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第五章 交通運輸及個人活動(機動性) 第五章 交通運輸及個人活動(機動性)

福祉科技與照顧管理 James L. Fozard 博士 南開科大客座教授 南佛羅里達大學老化研究 學院教授 福祉系助理教授華慧敏 倫敦大學瑪麗皇后學院 資訊科技研究所 福祉科技與照顧管理 James L. Fozard 博士 南開科大客座教授 南佛羅里達大學老化研究 學院教授 福祉系助理教授華慧敏 倫敦大學瑪麗皇后學院 資訊科技研究所

Readings for out of home mobility 閱讀資料:外出機動力 Mollenkopf H, Marcellini F, Ruoppila I, Szeman Readings for out of home mobility 閱讀資料:外出機動力 Mollenkopf H, Marcellini F, Ruoppila I, Szeman S, Tacken M. (Eds) Enhancing mobility in later life 強化老年時的機動力. Amsterdam: IOS Press, 2005, pp. 295 -316. (photocopy) This chapter is the summary of a very good book about a European five country study of out of the home mobility involving over 3300 participants. Transportation modes studied included foot, car, bicycle, mopedmotorcycle, public transportation. I will discuss some of the findings in lecture, but it will summarize only a very small part of the book. 本章是總結一本對五個歐洲國家, 3300名實驗參與者,有關於外出之活動(機動) 能力研究。有關交通型式研究包括步行,私人汽車,自行車,moped-機車,大 眾運輸 具。本章會做些討論在文獻中的發現,但只佔書中的一小部分。 You will read the final chapter. There will be a few study questions on the chapter that will help you focus on the main points. If you are interested in learning more about the mobility of older persons outside the home, this book is must reading. 你將會讀到最後一章。有幾個很好的問題可以幫助你集 中於主要的議題上。如果你對於老人於外出時的活動(機動)能力,這本書一定 要列為必讀!!

Mollenkopf H, Marcellini F, Ruoppila I, Szeman S, Tacken M. (Eds) Enhancing mobility in Mollenkopf H, Marcellini F, Ruoppila I, Szeman S, Tacken M. (Eds) Enhancing mobility in later life; mobilitate, Amsterdam: IOS Press, 2005, pp. 295 -316. Study questions Here a few study questions on the chapter that will help you focus on the main points. If you are interested in mobility of older persons outside the home, this book is must reading. 這裡有幾個本章節的問題,這些問題可以幫助你聚焦在主要重點上。如果你對老人在外出 時的機動/交通問題,這本書則列為必看! • What were the 5 goals of MOBILATE? (pp. 295 -6)? MOBILATE 的五個目標為何? (Enhancing outdoor mobility in later life) • What were the main findings regarding trips and journeys? (pp. 298 -299) 在旅行中主要的發現為何? (pp. 298 -299) • What were the main findings regarding transport options and outdoor activities? (pp. 299 -302) 對於交通 具的選擇與戶外活動主要的發現為何? • On pp. 302 -305 the authors list four types of “prerequisites and problems” that affect outdoor mobility of older men and women: 在第 302至 305頁,作者列出了四種型態會影響老人戶外活動力(機動力)的”預期 要求與問題” – Health健康 – Psychological 生理 – Regional and neighbourhood resources 區域性及居家附近的資源 – Social resources 社交資源 Briefly summarize their conclusions. Don’t get into too much detail because you have not read the entire book. 簡單的綜合他們的結論。不要太深入,因為你還沒有讀完整本書。

