【導讀】馬德里關于老齡化的國際行動計劃,為了一個平衡的照顧策略;及社會保護的挑戰(zhàn)。參與及社會的包含;利，以確保課程的時間和資源。把老年醫(yī)學整合入醫(yī)學院的每一學科。要求所有醫(yī)學生輪轉(zhuǎn)老齡病人照顧的。含醫(yī)院、康復照顧、家庭照顧、療養(yǎng)。院照顧、舒緩照顧等。功能和生活質(zhì)量維持的改良。終末期疾病的安慰。一般為慢性病與急性病重疊。經(jīng)常是多個和復合存在

　　

【正文】 Healthy Aging:健康地老齡化 Successful成功的 Absence of disease and disability。 high cognitive and physical functioning。 and active engagement with life. 沒有疾病和殘疾 。高的認知和身體機能；及積極地參與生活。 K. BrummelSmith, . 2020. Optimal Aging, Part I: Demographics and Definitions. Annals of Longterm Care. 15(11).: 2628 Healthy Aging健康地老齡化 New England Centenarian Study Thomas T. Perls, MD MPH, Margery Silver EdD 新英格蘭百歲老人研究 Thomas T. Perls, MD MPH, Margery Silver EdD ? 169 centenarians in 8 munities near Boston ? 居住在靠波士頓的 18個社區(qū)的 169個百歲老人 ? 85% female ? 85%是女性 ? 15% living independently, 35% with family, 50% in nursing homes ? 15%獨立生活、 35%與家庭、 50%在護理院 ? 25% free of cognitive disorders ? 25%無認知障礙 ? 4/5 male centenarians have extremely good mental and physical health ? 4/5男性百歲老人擁有極好的精神和身體健康 ? Female centenarians: wide spectrum of mental and physical health 女性百歲老人：寬廣的精神和身體健康譜 Healthy Aging健康地老齡化 Characteristics of Centenarians : NECS 百歲老人的特點： ? 95% physically healthy, cognitively independent into 90s ? 95%身體健康、認知獨立進入 90歲 ? Significantly lower scores for “neuroticism” and “negative emotionality”。 only 4/74 with severe depression on GDS ? “神經(jīng)過敏”和“消極情緒”的分數(shù)明顯低，僅 4/74在劑量遞增表上有嚴重的抑郁 ? Almost all ahad suffered severe bereavement, but demonstrated ability to cope with stress and loss ? 幾乎所有的 ahad經(jīng)歷了痛苦的死別，但顯示了處理壓力和損失的能力 ? High degree of continued intellectual stimulation: musical instrument, painting, sculpture, new language ? 高度持續(xù)的智力刺激：樂器、繪畫、雕塑及學習新語言 ? No pattern in diets ? 沒有典型的飲食 ? Wide range of education ? 廣泛的教育 Healthy Aging健康地老齡化 Characteristics of Centenarians : NECS 百歲老人的特點： ? 99% nonobese ? 99%不肥胖 ? Alcohol consumption minimal ? 最小限度地消費酒精 ? Smoking nonexistent ? 不 吸煙 ? Prominent use of humor as coping mechanism ? 卓越地使用幽默作為應付機制 ? Nearly all have many meaningful relationships and ability to attract people ? 幾乎所有人擁有許多有意義的關系和能力吸引人們 ? 82% report religious beliefs important influence in life ? 82%報告宗教對生活有重要的影響 Healthy Aging健康地老齡化 Exercise : The Real Fountain of Youth 鍛煉：年輕的真正源泉 Reduction in: 減少： CAD and stroke (effect on BP, HDL, DM)冠心病和中風（對血壓、高密度脂蛋白、糖尿病有影響） colon cancer 結腸癌 osteoporosis 骨質(zhì)疏松癥 diabetes mellitus 糖尿病 obesity 肥胖癥 depression 抑郁 Improvement in: muscle mass, balance, strength, Sleep 改善：肌肉質(zhì)量、平衡、力量、睡眠。 Healthy Aging健康地老齡化 Numerous Studies Demonstrate Benefits of Exercise in Reduction of AllCause Mortality 大量的研究顯示鍛煉在減少全因死亡率的益處 ? Kaplan, 1987, Alameda County Study : increased risk of death in persons 70 who reported low levels of activity ? Kaplan, 1987, Alameda 縣研究：低水平活動量增加年齡 70 的人的死亡風險 ? Blair, 1989, JAMA : 10,224 men, 3,120 women. Allcause mortality decreased across quintiles of treadmilldetermined physical fitness. ? Blair, 1989, JAMA : 10,224 男士 , 3,120 女士。通過 1/5的平板決定的體能的全因死亡率下降。 ? Kujala, 1998, Finnish Twin Cohort, JAMA: leisuretime physical activity associated with reduced mortality, even after geic and familial factors accounted for ? Kujala, 1998, Finnish Twin Cohort, JAMA:甚至在可以解釋的基因和家族因素后， ? 業(yè)余時間的體力活動伴隨死亡率下降 Healthy Aging健康地老齡化 Myers, 2020, NEJM: After adjustment for age, treadmill peak exercise capacity was the strongest predictor of mortality in normal subjects and those with cardiovascular disease. 在年齡調(diào)節(jié)后，平板高峰運動能力是正常個體和有心臟病者最強的死亡預測因素。 Each 1 MET increase in exercise capacity conferred 12% increase in survival. 運動能力每增加 1級賦予 12%生存率的增加 Healthy Aging健康地老齡化 Helen Zechmeister, 91, weight lifter (200 lbs.) 舉重者（ 200磅） Healthy Aging健康地老齡化 Woody Brown, 83, surfer 沖浪運動員 Healthy Aging健康地老齡化 Ida Kline, 100, aerobics instructor有氧健身操教練 Healthy Aging:健康地老齡化 Psychosocial Factors in Longevity長壽的心理社會因素 Studies suggest that 研究提示 – social support systems –社會支持體系 – ability to cope with stress 處理壓力的能力 – lifelong learning, meaningful activity 終生學習，有意義的活動 – Laughter 笑 may contribute as much if not more to longevity than healthy behaviors 也許對長壽的貢獻與健康行為一樣，即使不超過 Healthy Aging健康地老齡化 Psychological WellBeing: The Value of Social Support 心理健康：社會支持的價值 ? Berkman, 1979, Alameda County Study: 7000 men and women, followed for 9 years, were 23x more likely to die if they lacked social and munity ties, regardless of age, gender, health practices, or physical health status ? Berkman, 1979, Alameda 縣研究 : 7000男人和女人，隨訪 9年，假如缺少社會和社區(qū)聯(lián)系，不論年齡、性別、健康情況或身體健康狀況， 23倍地易于死亡， ? OrthGomer, 1987. 17,000 Swedish persons over 60 years. Socially isolated 4x more likely to die prematurely, even if age, health behavior, and health status controlled ? OrthGomer, 1987. 17,000 超過 60歲的瑞典人 . 即使控制年齡、健康行為及健康狀態(tài)，與社會隔離， 4倍易于過早地死亡。 We don’t not stop working because we are old。 we grow old because we stop working. 因為我們老，我們不停止工作； 因為我們停止工作，我們變老。