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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

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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。

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