palliative care然而很多晚期
21、老年癡呆症患者並未獲得紓緩護理(Lee and Woo, 2008),23,Due to more dementia patients, the costs of caring for dementia patients in terms of hospitalisation, residential care and informal care will increase substantially由於老年癡呆症患者增加，就留院、入住安老院舍及非正式照顧者方面的照顧患者的成本預料會急劇上升These estimates only include part of the costs invol
22、ved in caring for dementia patients 這些僅為照顧老年癡呆症患者的部份成本,Costs of Caring for Dementia Patients 照顧老年癡呆症患者的成本,24,Fig. 6 Estimated annual costs of caring for dementia patients aged 60+ in Hong Kong, 2010 and 2036圖六. 推算2010 年及2036 年每年照顧香港 60 歲或以上老年癡呆症患者的成本,Costs of Caring for Dementia Patients (contd)照顧老年
23、癡呆症患者的成本 （續）,25,Health Literacy & Stigma Relating to Dementia與老年癡呆症有關的健康知能及標籤效應,Knowledge of dementia is low among the public and health care professionals不論公眾或醫護人員普遍對老年癡呆症的認識很少 (Chau et al., 2010; Department of Health and Chinese Dementia Research Association, 2010)There is stigma associated with d
24、ementia對老年癡呆症存在標籤效應(Department of Health and Chinese Dementia Research Association, 2010),26,Implication of Findings 研究結果的意義,27,Implications for the General Public對公眾的意義,We should be aware that使公眾關注dementia is a chronic disease 老年癡呆症是一項慢性疾病patients may ultimately die from dementia可最終導致患者死亡dementia i
25、s a main contributor to disability老年癡呆症是引致殘疾的其中一種主要原因,28,Implications for the General Public (contd)對公眾的意義（續）,We could prevent or postpone dementia by下列方法可預防或延遲老年癡呆症modifying lifestyle: do not smoke, drink in moderation, maintain a diet rich in fruits, vegetables and fish but low in saturated fats,
26、maintain optimal body weight, and exercise regularly改變生活方式不吸煙，飲酒要節量，多吃蔬果及魚，少吃飽和脂肪含量較高的食物，保持理想體重，定期運動detecting hypertension early and treating it effectively 對高血壓盡早察覺及妥善處理,29,Implications for the General Public (contd)對公眾的意義（續）,We can detect dementia at an early stage through盡早察覺老年癡呆症regular health a
27、ssessment in the elderly in primary care, as part of a comprehensive geriatric assessment in community centres讓長者在社區中心作定期及全面的身體檢查,30,Implications for Dementia Patients and their Caregivers對老年癡呆症患者及其照顧者的意義,We can manage dementia comprehensively by要全面管理老年癡呆症應taking into account multiple morbidity of p
28、eople with dementia 注意老年癡呆症患者可能同時患有其他疾病caring by a multidisciplinary team in the primary care setting, supported by psycho-geriatricians and geriatricians in secondary or tertiary care settings 在基層醫療設施以跨部門醫護團隊提供護理，並以老人精神科及老人科醫生在第二層及第三層醫療設施作支援,31,Implications for Dementia Patients & their Caregivers
29、(contd)對老年癡呆症患者及其照顧者的意義（續）,We can manage dementia comprehensively by要全面管理老年癡呆症應setting up assessment teams composed of trained healthcare workers, such that doctor consultation time is maximised to enable investigations and care plans to be formulated based on the report of assessment forms 成立以經訓練的醫
30、護人員組成的評估隊伍，讓醫生有最多的時間根據其評估報告規劃更深入評估及護理計劃providing personal, cognitive and social rehabilitation, other than just relying on pharmacological intervention提供個人、認知及社交層面的康復治療，不應只倚重藥物治療,32,We should give care and support to affected people and their caregivers by關懷及支援老年癡呆症患者及其照顧者promoting interaction betwe
31、en patients, caregivers, various health and social care professionals and the public to avoid social exclusion加強患者、照顧者、醫護人員、社會工作人員及公眾間的交流，以減低社會對老年癡呆症患者的排斥detecting behavioural and psychological symptoms of dementia (BPSD) early and treating them effectively及早察覺並治療患者的行為與心理症狀providing end-of-life care
32、 for patients with advanced dementia為晚期老年癡呆症患者提供臨終護理,Implications for Dementia Patients & their Caregivers (contd)對老年癡呆症患者及其照顧者的意義（續）,33,We should give care and support to affected people and their caregivers by關懷及支援老年癡呆症患者及其照顧者providing information and long term support to caregivers 為照顧者提供充足的資訊及長期
33、的支援empowering caregivers through education, training, social support and counselling 通過教育、訓練、社交支援及輔導使照顧者提高照顧能力providing easily accessible day and respite care提供便於使用的日間護理及暫託服務,Implications for Dementia Patients & their Caregivers (contd)對老年癡呆症患者及其照顧者的意義（續）,34,Implications for the Society對社會的意義,Caring
34、 for people with dementia involves considerable costs 護理老年癡呆症患者涉及龐大的成本expensive drugs and long term social and medical care藥費、長期護理及醫療費高昂Consider co-payments in addition to Government resources除了政府資源以外，考慮患者共同分擔護理成本,35,A Practical Example一個實際例子,Jockey Club Centre for Positive Ageing (JCCPA) establishe
35、d in 2001 by the Hong Kong Jockey Club Charities Trust 賽馬會耆智園由香港賽馬會慈善信託基金於2001年創立(Tel 電話2636-6323 ; Website 網頁http:/ )Provides day care programmes (proven to reduce BPSD, the rate of functional decline and caregiver stress)提供日間護理服務(獲確認能減少患者行為與心理症狀及減慢患者功能退化，並減低照顧者壓力)Entirely self-sustaining已達至收支平衡,36
36、,Role of CADENZA 流金頌的角色,Initiated an integrated social-medical care model in the community (CADENZA HUB) which provides services for those with cognitive impairment, including day care在社區建立了一項醫社合作的照顧模式(流金匯)，為有認知障礙者提供服務(包括日間護理服務)(Tel 電話3763-1000; Website 網頁http:/www.jcch.org.hk )Dedicated training pr
37、ogramme for caregivers 為照顧者提供訓練課程,37,Conclusion & Recommendations 結論及建議,38,Conclusion & Recommendations結論及建議,An increasing number of cases requires urgent creation of a strategy to deal with dementia患者數目一直上升，突顯社會對建立一套全面的處理老年癡呆症策略的需要Education and training to the public and health and social care prof
38、essionals are indicated反映了須加強對公眾以及醫護及社會工作人員的教育及訓練Comprehensive assessment and management of multiple morbidities of people with dementia are needed應更完善地評估及管理老年癡呆症患者兼患多種疾病的情況New services partially paid for by patients may be considered to complement existing services可考慮以患者共同分擔護理成本的模式，去支援現有服務,39,Further information on CADENZA can be obtained via:有關 流金頌的詳細資料可經下列途徑索取 Website 網址: www.cadenza.hk Email 電郵 : infocadenza.hk Telephone 電話:2219-4271,Enquiry 查詢,