交通形式的重要性– 區域、年齡及性別 城市 65 -74 形式 鄉村 75+ 男 65 -74 女 男 75+ 交通形式的重要性– 區域、年齡及性別 城市 65 -74 形式 鄉村 75+ 男 65 -74 女 男 75+ 男 女 女 汽車 3. 7 2. 3 2. 6 1. 4 3. 7 2. 4 2. 7 1. 5 自行車 2. 4 2. 2 1. 8 1. 4 3. 1 2. 6 2. 0 機車 1. 2 1. 1 1. 4 1. 2 大眾 運輸 3. 1 3. 9 3. 2 3. 3 2. 4 2. 8 2. 4 特殊 具 1. 5 1. 6 1. 7 1. 9 1. 4 1. 5 1. 6 1. 8 步行 4. 4 4. 6 4. 3 4. 2 4. 4 4. 5 4. 3 1=不重要. -5=非常重要; Source: MOBILATE 2000, N=3950 男 女

兩日以上旅行之交通運輸形式 – 區域、年齡及性別 城市 65 -74 形式 男 女 鄉村 75+ 男 65 -74 兩日以上旅行之交通運輸形式 – 區域、年齡及性別 城市 65 -74 形式 男 女 鄉村 75+ 男 65 -74 女 男 女 75+ 男 女 汽車 48 28 27 17 51 34 33 26 大眾 運輸 8 15 13 18 5 3 8 4 火車 0 0 0 0 自行車 8 9 6 3 13 16 13 9 步行 37 48 54 62 30 47 46 60 MOBILATE 2000, Diary, weighted

不同交通模式之意外事件發生比率以 區域,年齡,性別區分 城市 65 -74 形式 男 女 鄉村 75+ 男 女 65 -74 不同交通模式之意外事件發生比率以 區域,年齡,性別區分 城市 65 -74 形式 男 女 鄉村 75+ 男 女 65 -74 男 女 75+ 男 女 汽車 駕駛 72 58 19 7 62 41 26 6 大眾 運輸 0 4 7 15 0 0 各人 乘車 6 2 7 4 6 0 14 0 自行車 8 12 19 7 12 21 29 31 步行 11 19 46 63 16 21 31 60 MOBILATE 2000, N= 373 accidents reported, 10% of total

Percent trips 1至 30 km 以區域,年齡,性別區分 城市 55 -75 里程 鄉村 75+ 55 -74 Percent trips 1至 30 km 以區域,年齡,性別區分 城市 55 -75 里程 鄉村 75+ 55 -74 75+ (km) 男 女 男 女 <1 31 44 45 55 38 48 51 68 1 -3 30 27 30 29 21 21 21 15 3 -10 25 20 18 12 21 15 14 7 10 -30 8 6 5 3 16 12 9 8 <30 5 2 3 2 4 4 4 2 MOBILATE 2000 Diary

MOBILATE 研究總結 • • • Most important modes-walking, driving a car 最重要的形式為– 步行、開車 Ability MOBILATE 研究總結 • • • Most important modes-walking, driving a car 最重要的形式為– 步行、開車 Ability to use car, good health important 開車的能力與健康情況有重要關係 – Younger age, male, income, education – 年紀較輕,男性,有收入,教育程度好 Private modes preferred—cars, bicycles, walking 個人化運輸方式– 私人車、腳踏車、步行 Public modes—used when alternatives not available or used in well served urban areas 大眾運輸方式—只有在沒有其他選擇的情況下或是在有良好設施的都會區。 77% made at least 1 journey, 2. 1 average/day 44% within 1 km, 24% within 3 km 44% 在 1 km內, 24% 在 3 km內 Reasons—shopping, meeting friends, family 原因—購物、和朋友聚會、與家人團聚

