一般財団法人 国際医学情報センター 信頼できる医学・薬学・医療情報を適切に提供することによって健康社会に貢献します。

一般財団法人 国際医学情報センター

IMICライブラリ IMIC Library

ホームIMICライブラリMMWR抄訳2018年(Vol.67)CDC Grand Rounds:高齢者に対する福・・・

MMWR抄訳

rss

2018/09/21Vol. 67 / No. 37

MMWR67(37):1036-1039
CDC Grand Rounds: Promoting Well-Being and Independence in Older Adults

CDC Grand Rounds:高齢者に対する福祉と自立の促進

アメリカでは毎日約10,000人が65歳を迎え、2030年までにアメリカ人全体の約1/5(7,270万人)が65歳以上となり、2050年までには8,370万人に達すると予想されている。このうち85歳以上の老人は2012年:590万人から2030年:890万人となる。長寿は社会的利益をもたらし、50歳以上のアメリカ人による経済活動は約7.6兆ドルを生み出すが、一方で慢性疾患(高血圧、糖尿病、関節炎)の有病率は年齢に伴い増加する。65歳以上の高齢者の約1/3は食事、入浴、着替えなどの日常活動に制限があり、また、1/3は一人暮らしのため、社会的孤立のリスクが高い。そのため2015年、U.S. Surgeon GeneralによるNational Prevention Councilは「Healthy Aging in Action」を立ち上げ、健康格差の是正、安全で健康的なコミュニティ、医療および地域での予防サービス、高齢者が健康的な意思を持つのを促すことを方策としている(例えば、インフルエンザの予防接種を選挙の投票所で受けられるVote & Vaxなど)。MedicareはWelcome to Medicare visitおよびAnnual Wellness Visitにより疾患予防に特化した身体検査プログラムを展開しているが、利用者はそれぞれ6.8%、約16%と少ない。現在、患者数が約570万人と推定されるアルツハイマー病による死亡率は10万人あたり16.5(1999年)から25.4(2014年)と約55%増加しており、死亡者数は44,536人から93,541人と110%増加している。アルツハイマー病患者の介護費は2017年にて約2,590億ドルと推定され、毎年約1,500万人の介護者による無償の介護費は2,300億ドルに達する。2015年、Institute of MedicineおよびAlzheimer’s Associationは認知症対策として定期的な運動、禁煙、糖尿病、高血圧および肥満などの心血管リスクの管理、また、記憶力が低下した時点で医療関係者に相談することが重要であるとし、認知症の早期発見、早期治療は介護する家族にも有益である。介護する家族および無償の介護者の高齢化も問題であり、1日の拘束時間が長期に及ぶ上に経済的な負担が大きいため、Resources for Enhancing Alzheimer’s Caregiver Healthプログラムなどによる支援が行われている。CDCのAlzheimer’s Disease and Healthy Aging Programはアメリカの高齢者の健康と自立を促進するプログラムであり、この他にオンラインで健康指標のデータを提供するHealthy Aging Data Portalなどがある。

