中文摘要
術前使用周全性老年醫學評估於高齡泌尿道癌症病患之初探
背景
泌尿道癌症病患日趨高齡化，術後常須面臨更多的併發症，以及功能衰退等合併症，使治療計畫改變、術後狀況變差。癌症治療近年來無論在藥物或手術術式，均有長足進步，周全性老年醫學評估已廣泛應用於諸多醫療領域的風險分類，並據此分析治療的好處與壞處。然而目前在泌尿道癌症高齡病患術前評估的相關實證研究仍屬缺乏。
研究目的與方法
利用周全性老年醫學評估，辨識高齡泌尿道癌症治療手術發生不良預後之風險因子。本研究採縱貫性研究設計，以南台灣某醫學中心為收案場域，研究對象為≥ 75歲、泌尿道癌症且預定接受治療性手術者。於術前對個案進行周全性老年醫學評估，項目包含:基本資料、共病症、跌倒、尿失禁、營養狀態、憂鬱、認知、生活功能、多重用藥、衰弱症等。追蹤預後包括術後一個月的重大併發症，以及術後一個月、三個月的生活功能狀態。
研究結果
總共82位病患納入研究，高齡泌尿道癌症病患術前有諸多老年症候群，包括:認知功能分數低(13.4%)、憂鬱程度高(17.1%)、術前日常生活功能依賴(18.3%)、營養不良(28.0%)、共病症多(69.5%)、用藥種類多(52.4%)、尿失禁(28.0%)，進一步迴歸分析發現，衰弱程度愈高之老年癌症病人會有較高風險於術後發生重大併發症(Clinical Frailty Scale, 1-point increase OR: 2.1, 95% CI: 1.19-3.72)、術後30日功能衰退(OR: 1.67, 95% CI: 1.04-2.68)及術後90日功能衰退(OR: 2.50, 95% CI: 1.35-4.62)，且預測力相較於傳統指標(ECOG)為佳。
結論
藉由臨床衰弱指標所辨識出的泌尿道癌症高風險族群，有較高機率發生不良預後，及術後功能衰退；特別是≥5分以上者，須進一步進行完整周全性評估並提供個人化跨專業照護介入措施。預先了解可能之術後重大併發症及功能衰退，有助於改善高齡泌尿道癌症手術不良預後及協助醫病討論決策。
關鍵詞：老年病人、周全性老年醫學評估、泌尿道癌症、腫瘤手術

SUMMARY
Geriatric patients with urologic malignancy suffer from more complications and functional decline compared with younger counterparts despite continued refinement of surgical techniques. Geriatric assessment has been used in medical risk stratification for outcome prediction and decision-making in spite of lacking evidence-based studies for pre-operative assessment upon geriatric patients with urological malignancy. Our purpose aims to investigate a comprehensive assessment tool regarding risk of outcome for elderly patients with urologic malignancy. The prospective study cohort was composed of 82 elderly patients aged ≥ 75 years scheduled to receive surgery for urologic malignancy. Preoperative comprehensive geriatric assessment had consisted of previous falls, incontinence, nutrition status, depression, cognition, baseline activities of daily living (ADLs), polypharmacy and frailty with the primary outcomes measure as major complications within 30 days after surgery, decline of ADLs within 30 days and 90 days post-operatively. Notably, several geriatric syndromes before operation were observed with risk of cognition impairment (13.4%), depressive mood (17.1%), disability (18.3%), malnutrition (28.0%), multi-comorbidities (69.5%), polypharmacy (52.4%), and urinary incontinence (28.0%). On multiple logistic regression analysis, degree of frailty, assessed by Clinical Frailty Scale (CFS), was associated with higher risk for major complications within 30-days (OR: 2.1, 95% CI: 1.19-3.72), post-operative function decline within 30 days (OR: 1.67, 95% CI: 1.04-2.68) and post-operative function decline within 90 days (OR: 2.50, 95% CI: 1.35-4.62). CFS had been demonstrated with better diagnostic accuracy by logistic regression and area under curve of ROC analysis in contrast to traditional parameter, ECOG. In future, frailty assessed by Clinical Frailty Scale, especially patients who scored above 5, may require further individualized intervention with multidisciplinary perioperative care to lessen post-operative risk of major complication and functional decline. Having a clear understanding of postoperative morbidity and functional trajectories is helpful for appropriate discussions between patients, their families, and physicians to set and achieve realistic treatment goals.