What is the future of public transportation for older persons? 未來大眾運輸與老人間的關係為何? • • Flexible What is the future of public transportation for older persons? 未來大眾運輸與老人間的關係為何? • • Flexible routing for buses and vans 彈性的巴士與廂型車路線規劃 – Several systems have been set up in Europe, where the elder makes an appointment for a van operated by city provides pickup and drop off services— not used very much – 在歐洲已建立一些系統,老人可以做預約由市政府營運的廂型車接送服務— 但並不普遍。 – In the USA where public transportation is poor except in large urban areas, a private nonprofit organization helps develop programs: – 在美國除了較大的都會區外大眾運輸設施均不普及,有些私人非營利性組織發展 些不同的計畫: • • • The National Center on Senior Transportation is administered by Easter Seals Inc. , in partnership with the National Association of Area Agencies on Aging (n 4 a) in cooperation with the Federal Transit Administration. National Center on Senior Transportation, 1425 K Street N. W. , Suite 200, Washington, DC 20005 Many older people are more willing to give up driving when confronted with the “true” costs of owning and operating a car. 許多老人在面對擁有私人車及車輛維護所需要的花費時,寧可選擇放棄開車。

應用 MOBILATE 研究 於福祉科技 • Visual problems that occur in aging affect driving ability 應用 MOBILATE 研究 於福祉科技 • Visual problems that occur in aging affect driving ability • 視力問題,會隨著老化影響駕駛能力。 – Technology based compensations include improvements in road signs, displays in car, limitations on driving – 科技可以補償老化所造成的問題包括:改善交通標誌,車內顯示,駕駛 的限制。 – Training older drivers on Useful Field of View and other interventions – 以[Useful Field of View]及其它方式訓練年長駕駛人。 • Ability to walk and ability to perform physical activities become more difficult with older age (75+). Declines in muscle strength, balance and gait are major contributors • 步行能力與生理活動力於 75+的年長者會更困難。肌肉強度、平衡與 步態能力下降是主要因素。

應用 MOBILATE 研究 於福祉科技 • Technology based interventions include devices and environments for • 應用 MOBILATE 研究 於福祉科技 • Technology based interventions include devices and environments for • 科技為基礎的介入協助包括設備與環境 – delaying or preventing losses in strength and balance – 延緩或預防力量與平衡能力的喪失 – Compensating for losses by providing mobility and strength aids other than the use of help by other people – 經由行動與增加力量之輔具的提供以補償年長者生理上的不足,而不需 要靠其他人的幫助。 – Providing devices to move people who cannot ambulate at all – 提供設備移動那些完全不能自主移動的人 • The remainder of this lecture discusses these topics • 在接下來的演講將討論上述所提及的主題

Vision identified as major problem: 視力確認為主要問題: Are there interventions? • Self reports by current Vision identified as major problem: 視力確認為主要問題: Are there interventions? • Self reports by current and former drivers identify same visual problems found in laboratory studies; in one study complaints correlate with age declines in carefully measured contrast sensitivity. 由現在仍在開車及之前開車駕駛人所做的自我調查報告與由實 驗室所做的研究確認相同的視力問題 ; 在一份研究報告中指出視 力辨別明暗對比的能力會隨年齡增加而遞減 • • Kline DW, Kline TJB, Fozard JL, Kosnick W, Schieber F, Sekuler R Aging and driving: the problems of older drivers. J Gerontol 1992; 47: 27 -34 老化與駕駛 : 年長駕駛人所遇到的問題 Schieber F, Kline DW, Kline TJB, Fozard JL The relationship between contrast sensitivity and the visual problems of older drivers. Warrendale PA: Society of Automotive Engineers Technical Paper 920613 1992 pp 1 -7 年長駕駛人的對比敏感度與視力問題之關係

等級 1 -3: 無至中等困難。與 年齡相關的七項課題趨勢, 由對比敏感度數據所預測。 From Schieber et al 1992 等級 1 -3: 無至中等困難。與 年齡相關的七項課題趨勢, 由對比敏感度數據所預測。 From Schieber et al 1992

