Frailty Screening in the Community Ageing Healthy without Frailty 社區衰老狀況篩查 推廣「老而不衰」 活出健康耆年 Press Conference 記者招待會

What is Frailty? 什麼是衰老 Old ≠ Frail 老≠衰老 Background 背景 What is Frailty? 什麼是衰老 Old ≠ Frail 老≠衰老 Frailty is a clinically recognized state of increased vulnerability. It results from ageing associated with a decline in the body’s physical and psychological reserves 衰老是身體及心理儲備能力隨著年齡增長而下降的一種臨床症狀 Frailty may be subdivided into physical frailty represented by sarcopenia, and cognitive frailty, represented by some degree of cognitive impairment (either the diagnosis of dementia or mild cognitive impairment) 衰老狀況可分為身體衰老(可導致缺肌症)和認知功能衰老(可導致腦 退化症或輕度認知障礙症) Fried L, et al. J Gerontol Medical Sciences 2001;56A(3):M146-M156 Kelaiditi E, et al. J Nutr Health Aging 2013;17(9):726-34

Consequences of frailty 衰老的後果 Background 背景 Consequences of frailty 衰老的後果 Older people living with frailty are at risk of adverse outcomes such as dramatic changes in their physical health and mental wellbeing after an apparently minor event which challenges their health 當衰老的長者遇到輕微的健康挑戰時，他們一般比較脆弱，有相對較高的 健康風險 Living with frailty 衰老的長者 Higher risk of dramatic changes in physical and mental health 有相對較高的身體及心理健康風險 Increased risk of adverse outcomes 增加不良後果的風險 Falls 跌倒 Disability 殘障 Hospitalization 住院治療 Institutionalization 入住護理院舍 Mortality 死亡 Increased burden 增加負擔 Caregiving burden 照顧者負擔 Healthcare expenditures 醫療開支

Is frailty treatable? 衰老是否可以醫治? Background 背景 Is frailty treatable? 衰老是否可以醫治? Yes! 是! Frailty is not an inevitable part of ageing 衰老並非老化過程的必然結果 Physical frailty (sarcopenia) is reversible 身體衰老(可導致缺肌症)是可逆轉的 Recognition of Frailty (Screening) 辨認衰老狀況(篩查) Comprehensive Geriatric Assessment 全面性 老年健康評估 Individualized care and training / intervention 個人化的介入治療、訓練及護理服務 Yu R et al. Geriatr Gerontol Int 2014;14(suppl1):15-28 Lee J et al. J Am Med Dir Assoc 2014;15(4):281-6

How can we recognize frailty 如何辨識衰老 Background 背景 How can we recognize frailty 如何辨識衰老 5-item FRAIL scale Fatigue Tired all or most of the time during the past four weeks (No/Yes) 在過去四星期你經常感覺疲倦 (不是/是) Resistance Difficulty walking up 10 steps without resting or aids (No/Yes) 若沒有中途休息或助行用品協助下步上十級樓梯，你會感到有困難 (不是/是) Ambulation Difficulty walking several hundred yards alone without aids (500-600 meters) (No/Yes) 在沒有助行用品的協助下步行500-600米路程(不停步行約5分鐘)，你會感到有困難 (不是/是) Illnesses 5 or more illnesses (No/Yes) 已知患有5種或以上疾病 (不是/是) Loss of weight Weight loss > 5% within the past month (No/Yes) 在過去一個月內體重減輕了5%或以上 (不是/是) Morley et al. J Nutr Health Aging 2012;16(7):601-8

Frailty screening in the community “抗衰老、齊起動”計劃 Frailty screening and intervention programme “抗衰老、齊起動”計劃 Frailty screening in the community “抗衰老、齊起動”計劃 Aims: 目的: To examine the prevalence of frailty 調查社區衰老狀況 To investigate the associated factors of frailty in community- dwelling older adults 調查衰老狀況的相關因素 To raise public awareness in the understanding of frailty 提升公眾人士對衰老的認識 To launch the intervention program on bone & muscle health, brain health , diet & healthy lifestyle 推廣強健骨骼 、 肌肉、腦筋、營養飲食及健康的生活模式的訓練 計劃

Frailty screening and intervention programme “抗衰老、齊起動”計劃 Health talks 健康講座 2014 Apr – Jul (四-七月) Over 20 talks 超過20次講座 Approximately 1500 participants 約1500位參加者 Phase 1 assessment (Screening) 第一階段評估(篩查) 2014 Apr – Jul (四-七月) Basic demographics 基本人口統計資料 Frailty status 衰老狀況 Sarcopenia 缺肌症 Mild cognitive impairment 輕度認知障礙症 Phase 2 assessment 第二階段評估 2014 Jul – Oct (七-十月) Comprehensive geriatric assessment 全面性老年健康評估 Medical consultation 醫療諮詢 Referrals 轉介 12-week comprehensive training program for frailty prevention 12週全方位抗衰老訓練 Bone and muscle strengthening exercises 骨骼及肌肉訓練運動 Brain Training 腦力訓練