Keywords: elderly, geriatric assessment, surgical oncology, urologic malignancy

重要參考文獻：

American Geriatrics Society Beers Criteria Update Expert Panel. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 60(4), 616-631. doi:10.1111/j.1532-5415.2012.03923.x
Badgwell, B., Stanley, J., Chang, G. J., Katz, M. H., Lin, H. Y., Ning, J., . . . Cormier, J. N. (2013). Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. Journal of Surgical Oncology, 108(3), 182-186. doi:10.1002/jso.23369
Banaszak-Holl, J., Liang, J., Quinones, A., Cigolle, C., Lee, I. C., & Verbrugge, L. M. (2011). Trajectories of functional change among long stayers in nursing homes: does baseline impairment matter? Journal of Aging and Health, 23(5), 862-882. doi:10.1177/0898264311399759
Bellera, C. A., Rainfray, M., Mathoulin-Pelissier, S., Mertens, C., Delva, F., Fonck, M., & Soubeyran, P. L. (2012). Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Annals of Oncology, 23(8), 2166-2172. doi:10.1093/annonc/mdr587
Bray, N. W., Smart, R. R., Jakobi, J. M., & Jones, G. R. (2016). Exercise prescription to reverse frailty. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 41(10), 1112-1116.
Caillet, P., Canoui-Poitrine, F., Vouriot, J., Berle, M., Reinald, N., Krypciak, S., . . . Paillaud, E. (2011). Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. Journal of Clinical Oncology, 29(27), 3636-3642. doi:10.1200/JCO.2010.31.0664
Chan, A. C. (1996). Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. Journal of Aging and Health, 8(2), 238-253.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383.
Chen, L. K., Liu, L. K., Woo, J., Assantachai, P., Auyeung, T. W., Bahyah, K. S., . . . Arai, H. (2014). Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association, 15(2), 95-101. doi:10.1016/j.jamda.2013.11.025
Chou, K.-L. (2003). Hong Kong Chinese everyday competence scale: a validation study. Clinical Gerontologist, 26(1-2), 43-51.
Chow, R., Chiu, N., Bruera, E., Krishnan, M., Chiu, L., Lam, H., . . . Chow, E. (2016). Inter-rater reliability in performance status assessment among health care professionals: a systematic review. Annals of Palliative Medicine, 5(2), 83-92. doi:10.21037/apm.2016.03.02
Clavien, P. A., Barkun, J., de Oliveira, M. L., Vauthey, J. N., Dindo, D., Schulick, R. D., . . . Makuuchi, M. (2009). The Clavien-Dindo classification of surgical complications: five-year experience. Annals of Surgery, 250(2), 187-196. doi:10.1097/SLA.0b013e3181b13ca2
Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., . . . European Working Group on Sarcopenia in Older, P. (2010). Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and Ageing, 39(4), 412-423. doi:10.1093/ageing/afq034
Decoster, L., Van Puyvelde, K., Mohile, S., Wedding, U., Basso, U., Colloca, G., . . . Extermann, M. (2015). Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendationsdagger. Annals of Oncology, 26(2), 288-300. doi:10.1093/annonc/mdu210
Diab, S. G., Elledge, R. M., & Clark, G. M. (2000). Tumor characteristics and clinical outcome of elderly women with breast cancer. Journal of the National Cancer Institute, 92(7), 550-556.
Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205-213.
Etzioni, D. A., Liu, J. H., O'Connell, J. B., Maggard, M. A., & Ko, C. Y. (2003). Elderly patients in surgical workloads: a population-based analysis. American Surgeon, 69(11), 961-965.
Extermann, M., Aapro, M., Bernabei, R., Cohen, H. J., Droz, J. P., Lichtman, S., . . . Task Force on, C. G. A. o. t. I. S. o. G. O. (2005). Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Critical Reviews in Oncology/Hematology, 55(3), 241-252. doi:10.1016/j.critrevonc.2005.06.003
Extermann, M., Boler, I., Reich, R. R., Lyman, G. H., Brown, R. H., DeFelice, J., . . . Balducci, L. (2012). Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer, 118(13), 3377-3386. doi:10.1002/cncr.26646
Extermann, M., & Hurria, A. (2007). Comprehensive geriatric assessment for older patients with cancer. Journal of Clinical Oncology, 25(14), 1824-1831. doi:10.1200/JCO.2007.10.6559
Feng, M. A., McMillan, D. T., Crowell, K., Muss, H., Nielsen, M. E., & Smith, A. B. (2015). Geriatric assessment in surgical oncology: a systematic review. Journal of Surgical Research, 193(1), 265-272. doi:10.1016/j.jss.2014.07.004
Fillenbaum, G. G., & Smyer, M. A. (1981). The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. Journal of Gerontology, 36(4), 428-434.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Fried, L., Tangen, C., Walston, J., Newman, A., Hirsch, C., Gottdiener, J., . . . Burke, G. (2001). Cardiovascular Health Study Collaborative Research Group. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 56(3), M146-M156.
