Professional Documents
Culture Documents
2009
" ,-
.doc_\ \ - \S:\Common
15
15
17
24
25
26
27
33
35
.doc_\ \ - \S:\Common
Ageism
, .
Delirium
,
.
Dementia
,
: , , .
Depression
, .
.
) , , ,"( ,
, /
.
, " : ,
) (.
Geriatrics
, ,
.
Geriatric
Nursing/Gerontologic
, , ,
.
Gerantology
,
.
Life Expectency
Life Span
Polypharmacy
Presbycusis
. .
Presbyopia
Sundowning
Orientation
.
.
Urinary Incontinence
50%- 75%-85% .
.
.doc_\ \ - \S:\Common
.
. ,1969
1976- .1987- .
, .
.
. .
.
:
. .
, , .
.
, ,
.
.
.-
.
,
.
65 % . .10%- 2003
.
2020 12%- . % 14.7%
2025 .21.1% % 2002 12.3% 2030 .20%
. 76.6 .80.4
" : , " .
.
: , . 2030 .20%
20% 65 80%-
. : , .
. , .
.
.
" .
.
.
.
. .
, : , .
. .
, .
3
.doc_\ \ - \S:\Common
.
DNA - .
.
1963 8-
. . ,
:
:
- /
(1968) Havighurst . :
9
9
9
9
9
9
9
-/
:
9
9
9
9
9
9
.
:
9
9
.
. ,
.
-.
.doc_\ \ - \S:\Common
)(Miller, 2009
. ,
.-
, .
.
.- ,
.
:
) FUNCTIONAL CONSEQUENCES ( :
, .
:NEGATIVE FUNCTIONAL CONSEQUENCES
.
:POSITIVE FUNCTIONAL CONSEQUENCES
.
:AGE RELATED CHANGES
, ,
.
:RISK FACTORS
.
.doc_\ \ - \S:\Common
, .
, - .
.
" .
.
.
.
:
9
9
9
9
9
9
:
-
95% 78%-.
58.6% 2003- , . .
71%
41%
50% - 86% 13% ,
.
.
.
.
.
.
.
,
. - . -,
- .81%-
. 2/3- 30 62% .
. :
. . 70%-
)( .
. .
70%-80% .
" , .
.
. , , .
.
.
6
.doc_\ \ - \S:\Common
9
9
9
9
9
9
9
9
9
9
9
Orthostatic Hypotention-
9
9
9
9
9
9
9
, ,
, ,
9
9
9
.doc_\ \ - \S:\Common
9
9
9
9
9
9
V. C
9
9
9
9
9
9
9
9
, , ,
, , ,
' 5 65
9
9
9
9
9
9
9
9
9
9
9
9
9
9
.doc_\ \ - \S:\Common
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
M F )*(
M F
F
F
M
9
9
9
9
9
9
M
M F
F
F
F
M F ) (
9
9
9
9
)*( M F ,
9
.doc_\ \ - \S:\Common
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
50%- .
. . .
Sleep Apnea .
9
9
9
9
9
9
9
9
9
9
9
9
9
10
.doc_\ \ - \S:\Common
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
11
.doc_\ \ - \S:\Common
9
9
9
9
9
9
9
, B12 D
B
9
9
9
9
9
9
80%- 45%-
9
9
9
9
9
9
9
9
9
, , ,
,
9
9
9
9
9
9
9
9
9
9
9
9
9
85%
12
.doc_\ \ - \S:\Common
9
9
9
9
9
9
, ,
/
9
9
9
9
9
9
9
9
9
9
9
9
9
9
,
)(
D
13
.doc_\ \ - \S:\Common
.
: , , , , , , , , ,
.
: , , .
.
,
.
. , : ,
, . ,
.
, .
: , , , ,
, .
9
9
9
9
9
9
9
9
9
9
9
:
9
9
9
9
14
.doc_\ \ - \S:\Common
PH - . , .
.
) (
) (
) (.
. : , , ,.
.
. , ,
.
. , ,
. GFR
. : , , , .
R
1/4 80 .