Characteristics of participants 參加者的特徵 Phase 1 findings 第一階段結果 Characteristics of participants 參加者的特徵 North District 240 Tai Po 300 Yuen Long 1 Phase 1 assessment 第一階段評估 Aged 65+ (N = 816) M 男性: 119 (14.6%) F 女性: 697 (85.4%) Shatin 232 Tuen Mun 1 Tsing Yi 1 Kowloon 16 HK Island 11 Number of participants may not sum to total due to missing data Number of participants may not sum to total due to missing data

Prevalence of frailty among those aged 65+ 65歲或以上的社區人口衰老狀況 Phase 1 findings 第一階段結果 Prevalence of frailty among those aged 65+ 65歲或以上的社區人口衰老狀況 About 1 in 8 (12.5 %) of community-dwelling population aged 65+ were frail 平均每8名年齡為65歲或以上的社 區人口中，便有1人出現衰老問題 Pre-frailty was found to be common, more than half (52.4%) of the community-dwelling population aged 65+ were pre- frail 前期衰老相當普遍，超過一半的 65歲或以上的社區人口（52.4%） 已踏入前期衰老 Morley et al. J Nutr Health Aging 2012;16(7):601-8

The prevalence of frailty increased with age 衰老情況隨年齡上升 Phase 1 findings 第一階段結果 The prevalence of frailty increased with age 衰老情況隨年齡上升 非衰老 前期衰老 衰老

Characteristics of participants 參加者的特徵 Phase 2 findings 第二階段結果 Characteristics of participants 參加者的特徵 衰老情況 North District 68 Tai Po 72 Yuen Long 1 Shatin 100 Tuen Mun 1 Phase 1 assessment 第一階段評估 Inclusion criteria for phase 2 assessment 第二階段納入條件: Aged 65+, pre-frail / frail 六十五歲或以上前期衰老/衰老長者 Phase 2 assessment 第二階段評估 N = 255 M 男性: 26 (10.2%) F 女性: 229 (89.8%) Tsing Yi 1 Kowloon 4 HK Island 6 Number of participants may not sum to total due to missing data Number of participants may not sum to total due to missing data Morley et al. J Nutr Health Aging 2012;16(7):601-8

Phase 2 findings 第二階段結果 Frail elderly tended to have more chronic diseases and received more medications compared with pre-frail elderly 與前期衰老的長者比較，衰老長者一般有較多慢性疾病，用藥數量較多 Age- and sex-adjusted p<0.01 (no. of diseases) P<0.01 (no. of drugs) 慢性疾病數目 用藥數量

Phase 2 findings 第二階段結果 Elderly with a higher physical activity level showed a lower prevalence of frailty 高運動量的長者較少出現衰老 Age- and sex-adjusted p<0.05 運動量

Phase 2 findings 第二階段結果 Frail elderly showed a higher prevalence of sarcopenia and mild cognitive impairment compared with pre-frail elderly 與前期衰老的長者比較，衰老長者患上缺肌症及輕度認知障礙症的情況較普遍 Age- and sex-adjusted p<0.01 (SARC-F) P<0.01 (AMIC) 缺肌症 輕度認知障礙症 SARC-F questionnaire for sarcopenia (strength, assistance with walking, rise from a chair, climb stairs, and falls) Malmstrom et al. JAMDA 2013;14(8):531-2 AMIC, Abbreviated Memory Inventory for the Chinese for subjective memory problems and related complaints Lam et al. Int J Geriatr Psychiatry 2005;20(9):876-82

Phase 2 findings 第二階段結果 Falls were more common among the frail elderly compared with pre-frail elderly 與前期衰老的長者比較，衰老長者較容易跌倒 Age- and sex-adjusted p<0.05 跌倒

Phase 2 findings 第二階段結果 ADL and IADL disabilities were more prevalent among the frail elderly compared with pre-frail elderly 與前期衰老的長者比較，衰老長者患上日常生活活動功能及工具性日常生活活動功能缺損較為嚴重 Age- and sex-adjusted p<0.05 (ADL) p<0.01 (IADL) 日常生活活動功能缺損 工具性日常生活活動功能缺損 ADL, Barthel index of Activities of Daily Living. Total possible scores range from 0-20, with lower scores indicating increased disability IADL, modified Lawton Instrumental Activities of Daily Living scale . Total possible scores range from 0-12, with lower scores indicating increased disability

Phase 2 findings 第二階段結果 Depressive symptoms were more prevalent among the frail elderly compared with pre-frail elderly 與前期衰老的長者比較，衰老長者出現較多抑鬱症狀 Age- and sex-adjusted p<0.01 抑鬱症狀 GDS, Geriatric Depression Scale (15-item). Total possible scores range from 0-15, with higher scores indicating higher levels of depressive symptoms

Phase 2 findings 第二階段結果 Frail elderly showed a higher prevalence of poor self-rated health compared with pre-frail elderly 與前期衰老的長者比較，衰老長者的自評健康程度較差 Age- and sex-adjusted p<0.01 自評健康程度較差