Fukuse, T., Satoda, N., Hijiya, K., & Fujinaga, T. (2005). Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest, 127(3), 886-891. doi:10.1378/chest.127.3.886
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J., & O'Mahony, D. (2008). STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, 46(2), 72-83.
Gironés, R., Torregrosa, D., Maestu, I., Gómez-Codina, J., Tenias, J. M., & Costa, R. R. (2012). Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: a single-center experience. Journal of Geriatric Oncology, 3(2), 98-103.
Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V., . . . Wallace, R. B. (2000). Lower extremity function and subsequent disability consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55(4), M221-M231.
Haglund, R. M., & Schuckit, M. A. (1976). A clinical comparison of tests of organicity in elderly patients. Journal of Gerontology, 31(6), 654-659.
Hajjar, E. R., Cafiero, A. C., & Hanlon, J. T. (2007). Polypharmacy in elderly patients. American Journal of Geriatric Pharmacotherapy, 5(4), 345-351. doi:10.1016/j.amjopharm.2007.12.002
Hamaker, M. E., Buurman, B. M., van Munster, B. C., Kuper, I. M., Smorenburg, C. H., & de Rooij, S. E. (2011). The value of a comprehensive geriatric assessment for patient care in acutely hospitalized older patients with cancer. Oncologist, 16(10), 1403-1412. doi:10.1634/theoncologist.2010-0433
Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., & Granger, C. V. (1994). Interrater reliability of the 7-level functional independence measure (FIM). Scandinavian Journal of Rehabilitation Medicine, 26(3), 115-119.
Horgan, A. M., Leighl, N. B., Coate, L., Liu, G., Palepu, P., Knox, J. J., . . . Alibhai, S. M. (2012). Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: a pilot study. American Journal of Clinical Oncology, 35(4), 322-328. doi:10.1097/COC.0b013e318210f9ce
Howlader, N., Noone, A., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., . . . Tatalovich, Z. (2011). SEER cancer statistics review, 1975–2008. Bethesda, MD: National Cancer Institute, 19.
Hoyl, M. T., Alessi, C. A., Harker, J. O., Josephson, K. R., Pietruszka, F. M., Koelfgen, M., . . . Rubenstein, L. Z. (1999). Development and testing of a five-item version of the Geriatric Depression Scale. Journal of the American Geriatrics Society, 47(7), 873-878.
Huisman, M. G., Audisio, R. A., Ugolini, G., Montroni, I., Vigano, A., Spiliotis, J., . . . van Leeuwen, B. L. (2015). Screening for predictors of adverse outcome in onco-geriatric surgical patients: A multicenter prospective cohort study. European Journal of Surgical Oncology, 41(7), 844-851. doi:10.1016/j.ejso.2015.02.018
Hurria, A. (2009). Geriatric assessment in oncology practice. Journal of the American Geriatrics Society, 57 Suppl 2, S246-249. doi:10.1111/j.1532-5415.2009.02503.x
Hurria, A., Togawa, K., Mohile, S. G., Owusu, C., Klepin, H. D., Gross, C. P., . . . Tew, W. P. (2011). Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Journal of Clinical Oncology, 29(25), 3457-3465. doi:10.1200/JCO.2011.34.7625
Indrakusuma, R., Dunker, M. S., Peetoom, J. J., & Schreurs, W. H. (2015). Evaluation of preoperative geriatric assessment of elderly patients with colorectal carcinoma. A retrospective study. European Journal of Surgical Oncology, 41(1), 21-27. doi:10.1016/j.ejso.2014.09.005
Jolly, T. A., Deal, A. M., Nyrop, K. A., Williams, G. R., Pergolotti, M., Wood, W. A., . . . Muss, H. B. (2015). Geriatric assessment-identified deficits in older cancer patients with normal performance status. Oncologist, 20(4), 379-385. doi:10.1634/theoncologist.2014-0247
Kanesvaran, R., Li, H., Koo, K. N., & Poon, D. (2011). Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. Journal of Clinical Oncology, 29(27), 3620-3627. doi:10.1200/JCO.2010.32.0796
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185(12), 914-919.
