1. ThS.BS. Nguyn Th Bch Duyn B mn Y hc gia nh Trng i hc Y khoa Phm Ngc Thch CHM SC SC KHE NGI CAO TUI 2. 1. I CNG Tnh trng lo ha ( >65 tui): ang tng nhanh trn biu dn s trn th gii. Ngi cao tui (>65 tui): chim n 13% dn s Ti VN: Nm T l ngi cao tui 2005 7.5% 2014 10% 2050 26% 3. 1. I CNG Tui th trung bnh tng ln: N: 84,2 nm Nam: 79,7 nm S dng dch v y t: gp 2 ln Chi ph nhp vin: 25% Chi ph chm sc ti nh: 75% 4. 2. NH GI SC KHE CAO TUI Tp trung vo vic phng nga bnh Tp trung ci thin v duy tr cc chc nng c th Cung cp gii php lu di cho BN kh qun l (khm nhiu BS, thng xuyn nhp cp cu, nhp vin nhng theo di km) Gip C cc VSK Lp k hoch theo di iu tr Xc nh nhu cu v ni CSSK lu di thch hp Ngn nga ti nhp vin Mc tiu: 5. nh gi v y khoa Hi bnh s Khai thc tin cn s dng thuc (qu kh v hin ti) nh gi ch dinh dng 6. Tui 40 Bo ph 50 i tho ng 55 Bnh tim thiu mu 65 Nhi mu c tim 70 Ri lon nhp tim 75 Suy tim 80 Tai bin MMN Nguy c bnh l tim mch theo tui 7. nh gi v chc nng Tp trung vo sinh hot ca BN: - Sinh hot c nhn: n, mc, tm ra - Hot ng thng ngy: mua sm, nu nng, qun l thuc men, tin bc Nu BN gp kh khn trong sinh hot, ngh BN: - C ngi thn chm sc - Hoc c ngi gip vic. - Hoc dng cc dch v CSSK ti nh, Phng php n gin nh gi vn di chuyn v dng i ca BN l hi: BN c t ng trong 12 thng gn y khng? 8. nh gi v tm l Cn tm sot 2 tnh trng quan trng, nh hng trc tip n Bn v gia nh ca h: - Suy gim nhn thc - Trm cm Dng Mini-Mental State Examination l phng tin tt nht nh gi tnh trng sa st tr tu 9. nh gi v tm l (tt) Dng thang im trm cm tm sot bnh vi 5 cu hi: 1. Nhn chung, ng/ b c hi lng vi cuc sng ca mnh khng? 2. ng/B c thng cm thy chn nn? 3. ng/B c thng cm thy b v? 4. ng/B c thch nh hn i ra ngoi? 5. Hin ti ng/b c cm thy hi v dng? Nu c t 2 cu tr li C, c th chn on BN c trm cm ( nhy 97%, c hiu 85%) 10. nh gi v x hi nh gi v mi trng sng v cc h tr x hi ng vai tr quan trng. Dng Mini-Mental State Examination l phng tin tt nht nh gi tnh trng sa st tr tu 11. nh gi sc khe BN cao tui thnh cng, cn qu trnh giao tip hiu qu Ngn ng, qu trnh o to, h tr x hi, tnh trng kinh t, yu t vn ha/ o c ng vai tr quan trng i vi kt qu sc khe ca bnh nhn. 12. 3. TIP CN BN CAO TUI BNH S: Khai thc bnh s v s h tr ca ngi nh BN Cc vn quan trng cn khai thc Cc vn BN than phin Ch n Tnh trng v sinh: tm ra H c quan: chc nng tiu ho, tim phi, tit niu- sinh dc Kh nng giao tip: nh gi tnh trng tm thn (trm cm?), nghe, nhn, ni, 13. BNH S: Cc vn quan trng cn khai thc (tt) Tin cn bnh l v tin cn nhp vin Tnh trng chng nga Vn dng thuc (Bs k toa, t mua) Thi quen ung ru, ht thuc Tin s gia nh Hon cnh gia nh 3. TIP CN BN CAO TUI 14. KHM LM SNG: Khm LS ngi cao tui: Tng t nh ngi ln tr tui, nhng mt s c quan cn ch k hn. Ngi cao tui thng mong ch: c khm y (c bit: o huyt p) Yu cu c s tn trng ph hp. 3. TIP CN BN CAO TUI 15. KHM LM SNG: Cc c quan sau nn c thm khm: Tng trng: da, tc, mt, tnh trng dinh dng Tnh trng tm thn: Kh nng nh hng khng gian, thi gian, Kh nng ch , lng nghe Kh nng