预防「老年忧郁症」 医教「3动原则」降低风险
<figure class="article-content__image" data-url="https://pgw.worldjournal.com/gw/photo.php?u=https://uc.udn.com.tw/photo/2024/12/27/draft/31165085.jpg&x=0&y=0&sw=0&sh=0&sl=W&fw=800&exp=3600&q=75" style="box-sizing: border-box; position: relative; overflow: hidden; margin-top: 20px; margin-bottom: 20px; color: rgb(0, 0, 0); --bg-image: url('https://pgw.worldjournal.com/gw/photo.php?u=https://uc.udn.com.tw/photo/2024/12/27/draft/31165085.jpg&x=0&y=0&sw=0&sh=0&sl=W&fw=800&exp=3600&q=75');"><picture style="box-sizing: border-box;"><font face="宋体" style="" size="4"><img alt="图片来源 /健康医疗网" class=" lazyloaded" data-src="https://pgw.worldjournal.com/gw/photo.php?u=https://uc.udn.com.tw/photo/2024/12/27/draft/31165085.jpg&x=0&y=0&sw=0&sh=0&sl=W&fw=800&exp=3600&q=75" src="https://pgw.worldjournal.com/gw/photo.php?u=https://uc.udn.com.tw/photo/2024/12/27/draft/31165085.jpg&x=0&y=0&sw=0&sh=0&sl=W&fw=800&exp=3600&q=75" _mstalt="45018350" _msthash="252" style="box-sizing: border-box; border-style: none; object-fit: contain; width: 580px; height: 386px;"></font></picture><figcaption _msttexthash="35687886" _msthash="253" style="box-sizing: border-box; line-height: 1.4; padding-top: 10px; padding-bottom: 10px; color: rgb(126, 126, 126); background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><font face="宋体" size="4">图片来源 /健康医疗网</font></figcaption></figure><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font _mstmutation="1" _msttexthash="4007301558" _msthash="254" style="box-sizing: border-box;" face="宋体" size="4">「<span _istranslated="1" style="box-sizing: border-box; background-color: initial; color: rgb(126, 126, 126); text-decoration-line: none; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">退休</span><font color="#7e7e7e"><span style="box-sizing: border-box; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">」是现代人普遍会经历的人生阶段，退休后没有生活目标，影响健康，罹患疾病风险增60%，该如何减少退休带来的失落感，降低罹患老年忧郁的风险。 世界卫生组织（WHO）估计，全球有2.6亿人以上患有</span></font><span _istranslated="1" style="box-sizing: border-box; background-color: initial; color: rgb(126, 126, 126); text-decoration-line: none; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">忧郁症</span><font color="#7e7e7e"><span style="box-sizing: border-box; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">，盛行率约3~4%，65岁以上的高龄忧郁症盛行率更高达10%，相当于每10个老人就有1人患有忧郁症。</span></font></font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><h2 class="content_title_1" _msttexthash="198267849" _msthash="255" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; font-weight: 400; color: rgb(0, 110, 181); line-height: 1.5;"><font face="宋体" size="4">老年忧郁症属多重危险因子 身体症状或疼痛、记忆或认知下降</font></h2><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font _mstmutation="1" _msttexthash="5655309296" _msthash="256" style="box-sizing: border-box;" face="宋体" size="4"><mh class="chrome-extension-FindManyStrings chrome-extension-FindManyStrings-style-3 CE-FMS-%E5%8F%B0%E6%B9%BE" style="box-sizing: border-box; border-radius: 3px; box-shadow: rgba(0, 0, 0, 0.3) 1px 1px 3px; color: rgb(255, 255, 255); background: rgb(57, 136, 255);">台湾</mh>台北市立联合医院松德院区社区精神科主治医师陈文莹说，老年忧郁症，往往是多重危险因子导致，包括多重身体疾病（如各种慢性病、癌症、<span _istranslated="1" style="box-sizing: border-box; background-color: initial; color: rgb(126, 126, 126); text-decoration-line: none; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">心血管疾病</span><font color="#7e7e7e"><span style="box-sizing: border-box; border-bottom: 1px solid rgb(126, 126, 126); transition: color 0.3s linear, border 0.3s linear;">等）或是遗传及特殊压力事件，如经济因素、早期创伤; 另需要特别关注的议题是失落感，像是身分地位丧失、社会价值低落、伴侣过世等都有影响。 