Kenis, C., Decoster, L., Van Puyvelde, K., De Greve, J., Conings, G., Milisen, K., . . . Wildiers, H. (2014). Performance of two geriatric screening tools in older patients with cancer. Journal of Clinical Oncology, 32(1), 19-26. doi:10.1200/JCO.2013.51.1345
Kenis, C., Geeraerts, A., Braes, T., Milisen, K., Flamaing, J., & Wildiers, H. (2006). 19 The Flemish version of the Triage Risk Screening Tool (TRST): a multidimensional short screening tool for the assessment of elderly patients. Critical Reviews in Oncology/Hematology, 60, S31.
Kim, S., Brooks, A. K., & Groban, L. (2014). Preoperative assessment of the older surgical patient: Honing in on geriatric syndromes. Clinical Interventions in Aging, 10, 13-27. doi:10.2147/CIA.S75285
Kim, S. W., Han, H. S., Jung, H. W., Kim, K. I., Hwang, D. W., Kang, S. B., & Kim, C. H. (2014). Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surgery, 149(7), 633-640. doi:10.1001/jamasurg.2014.241
Klepin, H. D., Geiger, A. M., Tooze, J. A., Kritchevsky, S. B., Williamson, J. D., Ellis, L. R., . . . Powell, B. L. (2011). The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia. Journal of the American Geriatrics Society, 59(10), 1837-1846. doi:10.1111/j.1532-5415.2011.03614.x
Korc-Grodzicki, B., Sun, S. W., Zhou, Q., Iasonos, A., Lu, B., Root, J. C., . . . Tew, W. P. (2015). Geriatric Assessment as a Predictor of Delirium and Other Outcomes in Elderly Patients With Cancer. Annals of Surgery, 261(6), 1085-1090. doi:10.1097/SLA.0000000000000742
Kothari, A., Phillips, S., Bretl, T., Block, K., & Weigel, T. (2011). Components of geriatric assessments predict thoracic surgery outcomes. Journal of Surgical Research, 166(1), 5-13. doi:10.1016/j.jss.2010.05.050
Kristjansson, S. R., Nesbakken, A., Jordhøy, M. S., Skovlund, E., Audisio, R. A., Johannessen, H.-O., . . . Wyller, T. B. (2010). Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Critical Reviews in Oncology/Hematology, 76(3), 208-217.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179-186.
Lee, S. J., Go, A. S., Lindquist, K., Bertenthal, D., & Covinsky, K. E. (2008). Chronic conditions and mortality among the oldest old. American Journal of Public Health, 98(7), 1209-1214. doi:10.2105/AJPH.2007.130955
Lee, S. J., Lindquist, K., Segal, M. R., & Covinsky, K. E. (2006). Development and validation of a prognostic index for 4-year mortality in older adults. JAMA, 295(7), 801-808. doi:10.1001/jama.295.7.801
Leng, S. X., Cappola, A. R., Andersen, R. E., Blackman, M. R., Koenig, K., Blair, M., & Walston, J. D. (2004). Serum levels of insulin-like growth factor-I (IGF-I) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty. Aging Clinical and Experimental Research, 16(2), 153-157.
Levy, C. R., Zargoush, M., Williams, A. E., Williams, A. R., Giang, P., Wojtusiak, J., . . . Alemi, F. (2016). Sequence of functional loss and recovery in nursing homes. The Gerontologist, 56(1), 52-61.
Lichtman, S. M. (2015). Polypharmacy: geriatric oncology evaluation should become mainstream. Journal of Clinical Oncology, 33(13), 1422-1423. doi:10.1200/JCO.2014.60.3548
Lincoln, N. B., & Gladman, J. R. (1992). The Extended Activities of Daily Living scale: a further validation. Disability and Rehabilitation, 14(1), 41-43.
Linn, B. S., Linn, M. W., & Gurel, L. (1968). Cumulative illness rating scale. Journal of the American Geriatrics Society, 16(5), 622-626.