tnh ton, ngn ng. Th lc Thnh lc Khoang ming: rng, nu C (b: tuyn gip) 3. TIP CN BN CAO TUI 16. KHM LM SNG (tt): Cc c quan sau nn c thm khm (tt): Phi: nn o lu lng nh (peak flow meter) Tim, v Bng, cc l thot v Ct sng Chi di: khp, mch mu, bn chn, mng Dng i n ng: khm trc trng, bu, tinh hon Ph n: khm c t cung 3. TIP CN BN CAO TUI 17. KHM LM SNG (tt): Cn thc hin bng nh gi quy lut ca 7 nu ngi cao tui: C biu hin cc triu chng khng c hiu Tnh trng sc kho suy gim Khng c kh nng thch ng vi sinh hot thng ngy 3. TIP CN BN CAO TUI 18. Bng nh gi quy lut ca 7 1. Tnh trng tm thn L ln/ sa st tr tu Trm cm Mt ngi thn B lm dng 2. Mt Th lc Cm mt 3. Nghe ic tai 4. Ming B rng Kh ming Suy dinh dng 5. Thuc Toa n nhiu thuc Phn ng ph 6. Bng quang v rut Khng t ch B tiu Nhim trng tiu 7. Vn ng Dng i, di chuyn: Parkinson? Vim khp: hng, gi Lng, thn kinh to Bn chn, mng chn: bnh thn kinh Mch mu, Lot chn 19. Cc vn cn quan tm ngi cao tui L ln T ng Mt t ch Ngi cao tui 20. NH GI TNH TRNG DINH DNG NCT C Ti ang bnh v lm thay i lng thc n ang dng 2 Ti n t hn 2 ba mi ngy 3 Ti n t rau qu, sn phm t sa 2 Ti ung 3 ly bia, hay ru mi ngy 2 Ti mc bnh rng - ming v lm ti kh n 2 Ti khng tin mua thc n 4 Hu ht thi gian, ti n mt mnh 1 Ti ung 3 toa thuc mi ngy 1 Ti st 5 kg trong 6 thng gn y 2 Ti khng sc khe t n ng, mua sm 2 Tng cng Tng cng 0-2 Tt, kim tra im dinh dng li sau 6 thng 3-5 Trung bnh, kim tra im dinh dng li sau 3 thng 6 Dinh dng km, cn t vn chuyn gia dinh dng 21. CN LM SNG: Cc CLS nn c thc hin da trn: nh gi BN Chi ph Li ch 3. TIP CN BN CAO TUI 22. CN LM SNG: Cc CLS c khuyn co NCT Cng thc mu Chc nng gan, thn, tuyn gip ng huyt in gii Calci, phosphat mu TPTNT XQ phi CT scan, MRI (nu cn) 3. TIP CN BN CAO TUI 23. IU TR: Vic k toa v phn ng ph ca thuc Ngi cao tui c nguy c tng phn ng ph ca thuc. Phn ng ph ca thuc n tr liu: 20 tui: 6% 70 tui: 20% Phn ng ph ca thuc phi hp: < 6 thuc phi hp : 6% 6 thuc phi hp : 20% 15% BN cao tui nhp vin b phn ng ph ca thuc. 3. TIP CN BN CAO TUI 24. IU TR (tt): Cc yu t c khuynh hng gy phn ng ph ca thuc Tng tc thuc thuc Tng tc thuc bnh vd: dng Tetracycline BN tn thng thn lm tng nguy c suy thn Tui tng lm tng nng thuc trong huyt tng Tui tng lm thay i nhy thuc: vd: p ng vi Warfarin tng ln NCT p ng vi Insulin gim i NCT Sai lm ca BN: Phi hp nhiu thuc c th gy nhm ln cho BN. T l sa st tr tu tng ln theo tui. 3. TIP CN BN CAO TUI 25. IU TR (tt): CC YTNC GY RA CC VN LIN QUAN N THUC Dng 5 thuc, hoc dng 12 liu thuc mi ngy Khm nhiu bc s khc nhau Nhng thay i iu tr gn y quan trng Thuc c ca s iu tr hp (vd: Digitalis) Thuc yu cu theo di (vd: Warfarin) Khng dung np L ln/ Sa st tr tu C vn v kh nng ngn ng/ c-vit Mi xut vin gn y 3. TIP CN BN CAO TUI 26. IU TR (tt): BT U VIC K TOA Ngi cao tui nn c dng liu thuc thp theo khuyn co. Vic tng liu nn c thc hin t t v c kim tra u n. LIU THP - TNG LIU CHM -THEO DI THNG XUYN Cn c th ho liu thuc cho NCT vi liu dng n gin nht. 3. TIP CN BN CAO TUI 27. Thank you!