:
9
9
9
9
9
)(
- /
.
,
:
.
. , O . T . C ,
. , .
. .(2003) 26%-59% : ,
, , , , , .
15
.doc_\ \ - \S:\Common
:
9
9
9
9
9
9
9
,
O . T . C'
. :
9
9
9
9
. ,
, .
, .
. MMSE :
MMSE
3 . .
) . '
(
100- .7
5
3
9
9
9 3
,
9 :
" "
9
9
O
"
REGISTRATION
RECALL
16
1
1
1
1
1
1+1+1
'
)(
5
1+1+1
1+1
1
1+1+1
1
1
1
30
.doc_\ \ - \S:\Common
. 15%-
12% . 30%- .
, .
: , , , ,
, , .
)( . .
. ,
. ,
.
: ) (
:
.1
.2
.3
.4
.5
.6
.7
.8
.9
.10
.11
.12
.13
.14
.15
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
. 5 .
:
, .
.
.
.
:
)Bupropion (Wellbutrin
)Venlafaxine (Effexor
)Mirtazapine (Remeron
)Nefazodone (Serzone
)Paroxctine (Paxil
- .
:
, , . .
,
.
4-6 . .
17
.doc_\ \ - \S:\Common
.
. , ..
10%-16% . .
. .
. , , .
, , , , ,- , ,
.
. ,
.
.
:
9
9
9
9
9
3%-11% 65 85
. 60%- 100 . .21%-72%-
:
.1
.2 : , , , , , .
.
3- :
9
9
9
2 :
9 )(50%-60%
9- )(10%-20%
): (15%
9
9
9 Pic's
18
.doc_\ \ - \S:\Common
, , , :
, . ,40
.65 .
. , : , .
" :
9
9
9
9
9
9
9
: 2-
9
9 ,
. 5%-10% . .45-65
, .
.65 .
:
, : .
.
, .
. .
:
, .
, , . .
.
.
. .
. ,
, , . . , .
,
. . , : , .
. 90%-.
:
, . , ,
.. ,. , MMSE , MRI , CT , B .
.
:
. .
" .
. DONEPEZIL .
19
.doc_\ \ - \S:\Common
MEMANTINE .
- , . RESPEREDAL , SEROQUEL , ZYPREXA
:
. , ,
, , , , ,
.
.
, , .
.
:
9
9
9
9
9
9
9
9
9
, , , ,
, . .
. . ) ,
( . . . .
.- .
.
, .
, , .
, ,
. " .
, .
. .
.
.
. .
. .
. ,
, ,
.
.
.
. ,
. :
, .
" . , . ,
, . ,
. /
.
.
, .
.
" :
9
9
9
9
9
ARICEPT
20
.doc_\ \ - \S:\Common
9 :
14,19,21
9
9
9
9
9
9
9
9
9
9 ,
50%-60% 9
20% 9
20% 9
9 .
T. I . A
9
9
9
30-
65
65
85
9 , ,
,,
9 20
9 -:
9
"
9 30%
9
9
9
9
9
9
9
70%
9 50-70
9 ,
9
9
9
9
, ,
,
9 ,
9
9
21
9
9
9
.
9
9
.doc_\ \ - \S:\Common
+
+
9
9
9
9
9
9
ADL
9
9
9
9
9
9
9
, ,
,
'
,
,
9
9
9
9
9
9
9
9
9
,,
22
.doc_\ \ - \S:\Common
, , ,
.
:
: , , ,,
. .
. .
) (
) " "( . :
. , : .
.
62% .
35% . 65% , . 80 20%-30% .
. .
: , , , , ,
, , . ,
. .
: , : ,
, , , , .
: . : ,
, , , .
.
.
. )( . ,
, , .
. . .
.
, .
"" .- , .
.
, , .
,
. .
,:
, , , 10%-20% .
114 .
36- . " 30,000 .
.
,
. MI .
. .
.
. 3 38 .,
.
, ,
. , , ,,
. .
, , .
.
23
.doc_\ \ - \S:\Common
3%-5%
)" 5 ( . 84%- .