References

  • Rowe JW, Kahn RL. Successful aging. New York, NY: Pantheon; 1998.
  • Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States, population estimates and projections. Washington, DC: US Department of Commerce, Census Bureau; 2014. <https://www.census.gov/prod/2014pubs/p25-1140.pdf>
  • AARP; Oxford Economics. The longevity economy: how people over 50 are driving economic and social value in the US. Oxford, England: Oxford Economics; 2016. <https://www.aarp.org/content/dam/aarp/home-and-family/personal-technology/2016/09/2016-Longevity-Economy-AARP.pdf>
  • CDC. Healthy aging: helping people to live long and productive lives and enjoy a good quality of life. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. <https://www.aarp.org/content/dam/aarp/livable-communities/learn/health/Healthy-Aging-Helping-People-to-Live-Long-and-Productive-Lives-and-Enjoy-a-Good-Quality-of-Life-2011-AARP.pdf>
  • National Alliance for Caregiving; AARP Public Policy Institute. Caregiving in the U.S. 2015. Bethesda, MD: National Alliance for Caregiving; 2015. <https://www.caregiving.org/caregiving2015>
  • National Prevention Council. Healthy aging in action. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2016. <https://www.surgeongeneral.gov/priorities/prevention/about/healthy-aging-in-action-final.pdf>
  • Shenson D, Moore RT, Benson W, Anderson LA. Polling places, pharmacies, and public health: Vote & Vax 2012. Am J Public Health 2015;105:e12–5. <https://doi.org/10.2105/AJPH.2015.302628>
  • Centers for Medicare & Medicaid Services. The ABCs of the initial preventive physical examination (IPPE). Baltimore, MD: US Department of Health and Human Services, Centers for Medicare & Medicaid Services; 2017. <https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf>
  • Agency for Healthcare Research and Quality. Physician practices use software-facilitated system to complete Medicare Annual Wellness Visit, improving preventive care and generating high satisfaction. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality. 2012. <https://innovations.ahrq.gov/profiles/physician-practices-use-software-facilitated-system-complete-medicare-annual-wellness-visit>
  • US Department of Health and Human Services. Healthy people 2020: older adults. Washington, DC: US Department of Health and Human Services; 2016. <https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-C31-OA.pdf>
  • Ganguli I, Souza J, McWilliams JM, Mehrotra A. Trends in use of the US Medicare Annual Wellness Visit, 2011–2014. JAMA 2017;317:2233–5. <https://doi.org/10.1001/jama.2017.4342>
  • Alzheimer’s Association. 2018 Alzheimer’s disease facts and figures. Alzheimers Dement 2018;14:367–429. <https://doi.org/10.1016/j.jalz.2018.02.001>
  • Taylor CA, Greenlund SF, McGuire LC, Lu H, Croft JB. Deaths from Alzheimer’s disease—United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2017;66:521–6. <https://doi.org/10.15585/mmwr.mm6620a1>
  • Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med 2013;368:1326–34. <https://doi.org/10.1056/NEJMsa1204629>
  • Institute of Medicine. Cognitive aging: progress in understanding and opportunities for action. Washington, DC: The National Academies Press; 2015. <https://www.nap.edu/catalog/21693/cognitive-aging-progress-in-understanding-and-opportunities-for-action>
  • Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimers Dement 2015;11:718–26. <https://doi.org/10.1016/j.jalz.2015.05.016>
  • Taylor CA, Bouldin ED, McGuire LC. Subjective cognitive decline among adults aged ≥45 years—United States, 2015–2016. MMWR Morb Mortal Wkly Rep 2018;67:653–7. <http://dx.doi.org/10.15585/mmwr.mm6727a1>
  • Cordell CB, Borson S, Boustani M, et al.; Medicare Detection of Cognitive Impairment Workgroup. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare annual wellness visit in a primary care setting. Alzheimers Dement 2013;9:141–50. <https://doi.org/10.1016/j.jalz.2012.09.011>
  • American Geriatrics Society Choosing Wisely Workgroup. American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc 2013;61:622–31. <https://doi.org/10.1111/jgs.12226>
  • Alzheimer’s Association Expert Task Force. Cognitive assessment and care planning services: Alzheimer’s Association Expert Task Force recommendations and tools for implementation. Chicago, IL: Alzheimer’s Association; 2018. <https://www.alz.org/careplanning/downloads/cms-consensus.pdf>
  • Rainville C, Skufca L, Mehegan L. Family caregivers cost survey: what they spend & what they sacrifice. Washington, DC: AARP; 2016. <https://www.aarp.org/research/topics/care/info-2016/family-caregivers-cost-survey.html>
  • Rosalynn Carter Institute for Caregiving. Resources for enhancing Alzheimer’s caregiver health. Americus, GA: Rosalynn Carter Institute for Caregiving; 2017. <http://www.rosalynncarter.org/rci_reach/>
  • AARP Public Policy Institute. Listening to family caregivers: the need to include family caregiver assessment in Medicaid home- and community-based service waiver programs. Washington, DC: AARP; 2013. <https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-AARP-ppi-ltc.pdf>
  • CDC. Alzheimer’s disease and healthy aging. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. <https://www.cdc.gov/aging>
  • CDC; Alzheimer’s Association. State and local public health partnerships to address dementia, the 2018–2023 road map. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. <https://www.cdc.gov/aging/healthybrain/roadmap.htm>
  • Alzheimer’s Association; CDC; Centers for Training and Technical Assistance. A public health approach to Alzheimer’s and other dementias. Chicago, IL: Alzheimer’s Association; Atlanta, GA: US Department of Health and Human Services, CDC; Atlanta, GA: Emory University Rollins School of Public Health, Emory Centers for Training and Technical Assistance; 2016. <https://www.alz.org/media/Documents/curriculum-outline.pdf>
  • Gerontological Society of America. Cognitive impairment detection and earlier diagnosis. KAER toolkit: 4-step process to detecting cognitive impairment and earlier diagnosis of dementia. Washington, DC: Gerontological Society of America; 2014. <https://www.geron.org/programs-services/alliances-and-multi-stakeholder-collaborations/cognitive-impairment-detection-and-earlier-diagnosis>

このコンテンツに「いいね」する

ページトップへ

一般財団法人 国際医学情報センター

〒160-0016 
東京都新宿区信濃町35番地 信濃町煉瓦館
TEL:03-5361-7080 (総務課)

WEBからのお問い合わせ

財団や各種サービスについてのお問い合わせ、お見積もりのご依頼、
サービスへのお申し込みはこちらをご覧ください。

お問い合わせ