www.wunan.com.

tw
(02)2705-5066


Geriatric Medicine

www.wunan.com.tw
(02)2705-5066

www.wunan.com.tw
(02)2705-5066

03

05

14

17

17

17

19

20

21

22

24

www.wunan.com.tw
(02)2705-5066

27

27

27

33

38

43

43

44

54

55

55

56

57

61

63

63

63

www.wunan.com.tw
(02)2705-5066

67

71

74

77

77

78

78

79

79

80

87

91

91

91

92

92

93

94

94

www.wunan.com.tw
(02)2705-5066

98

99

101

101

101

102

104

106

109

109

109

110

111

116

119

123

123

123

www.wunan.com.tw
(02)2705-5066

124

124

133

137

137

138

139

140

141

143

143

145

151

153

153

153

154

154

www.wunan.com.tw
(02)2705-5066

155

157

158

158

161

163

163

163

166

171

174

176

179

179

180

182

183

184

www.wunan.com.tw
(02)2705-5066

187

187

188

188

189

193

197

201

201

202

208

211

211

211

214

216

220

225

www.wunan.com.tw
(02)2705-5066

227

227

229

231

235

237

239

239

240

241

243

254

257

257

259

262

264

www.wunan.com.tw
(02)2705-5066


269

269

269

278

279

279

279

283

287

289

289

290

290

290

293

300

www.wunan.com.tw
(02)2705-5066

305

305

306

306

308

309

310

www.wunan.com.tw
(02)2705-5066

www.wunan.com.tw
(02)2705-5066



5-165

www.wunan.com.tw
(02)2705-5066

43

44

5-1

1.

2.

3.

4.

5.

6.

www.wunan.com.tw
(02)2705-5066

 85
89mmHg130139mmHg

75

4,066


4555
UnitedStatesPreventiveServiceTaskForce;
USPSTF

USPSTF

AmericanCollegeofPhysicians
 240mg/dL 160mg/dL 
400mg/dL40mg/dL

www.wunan.com.tw
(02)2705-5066

45

46

AmericanDiabetesAssociation
45126mg/dL

Bone
mineraldensity,BMDNationalOsteoporosisRiskAssessment
200,1607.2%
36.9%
4
1.8

 2002
TheheartandEstrogen/ProgestinReplacementStudy
HERS2,763

68
WomensHealth
InitiativeWHI161,809

www.wunan.com.tw
(02)2705-5066

29%

D

NationalOsteoporosisFoundation65

 15%

 D

USPSTF
Body

www.wunan.com.tw
(02)2705-5066

47

48

massindex,BMI
2229

10%

NutritionScreeningInitiative
Checklist6
1/4
5-2

USPSTF

83%79%Geriatric
DepressionScaleGDS-15GDS-30
GDS-15100%
72%GDS5-3

AmericanAcademyofNeurology

www.wunan.com.tw
(02)2705-5066

5-2

1.

2.

3.

4.1,000cc.
 130cc.
 300cc.

5.

6.

7.

8.

9.
45

10.

620%65690.2%
8589  3.9%

www.wunan.com.tw
(02)2705-5066

49

50

5-3

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

USPSTFMini-Mental Status
Examination, MMSEShort Portable
MentalStatusQuestionnaire,SPMSQclock-drawingtest

www.wunan.com.tw
(02)2705-5066

MMSE1824
MMSE
1/4

ConfusionAssessmentMethod,CAM

Snellenacuitytest

1110

www.wunan.com.tw
(02)2705-5066

51

52

www.wunan.com.tw
(02)2705-5066

5-4


 10



0.65

0.87

5.0



 
 Snellen

0.67

0.86

4.8

40
  1,000  2,000

0.93

0.60

2.3

0.90

0.64

2.5





0.89

0.95

17.8

0.83

0.79

4.0

I








www.wunan.com.tw
(02)2705-5066

53

54

1. CathyJoCress.HandbookofGeriatricCareManagement,2ndEdition.
2. FamMed.1990Jul-Aug;22(4):299-302.Healthpromotionforelderlypatients.
RadeckiSE,CowellWG.
3. Joseph J. Gallo,Terry Fulmer, Gregory. J. ph. D Handbook of Geriatric
assessment,FourthEdition,2006.
4. KarlEM,RobertGZ,JohnBS:Thegeriatricpatient:asystemicapproachto
maintaininghealth.AmFamPhysician,2000;61:1089-104.
5. Robert Kane, Joseph Ouslander and ItmarAbrass Essentials of Clinical
Geriatrics:sixthedition.6thEdition,Sep,2009.
6. VitaminDsupplementationforpreventionofmortalityinadults.BjelakovicG,
GluudLL,NikolovaD,WhiteldK,WetterslevJ,SimonettiRG,BjelakovicM,
GluudC.CochraneDatabaseSystRev,2011Jul6;(7):CD007470.Review.
7. William;Blass,John;Halter,Jeffrey;Ouslander,JosepHazzard:Principlesof
GeriatricMedicineandGerontology.FiftheditionNewYork:McGraw-Hill,
2003,95-110.

www.wunan.com.tw
(02)2705-5066

1.
2.
3.

A B

1.
2.
3.
4.