Vision: Compensation: Driving 視力:補償:駕駛 • As in static visual environments, illumination levels and glare Vision: Compensation: Driving 視力:補償:駕駛 • As in static visual environments, illumination levels and glare profoundly affect visibility for signs and objects while driving • 處於靜態的環境中,照明程度與炫光嚴重的影響駕駛中看號誌及物體 的視覺。 • Compensations include better sign lighting and increased size of sign symbols • 補償的方法包括:較好的號誌亮度與增加號誌符號的大小。 • Road signs in Chinese and other Asian languages are especially difficult for older people because of the many small details (high frequency) in the characters • 道路號誌以中文或其他亞洲文字表示時,因為文字中有許多筆劃,年 長者會特別難辨識。 • • Schieber F, Kline DW Age differences in the legibility of symbol highway signs as a function of luminance and glare level. Proceedings of the Human Factors and Ergonomics Society 38 th Annual Meeting 1994 133135 Dewar RE, Kline DW Mark I, Schieber F Symbol signing design for older drivers. Final Report, DTFH-61 -C 0018 Mc. Lean VA: Federal Highway Administration, 1994

Vision: Compensation: Driving 視力:補償:駕駛 • Steering task study and illumination 轉向控制課題與照明 • Old adults Vision: Compensation: Driving 視力:補償:駕駛 • Steering task study and illumination 轉向控制課題與照明 • Old adults are involved in relatively fewer night time automobile accidents than younger drivers. 相較於年輕駕駛人, 年長駕駛人發生意外事件較少 • Older adults make more steering errors in driving simulator under poor illumination than young adults 在較差的照明度下年長駕駛人有較高的轉向控制錯誤發生 • Owens DA, Tyrell RA Effects of luminance, blur and age on nighttime visual guidance: A test of the selective degradation hypothesis. J Exp Psychol: Appl 1999; 5: 1 -14

30 在四個等級 照明程度下, 於使用駕駛 模擬器上, 方向控制錯 誤曲線圖。 Data from Owens and Tyrrell (1999) 20 30 在四個等級 照明程度下, 於使用駕駛 模擬器上, 方向控制錯 誤曲線圖。 Data from Owens and Tyrrell (1999) 20 10 Luminance (log cd/m 2)

Using technology to improve driving skills of older drivers 利用科技來增進老人之駕駛技術 • • • The Using technology to improve driving skills of older drivers 利用科技來增進老人之駕駛技術 • • • The idea of more stringent tests for drivers licenses for older people has not gone very far despite much research 儘管有許多的研究,專對年長者設計合適且嚴謹的駕照考試並沒有訂定完成。 Driver education courses are widely used to help older drivers although the evidence for their effectiveness is limited 駕駛人教育課程雖被廣泛的運用在幫助年長駕駛人,然而證據顯示幫助並不明顯。 Driver training courses on the road are useful for assessing older driver problems and retraining 駕駛人實際上路訓練課程,對評估年長駕駛人之駕駛問題與進行再訓練是有助益。 Training older persons to increase their useful field of view (how much information can be taken in a single glance) is effective in decreasing accidents 訓練年長者增加他們的視野(看一眼,可以接受多少訊息 )可以有效的降低意外發生。 Driver simulators are useful in identifying some problems of older drivers and for evaluating interventions in a safe environment 駕駛模擬器可以用來發現年長駕駛人的問題,及評估外來事件對安全環境中的影響。 We will only have time to selectively review the role of technology in these issues. The literature is immense 因為文獻很多,我們只能選擇性的針對科技在上述這些議題上討論。

由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, 由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, Edwards JD, Roth DL, Mc. Gwin G Jr. , Raleigh R, Joyce JJ, Cissell GM, Dube G. Can High-Risk Older Drivers Be Identified Through Performance-Based Measures in a Department of Motor Vehicles Setting? Journal of the American Geriatric Society, 54: 77– 84, 2006 • OBJECTIVES: To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision (MVC) involvement in a cohort of older drivers. 目的:評估年長駕駛人之操作性風險因子與因錯誤產生的汽車碰撞的關連性 • • DESIGN: Prospective cohort study. 實驗設計:潛在性群體研究 SETTING: Motor Vehicle Administration (MVA) field sites in Maryland 實驗地點:測試機構於馬禮蘭州. PARTICIPANTS: Of the 4, 173 older drivers invited to participate in the study, 2, 114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1, 910 individuals recruited through MVA field sites. 參與人員: 4, 173年長駕駛人被邀參加研究。 2, 114 人年齡 55 至 96 歲願意參加。這些分析主 要針對由「機動車輛監理處」所徵召的1, 910新手。 MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOVs) subtest 2; a Mobility Questionnaire; and MVC occurrence 量測:初步損傷篩檢系列。包括:快步走、頭/頸旋轉、腳輕踏、手臂伸直、提示的回憶 、符號瀏 覽 ……