.50%
Selfe neglect .
: , , .
:
9
9
9
9
9
.
3 :
. " " .
9
9
9
9
) ,65 (70
) (1996
60 "
9 16% ) ,( 1,124 ( 1,671) 24%
+ 2% 50%
8%
5%
9 ,
9 .28-
. .
65 . " 2% .
. 70%.
" .
. , .
. ,
.
.
9
9 ) (1986 , " " . "
, , , '
16 11 ;150% 80% ;100%
9
9 " . -
9
9
24
.doc_\ \ - \S:\Common
.
.
)
( , ,
.
?
.
/ .
) (1986
.
. ,
.
, . " " ,
) , (
.
100% 10-11- .
150% 15-16- .
24 , " )
.($ 500-600-
- . "
.
1995
. : , , '.
.
.
. .
.
.
, , . .
:
9
9
9
:
9
9
9
25
.doc_\ \ - \S:\Common
:
9
9
9
9
9
65
"
. Activity ) ADL
(Daily Living.( Instrumental ADL ) IADL -
ADL , : , , ,
.
IADL , : , , , ,
.
.( Functional Independence Measure ) FIM
.( FUNCTIONAL INDEPENDENCE MEASURE ) FIM
:
9
9
9
9
9
9
9
18
" "
:
18 . ,1-7 7 1- .
1
2 25%
3 . 50%-75%
4 75%
5
6 : , ,
7
: FIM
9
9
9
9
9
9
9
9
, ,
,/
26
.doc_\ \ - \S:\Common
:
9
9
9
:
9
9/
:
9
:
9
9
9
, .
, .
: DIAPERS
D
I
A
P
E
R
S
Delirium
Infection
Atrophic
27
.doc_\ \ - \S:\Common
10:
? ? ?
) .( Snellen
40- . 1,000-
2000-.
, 7 , .
15-.
?
?
5" 1/2- ?
50-".
.
3 .
:
) , (
: , , ,
.
ADL -
) , ,
, ,- , , (
28
.doc_\ \ - \S:\Common
40%-50% .
25%- .
.
- ) (
:
American Geriatric Society, British Geriatrics Society, American Academy of Orthopaedic
Surgeons. Guidelines for prevention of falls in older persons. Am geriatric Soc 49(5): 664-672,
2001
29
.doc_\ \ - \S:\Common
)( FARMER , 2000
15
65
/
/
),
,(
"
5
5
5
5
5
:
15 :
.1
.2
.3
.4
.5
.6
.7
, "
,
, ) , (
, "
,
, , / , ) , ,(:
.8
.9
.10
_____________________________
_____________________________
30
.doc_\ \ - \S:\Common
.1
.
A. D . L
4
3
4
3
4
)(
3
3
2
"
1
0
.2
.
3
2
1
17-20 :
13-16
12-
"
31
.doc_\ \ - \S:\Common
,
. ,
, : , , .
:
,
.
.
: , .
1959
.
1966 .
.
"
1963 .
.
. : LIVING WILL .
.
. , :
, , '.
.
,1962 " :
. 2 ,
.
) / ( . .
, :
, , ' . "
" ".
4 :
1962
1966
1977 :
. ,
.
1991
32
.doc_\ \ - \S:\Common
, :
.1
.2
.3
" :
:
,65 70
9
9
60
9
9
9
9
:
.
:
, .
1994 "
. "
. . ,
.
1986- .
.
.
.
. , .
,60 .65
.
" .
?
. .
, ,
. .
33
.doc_\ \ - \S:\Common
,) . ( .(2007) . . :
".
, ,. , .(2008) . , , . :
".
,) .( .(2003) . . :
.
Miller, C. A. (2009). Nursing for wellness in older adults. (5th ed.). Philadelphia: Lippincott
Williams & Wilkins.
Smeltzer S.C., Bare B.G., Hinkle, G.L & Cheever, K.H. (2008). Brunner & Suddarth's textbook of
Medical surgical nursing. (11th ed). Lippincott: Williams & Wilkins.
34