Press Conference 新聞發佈會

Challenges of Population Ageing on Disease Trends and Burden Part 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

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-dwelling Hong Kong population, by age group, 2005-2006 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

Subtype 老年癡呆症的種類 Dementia can be classified into Alzheimer's 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 cardiovascular 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)

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 Department, Hong Kong. (2) Hong Kong Population Projections 2007-2036.

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) Please discuss

Impact of an Ageing Population (cont’d) 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 more 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

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.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)

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 Examine 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

Findings 研究結果

Prevalence 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)

Prevalence Rate 患病率 Fig. 3 Prevalence rate of clinically-diagnosed dementia among people aged 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 Sources: (1) Chiu et al., 1998. (2) Elderly Commission, 2006.

Number of People with Dementia 老年癡呆症患者的數目 Assuming no increase in prevalence rates, the number of people aged 60+ with dementia will still increase from 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 (cont’d) 老年癡呆症患者的數目（續） Fig. 4 Estimated number of people aged 60+ with dementia in 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

Incidence 新個案 A study in 1991-1992 found 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

Mortality 死亡 An 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) Prognosis with dementia in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group http://www.ncbi.nlm.nih.gov/pubmed/10854356

Mortality (cont’d) 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)

Mortality (cont’d) 死亡 （續） 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 population 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 Source: Vital Statistics, Department of Health

Mortality (cont’d) 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

Life Expectancy 預期壽命 Despite 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 Prognosis with dementia in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group http://www.ncbi.nlm.nih.gov/pubmed/10854356

Disability 殘疾 Caused by the disease itself as well as the social environment (such as not user-friendly environment 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)

Long Term 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 …然而很多晚期老年癡呆症患者並未獲得紓緩護理 (Lee and Woo, 2008)

Costs of Caring for Dementia Patients 照顧老年癡呆症患者的成本 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 involved 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 (cont’d) 照顧老年癡呆症患者的成本 （續） 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

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 dementia 對老年癡呆症存在標籤效應 (Department of Health and Chinese Dementia Research Association, 2010)

Implication of Findings 研究結果的意義

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 is a main contributor to disability 老年癡呆症是引致殘疾的其中一種主要原因

Implications for the General Public (cont’d) 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, 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

Implications for the General Public (cont’d) 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 assessment 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

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 people 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

Implications for Dementia Patients & their Caregivers (cont’d) 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

Implications for Dementia Patients & their Caregivers (cont’d) 對老年癡呆症患者及其照顧者的意義（續） 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 between 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 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 (cont’d) 對老年癡呆症患者及其照顧者的意義（續） 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 the Society 對社會的意義 Caring 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

A Practical Example 一個實際例子 Jockey Club Centre for Positive Ageing (JCCPA) established 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://www.jccpahk.com ) 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

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 programme for caregivers 為照顧者提供訓練課程

Conclusion & Recommendations 結論及建議

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 professionals 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

Enquiry 查詢 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 : info@cadenza.hk Telephone 電話: 2219-4271