由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, 由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, Edwards JD, Roth DL, Mc. Gwin G Jr. , Raleigh R, Joyce JJ, Cissell GM, Dube G. Can High-Risk Older Drivers Be Identified Through Performance-Based Measures in a Department of Motor Vehicles Setting? Journal of the American Geriatric Society, 54: 77– 84, 2006 高風險年長駕駛人是否可經由監理單位安排的以操作性為基礎的量測鑑定出? • • • RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 1401 visual field), age, sex, history of falls, and poorer cognitive performance, as measure using Trails B, MVPT, and UFOV subtest 2, were predictive of future at-fault MVC involvement. 結果:駕駛人年齡為 55+ ,視力無損傷(20/70 far visual acuity and 1401 visual field), 年齡,性別,有無跌倒紀錄,與較差的認知能力, 以測試法B,MVPT與UFOV 次級測 試 2 ,來進行預測未來於MVC出錯的機率。 After adjusting for annual mileage, participants aged 78 and older were 2. 11 as more likely to be involved in an at-fault MVC, those who made four or more errors on the MVPT were 2. 10 times as likely to crash, 在調整駕駛人的每年里程數, 參與測試者年齡為 78+ 為 2. 11 的可能性形成MVC 的出錯。 那些在MVPT上有4次以上錯誤的人,則有2. 10倍發生車禍的可能性。

由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures • • those who took 147 由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures • • those who took 147 seconds or longer to complete Trails B were 2. 01 times as likely to crash, 那些需要147秒以上才完成測試法B的人,會有2. 01倍出車禍的可能性。 and those who took 353 ms or longer on subtest 2 of the UFOV were 2. 02 times as likely to incur an at-fault MVC. 那些在UFOV中之次級測試 2需要353毫秒以上的人,會有2. 02倍可能性發生MVC出錯。 Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs. 年長成人,男性及具有跌倒經驗的個人會有發生因MVC出錯後隨之至的問題的可能性。

由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, 由操作性量測進行高風險高齡駕駛人驗證 High-Risk Older Drivers Identified Through Performance-Based Measures Ball KK, Roenker DL, Wadley. VG, Edwards JD, Roth DL, Mc. Gwin G Jr. , Raleigh R, Joyce JJ, Cissell GM, Dube G. Can High-Risk Older Drivers Be Identified Through Performance-Based Measures in a Department of Motor Vehicles Setting? Journal of the American Geriatric Society, 54: 77– 84, 2006 • CONCLUSION: Performance-based cognitive measures are predictive of future atfault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High-risk older drivers can be identified through brief, performance based measures administered in a MVA setting. 結論: 以操作性為基礎的認知量測可以預測年長者於MVCs之差錯。認知性能,對於年 長者發生車禍,是個特殊的預測器。高風險年長駕駛人可以經由監理單位的安排簡易 的操作性為基礎的測試而鑑定!