而忧郁症在老年人身上的表现，通常较不典型，一般常见以下两类表征：</span></font></font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p _msttexthash="1445579135" _msthash="297" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">1.常以身体症状或疼痛来表现：主要是长辈不习惯表达自我的情绪及心理状态，也较倾向压抑而非表达，所以经常会以无法解释的身体症状或难治型疼痛，来传达其内在心情的不适。</font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p _msttexthash="1397797505" _msthash="298" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">2.有专注力下降、记忆力不佳、呈现失能等情形，很容易和失智症混淆，通常记忆力或认知功能下降，也会伴随其他忧郁症状，且失能下降速度较快（相较于阿兹海默症）。</font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><h2 class="content_title_1" _msttexthash="132139943" _msthash="299" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; font-weight: 400; color: rgb(0, 110, 181); line-height: 1.5;"><font face="宋体" size="4">观察日常、情绪、认知 症状逾两周应就医评估治疗</font></h2><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p _msttexthash="3376461660" _msthash="300" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">陈文莹表示，忧郁和失智是影响老年身心健康的两大威胁，一般可从「日常」、「情绪」、「认知」等来观察。 如上述症状持续超过两周以上，且每天有大部分的时间，都处于情绪低落、充满负面想法、对生活丧失兴趣时，就要高度注意长者是否有忧郁倾向，应即时就医评估，及早诊断治疗。</font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p _msttexthash="3589967979" _msthash="301" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">老年忧郁症在诊断上，会需要先了解各种身体疾病及相关因素，通过问诊并依病史来诊断及给予治疗，目前通过适当药物搭配心理治疗，对老年轻、中度患者的疗效很好，不比年轻忧郁症患者效果差; 而针对难治型的忧郁症患者，需要时会辅助以重复经颅磁刺激（rTMS）目前也都有显著的效果。</font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><h2 class="content_title_1" _msttexthash="113499230" _msthash="302" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; font-weight: 400; color: rgb(0, 110, 181); line-height: 1.5;"><font face="宋体" size="4">老年忧郁预防行动 「身动、脑动、交互」三动原则</font></h2><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p _msttexthash="1588006862" _msthash="303" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">陈文莹指出，老年忧郁的病因，可能来自于生理、心理、社会等不同的因素，年长者的身心健康，可以「三动」来做为预防保健的准则，通过身动、脑动、交互的三原则，作为老年忧郁的预防行动。</font></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><p style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"></p><blockquote class="article-blockquote article-blockquote__1" style="box-sizing: border-box; color: rgb(0, 0, 0); line-height: 1.8; padding: 45px 35px; border-left: 2px solid rgb(135, 144, 149); background: rgb(249, 249, 249); margin-top: 30px; margin-bottom: 30px;"><p _msttexthash="821990637" _msthash="304" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">身动：慢性心血管或中风等疾病，都属于忧郁症的危险因子，因此均衡饮食及适当运动，可增进自我性能，减少心血管疾病风险。</font></p><p _msttexthash="182259558" _msthash="305" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">脑动：转动大脑活络脑部，转换情绪，降低失智发生。</font></p><p _msttexthash="594117082" _msthash="306" style="box-sizing: border-box; letter-spacing: 1px; margin-bottom: 20px; line-height: 1.75; color: rgb(34, 34, 34); word-break: break-word;"><font face="宋体" size="4">交互：通过良好的交互与陪伴，以因应高龄者面对的角色转换与生活模式改变，因应高龄产生的孤独感与失落感。</font></p></blockquote><p></p><div align="left"><font color="#444444"><font color="#444444"><font color="#000"><font color="#444444"><font color="#444444"><font face="宋体"><font size="4"><font face="&quot"><font style="font-size: 16px;"><font face="宋体"><font color="#444444"><font face="&quot"><font color="#444444"><font color="#444444"><font face="宋体"><font face="&quot;"><font face="黑体"><div align="center"><font 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