Liuu, E., Canoui-Poitrine, F., Tournigand, C., Laurent, M., Caillet, P., Le Thuaut, A., . . . Group, E. S. (2014). Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study. Journal of Geriatric Oncology, 5(1), 11-19. doi:10.1016/j.jgo.2013.08.003
Mahoney, F. I. (1965). Functional evaluation: the Barthel index. Maryland State Medical Journal, 14, 61-65.
Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., . . . Fried, L. P. (2010). Frailty as a predictor of surgical outcomes in older patients. Journal of the American College of Surgeons, 210(6), 901-908. doi:10.1016/j.jamcollsurg.2010.01.028
Miller, M., & Towers, A. (1991). A manual of guidelines for scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Pittsburgh, PA: University of Pittsburgh.
Mitnitski, A. B., Mogilner, A. J., & Rockwood, K. (2001). Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal, 1, 323-336. doi:10.1100/tsw.2001.58
Morris, J. N., Fries, B. E., & Morris, S. A. (1999). Scaling ADLs within the MDS. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54(11), M546-M553.
Mottet, N., Bastian, P., Bellmunt, J., Van den Bergh, R., Bolla, M., Van Casteren, N., . . . Matveev, V. (2014). Guidelines on prostate cancer. European Urology, 65(1), 124-137.
Nabhan, C., Smith, S. M., Helenowski, I., Ramsdale, E., Parsons, B., Karmali, R., . . . Evens, A. M. (2012). Analysis of very elderly (>/=80 years) non-hodgkin lymphoma: impact of functional status and co-morbidities on outcome. British Journal of Haematology, 156(2), 196-204. doi:10.1111/j.1365-2141.2011.08934.x
National Comprehensive Cancer Network. (2017a). Bladder Cancer. Retrieved from https://www.tri-kobe.org/nccn/guideline/urological/english/bladder.pdf
National Comprehensive Cancer Network. (2017b). Older Adult Oncology. Retrieved from https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/senior.pdf
Neuman, M. D., & Bosk, C. L. (2012). What we talk about when we talk about risk: refining surgery's hazards in medical thought. The Milbank Quarterly, 90(1), 135-159.
Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., & Carbone, P. P. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649-655.
Olivieri, A., Gini, G., Bocci, C., Montanari, M., Trappolini, S., Olivieri, J., . . . Leoni, P. (2012). Tailored therapy in an unselected population of 91 elderly patients with DLBCL prospectively evaluated using a simplified CGA. Oncologist, 17(5), 663-672. doi:10.1634/theoncologist.2011-0355
Ommundsen, N., Wyller, T. B., Nesbakken, A., Jordhoy, M. S., Bakka, A., Skovlund, E., & Rostoft, S. (2014). Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist, 19(12), 1268-1275. doi:10.1634/theoncologist.2014-0237
participants, P., Audisio, R. A., Pope, D., Ramesh, H. S., Gennari, R., van Leeuwen, B. L., . . . Marshall, E. (2008). Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Critical Reviews in Oncology/Hematology, 65(2), 156-163. doi:10.1016/j.critrevonc.2007.11.001
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(10), 433-441.
Raji, M. A., Kuo, Y. F., Freeman, J. L., & Goodwin, J. S. (2008). Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Archives of Internal Medicine, 168(18), 2033-2040. doi:10.1001/archinte.168.18.2033
Repetto, L., Fratino, L., Audisio, R. A., Venturino, A., Gianni, W., Vercelli, M., . . . Zagonel, V. (2002). Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. Journal of Clinical Oncology, 20(2), 494-502.
Repetto, L., & Luciani, A. (2015). [Cancer treatment in elderly patients: evidence and clinical research]. Recenti Progressi in Medicina, 106(1), 23-27. doi:10.1701/1740.18952
Revenig, L. M., Canter, D. J., Taylor, M. D., Tai, C., Sweeney, J. F., Sarmiento, J. M., . . . Ogan, K. (2013). Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. Journal of the American College of Surgeons, 217(4), 665-670 e661. doi:10.1016/j.jamcollsurg.2013.06.012
Rinaldi, P., Mecocci, P., Benedetti, C., Ercolani, S., Bregnocchi, M., Menculini, G., . . . Cherubini, A. (2003). Validation of the five-item geriatric depression scale in elderly subjects in three different settings. Journal of the American Geriatrics Society, 51(5), 694-698.