2010

www.wunan.com.tw
(02)2705-5066

55

56

6574 7584
85
65

antigenic drift

FDA
FDA 1548
A B

23

Centers for Disease Control and

Preventions Advisory Committee on Immunization Practices

www.wunan.com.tw
(02)2705-5066

HIV

65
56

1530

4,000

Americans Cancer Society; ACS

FOBTexible sigmoidoscopy
FSIG

www.wunan.com.tw
(02)2705-5066

57

58

ACS

adenomatous polyp
ACS

5060%

American College of Gastroenterology; ACG

2009 50
colonoscopy

www.wunan.com.tw
(02)2705-5066

4555 30
2% 0.5% 4 5069

70
American Geriatric Society
75

5069 40
23 4050
X
50 X

Raloxifene
Tamoxifen
30% 65 Tamoxifen
50%
estrogen receptor positive

www.wunan.com.tw
(02)2705-5066

59

60

United States Preventive Service

65

Prostate-specific antigen, PSA

PSA
PSA
PSA

PSA 4ng/mL

www.wunan.com.tw
(02)2705-5066

1.
2007; 2(3)145-163
2. Breast cancer screening in woman at average risk and high risk. Griffin JL.
Pearlman MD. Obstetrics & Gynecology. 116(6):1410-21, 2010 Dec.
3. Evidence for colorectal cancer screening. Bretthaner M. Best Practice &
Research in clinical Gastroenterology. 24(4):417-25, 2010 Aug.
4. Management of pneumonia in the nursing home. El-Solh, AA., Niederman MS,
Drinka P. Chest 138(6):1480-5, 2010, Dec.
5. Streptococcus pneumonia: epidemiology and risk factors, evolution of
antimicrobial resistance; and impact of vaccines. Lynch JP 3rd, Zhanel GG.
Current Opinion in Pulmonary Medicine, 16(3):217-25, 2010, May.
6. The 2009 US Preventive Services Task Force (US PSTF): the scientic support
for mammography screening. Kopans DB. Radio logic Clinics of North
America. 48(5):843-57, 2010 Sep.

www.wunan.com.tw
(02)2705-5066

61

1.
2.
3.

Malabsorption
Syndrome

www.wunan.com.tw
(02)2705-5066

63

64

lean body
mass

benzodiazepineslithium

phenytoin

www.wunan.com.tw
(02)2705-5066

 50
2565
4045%
verapamillidocainelalolrst-pass

cytochromeP450system

digoxinlithiumranitidineaminoglycosideantibiotics

3

BUNcreatinine

www.wunan.com.tw
(02)2705-5066

65

66

BUN

 BUN
creatinine

creatinineBUN
creatinine
Cockcroft-Gaultaminoglycosidesdigoxin

creatinine=
0.85

creatinine

warfarinopioids

www.wunan.com.tw
(02)2705-5066

7-1

7-1





 





 

polypharmacy

www.wunan.com.tw
(02)2705-5066

67

68

2659%

tabletsplittertabletcrusher

www.wunan.com.tw
(02)2705-5066

70%
eyedropguide

2087%
metered-doseinhaler,MDI
MDI

7-2

www.wunan.com.tw
(02)2705-5066

69

70

7-2

1.
2.
3.
4.




5.


6.



7.
8.
LeipzigRM.Prescribing:keystomaximizingbenefitwhileavoidingadversedrug
effects.Geriatrics2001Feb;56(2):30-34,withpermission.

www.wunan.com.tw
(02)2705-5066

24eliminationhalf
lives

www.wunan.com.tw
(02)2705-5066

71

72

urazepam,diazepamchlordiazepoxide

a m i t r i p t y l i n e ,  d o x e p i n  
imipramine

2/3
INR


INR

NSAID
cyclooxygenase

www.wunan.com.tw
(02)2705-5066

13%

4g

COX-IIinhibitors

www.wunan.com.tw
(02)2705-5066

73

74

 GFR






GFR


1. ClassenDC,PestotnikSL,EvansRS,etal.Adversedrugeventsinhospitalized
patientsJAMA,1997;277:301-306.
2. Mattila-EvendenM.AStudyofbenzodiazepineusersclaimingdrug-induced
psychiatricmorbidity.NordJPsychiatry2001;55:271-8.
3. ShaughnessyAF.Commondruginteractionintheelderly.EmergMed,1992;
24:21-32.

www.wunan.com.tw
(02)2705-5066

4. Straus WL Gastrointestinal toxicity associated with nonsteroidal anti-

inflammatorydrugs.Epidemiologicandeconomicissues.GastroenterolClin
NorthAm,2001;30:895-920.
5. SweitzerNK.Drugtherapyofheartfailurecausebysystolicdysfunctioninthe
elderly.ClinGeriatrMed,2000;16:513-34.
6. Williams CM. Using medications appropriately in older adults.Am Fam
physician,2002;66:1917-29.

www.wunan.com.tw
(02)2705-5066

75

. .
, 2011.11

ISBN 978-957-11-6187-7 ()
1.
417.7

99025132

5J35

399.1










106 3 3 9 4
(02)2705-5066(02)2706-6100
http://www.wunan.com.tw
wunanwunan.com.tw
0 1 0 6 8 9 5 3

/ 6
(04)2223-0891(04)2223-3549
/290
(07)2358-702 (07)2350-236

2 0 1 1 1 1
4 2 0

www.wunan.com.tw

(02)2705-5066