Summary of findings 調查結果摘要 In 2014, about 1 in 8 (12.5%) of community-dwelling population aged 65 and above had frailty 在2014年， 約每8名年齡為65歲或以上的社區人口中，便有1人出現衰老問 題 (12.5%) Pre-frailty was also found to be common, more than half (52.4%) of the community-dwelling population aged 65+ were pre-frail 65歲或以上的社區人口中，超過一半已踏入前期衰老(52.4%) The prevalence of frailty increased with age, being 5.1% for people aged 65-69 years and 16.8% for those aged 75 years and above 衰老情況隨隨受訪者年齡上升變得普遍，由65-69歲年齡組別的5.1%上升至 75歲及以上年齡組別的16.8% Older age, number of chronic diseases, use of medication, physical activity, sarcopenia, mild cognitive impairment, falls, ADL and IADL disabilities, depressive symptoms and self-rated health were factors associated with frailty 年齡、慢性疾病數目、用藥數量、運動量、缺肌症、輕度認知障礙症 、跌倒、日常生活活動功能及工具性日常生活活動功能缺損、 抑鬱症狀和自評健康程度是衰老的相關因素

Increase public’s awareness that 提高公眾關注以下事項: Implications and recommendations 意義和建議 Increase public’s awareness that 提高公眾關注以下事項: As the population ages, the prevalence of frailty is expected to increase 隨著人口老化，預計社區整體衰老情況漸趨普遍 Older people living with frailty are at a higher risk of a range of adverse health outcomes 衰老的長者一般比較脆弱，有相對較高的健康風險 Physical frailty (sarcopenia) is reversible 身體衰老(可導致缺肌症)是可逆轉的

Identify frailty at early stage in all settings 及早辨識衰老情況 Implications and recommendations 意義和建議 Identify frailty at early stage in all settings 及早辨識衰老情況 Establishment of frailty clinics 建立衰老治療診所 Provide training in frailty recognition to health and social care professional 為從事醫護及社福界專業人員提供衰老狀況辨認的訓練 The FRAIL scale may be used by non-health care professionals as a community screening tool for frailty FRAIL scale可作為社區衰老狀況篩查工具，並適合非醫療專業人員使 用

Manage frailty by providing 管理衰老情況 Implications and recommendations 意義和建議 Manage frailty by providing 管理衰老情況 Comprehensive geriatric assessment 全面性老年健康評估 Individualized care and support 個人化的護理服務 Training and intervention programmes 訓練與介入治療 Incorporate physical, cognitive, social support and nutritional programmes in the early stages of frailty in order to slow and/or reverse progression which can help to prevent and minimize the impact of frailty 長者可透過適當的運動及訓練，社區支援，營養飲食的生活模式 的訓練等，減慢和/或逆轉衰老情況

12-week comprehensive training program for frailty prevention 12週全方位抗衰老訓練 Bone and Muscle Strengthen Exercises 骨骼及肌肉訓練運動： Pre-Post 15 mins Stretching and Relaxation exercises 訓練前後各15分鐘拉筋熱身及鬆弛運動 30 mins Cardio-Pulmonary exercises 、 Strength Training Exercises 30分鐘心肺功能運動、負重運動、阻力運動

12-week comprehensive training program for frailty prevention 12週全方位抗衰老訓練 Brain Training 腦力訓練： 30 mins for each section每段訓練時間30分鐘 Concentration and Relaxation Training 專注力及放鬆度訓練 Cognitive and Brain Fit Training 智力及腦力訓練： Board games: Rummikub 、Sudoku 、X-Box games、 Fit brain computer games 魔力橋、 數獨遊戲、電腦遊戲、運算及桌上比賽遊戲等

舉行日期 ：2014年9月3日至11月28日(共36節) 訓練時間 ：每星期3節，每節訓練時間1.5小時 報名人數 ：40人(每班10人) 舉行日期 ：2014年9月3日至11月28日(共36節) 訓練時間 ：每星期3節，每節訓練時間1.5小時 報名人數 ：40人(每班10人) 50-64歲 65歲以上 23人 17人 居住香港區 居住九龍 居住新界 3人 10人 27人 總出席人次 總堂數 出席率 1072 144 74.4% 男 女 8人 32人

12-week comprehensive training program for frailty prevention 12週全方位抗衰老訓練 參加者意見調查： 非常同意 同意 1. 完成訓練後我對健康有更深入的認識 32% 68% 2. 完成訓練後我覺得我的體能比之前好 36% 58% 3. 完成訓練後我覺得我的腦筋比之前靈活 19% 61% 參加者心聲： 「以前因為腰傷，喺屋企坐咗3年。今次可以出返嚟做運動，好返好多，腦筋都靈活咗﹗」 「我由細開始都好抗拒做運動，而家我唔會用抗拒嚟形容，亦明白到做運動的重要。」 「參加咗訓練班之後，除咗體能好咗，平衡力同專注力都好咗，頭腦都靈活咗﹗」 「之前有半邊身有勞損，成日都好痛。依家唔單止唔痛，仲靈活咗﹗以前覺得自己有認知障礙，不過經過3個月訓練，姑娘話我進步咗好多﹗」

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