Robinson, T. N., Eiseman, B., Wallace, J. I., Church, S. D., McFann, K. K., Pfister, S. M., . . . Moss, M. (2009). Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Annals of Surgery, 250(3), 449-455. doi:10.1097/SLA.0b013e3181b45598
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495.
Rodin, M. B., & Mohile, S. G. (2007). A practical approach to geriatric assessment in oncology. Journal of Clinical Oncology, 25(14), 1936-1944. doi:10.1200/JCO.2006.10.2954
Saliba, D., Elliott, M., Rubenstein, L. Z., Solomon, D. H., Young, R. T., Kamberg, C. J., . . . Wenger, N. S. (2001). The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. Journal of the American Geriatrics Society, 49(12), 1691-1699.
Shin, D.-Y., Lee, J.-O., Kim, Y. J., Park, M.-S., Lee, K.-W., Kim, K.-I., . . . Kim, J. H. (2012). Toxicities and functional consequences of systemic chemotherapy in elderly Korean patients with cancer: A prospective cohort study using Comprehensive Geriatric Assessment. Journal of Geriatric Oncology, 3(4), 359-367.
Soubeyran, P., Fonck, M., Blanc-Bisson, C., Blanc, J. F., Ceccaldi, J., Mertens, C., . . . Rainfray, M. (2012). Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. Journal of Clinical Oncology, 30(15), 1829-1834. doi:10.1200/JCO.2011.35.7442
Spina, M., Balzarotti, M., Uziel, L., Ferreri, A. J., Fratino, L., Magagnoli, M., . . . Tirelli, U. (2012). Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma. Oncologist, 17(6), 838-846. doi:10.1634/theoncologist.2011-0417
Studenski, S., Perera, S., Patel, K., Rosano, C., Faulkner, K., Inzitari, M., . . . Guralnik, J. (2011). Gait speed and survival in older adults. JAMA, 305(1), 50-58. doi:10.1001/jama.2010.1923
Tan, K.-Y., Kawamura, Y. J., Tokomitsu, A., & Tang, T. (2012). Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. The American Journal of Surgery, 204(2), 139-143.
Wallis, S. J., Wall, J., Biram, R. W., & Romero-Ortuno, R. (2015). Association of the clinical frailty scale with hospital outcomes. QJM, 108(12), 943-949. doi:10.1093/qjmed/hcv066
Walston, J., McBurnie, M. A., Newman, A., Tracy, R. P., Kop, W. J., Hirsch, C. H., . . . Cardiovascular Health, S. (2002). Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Archives of Internal Medicine, 162(20), 2333-2341.
Weir, H. K., Thun, M. J., Hankey, B. F., Ries, L. A., Howe, H. L., Wingo, P. A., . . . Edwards, B. K. (2003). Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. Journal of the National Cancer Institute, 95(17), 1276-1299.
Wildiers, H., Heeren, P., Puts, M., Topinkova, E., Janssen-Heijnen, M. L., Extermann, M., . . . Hurria, A. (2014). International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. Journal of Clinical Oncology, 32(24), 2595-2603. doi:10.1200/JCO.2013.54.8347
Williams, B. C., Li, Y., Fries, B. E., & Warren, R. L. (1997). Predicting patient scores between the functional independence measure and the minimum data set: development and performance of a FIM-MDS "crosswalk". Archives of Physical Medicine and Rehabilitation, 78(1), 48-54.
Wilson, J. R., Clarke, M. G., Ewings, P., Graham, J. D., & MacDonagh, R. (2005). The assessment of patient life-expectancy: how accurate are urologists and oncologists? BJU International, 95(6), 794-798. doi:10.1111/j.1464-410X.2005.05403.x
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17(1), 37-49.
Yesavage, J. A., & Sheikh, J. I. (1986). 9/Geriatric Depression Scale (GDS) recent evidence and development of a shorter violence. Clinical Gerontologist, 5(1-2), 165-173.
行政院國家發展委員會. (2016). 中華民國人口推計（105至150年）. Retrieved from https://www.ndc.gov.tw/Content_List.aspx?n=84223C65B6F94D72
張家銘, & 蔡智能. (2003). 老年人之周全性評估. 臺灣醫學, 7(3), 364-374.
張靜怡, 黎家銘, 陳晶瑩, 林莉茹, 黃國晉, 許志成, . . . 陳慶餘. (2013). 臺北市老人衰弱症篩檢試辦計畫. 台北市醫師公會會刊, 57(2), 14-17.