Intelligent transportation systems 智慧型運輸系統 Summary and study questions 總結及研究問題 Hanowski RJ, Dingus TA. Will Intelligent transportation systems 智慧型運輸系統 Summary and study questions 總結及研究問題 Hanowski RJ, Dingus TA. Will intelligent transporation systems improve older driver mobility? In Schaie KW, Pietrucha M, Eds Mobility and transportation in the elderly (pp. 279 -298). New York: Springer, 2000. photocopy 智慧型運輸系統是否可以改善年長駕駛人的機動(交通)力? This chapter describes several intelligent travel systems for cars: 本章描述幾種智慧型車用旅行系統: advanced vehicle control systems 先進車輛控制系統 automated highway systems 自動化的公路系統 advanced traffic management systems 先進交通管理系統 advanced traveler information systems including in vehicle navigation 先進旅行者資訊系統包括車輛導航

Intelligent transportation systems 智慧型運輸系統 Summary and study questions 總結及研究問題 The chapter clearly discusses the Intelligent transportation systems 智慧型運輸系統 Summary and study questions 總結及研究問題 The chapter clearly discusses the advantages and disadvantages of these systems from the point of view of the older driver. However, the chapter is dated so you should surf the Internet for more recent developments 本章清析的由年長者駕駛人的觀點討論先進與落後的系統。然而,本章資訊已有時日,讀 者應該自行上網找尋最新的發展。 • On page 283, the author says that ITS has the potential to be a double-edged sword? What does he mean? 在第 283頁 ,作者指出ITS有成為雙面刃的潛在趨勢? 請問作者是什麼意思? • What are the main lessons learned from Trav. Tek about the use of navigation systems by older persons? (pp. 284 -286) 在Trav. Tek中所受到有關年長駕駛人使用導航系統的主要教訓為何? • What are the main issues for older drivers using safety advisory and warning systems? (pp. 286 -292 with special attention to Figs 6. 3 and 6. 4) 年長駕駛人使用安全性見議與警告系統主要的課題為何? • What were the age differences in the use of early collision warning systems? (pp. 292 -296) • 年齡上的差異於使用早期碰撞系統為何?

Readings for out of home mobility and some discussion questions 外出機動能力相關資料閱讀及問題討論 Rebok GW, Keyl Readings for out of home mobility and some discussion questions 外出機動能力相關資料閱讀及問題討論 Rebok GW, Keyl PM. Driving simulators and older adults. In Burdick DC, Kwon S, (Eds) Gerotechnology: Research and practice in technology and aging (pp. 191 -208). New York: Springer, 2004 (photocopy) 駕駛模擬器與年長駕駛人 Driver simulation has been a standard tool to study many aspects of driver behavior and the effectiveness of technological and training interventions on improving driving safety both in young and elderly drivers. Simulators vary greatly in their verisimilitude. This is an authoritative review as of about 2002. Go to internet for later articles. 駕駛模擬已成為一研究年輕及年長駕駛人多方面駕駛行為及高 效益的技術與訓練以增進駕駛安全性的標準 具。模擬器可以模擬多種不同的真 實路況。這是一篇官於 2002年具權威性的回顧文獻。讀者可以上其網站找尋 最新的文獻。

Readings for out of home mobility and some discussion questions 外出機動能力相關資料閱讀及問題討論 • • What Readings for out of home mobility and some discussion questions 外出機動能力相關資料閱讀及問題討論 • • What did research comparing high- and low-risk simulator drivers predict about crashes in real drivers? (p. 194) 研究中比較「高風險與低風險之模擬器駕駛人」預測「真實駕駛人發生車禍 」之結果為何? Can simulators be used to tell when patients with Alzheimer’s disease should not drive anymore? Defend your answer 模擬器可否用來辨別患有阿茲海默症的病人是否可以再駕駛?深論你的觀點! What are the similarities and differences between simulator driving and other assessments? (196 -199) 模擬駕駛與其他評估方式之間有何相似處與相異處? ? Can driver simulations be used to retrain older drivers? (199 -201) 駕駛人模擬器是否可以對年長駕駛人進行再訓練(再教育)?

視力問題與跌倒及步態 • Poor illumination, confusing information resulting from bad stair design implicated in many 視力問題與跌倒及步態 • Poor illumination, confusing information resulting from bad stair design implicated in many studies of falls and accidents. 在許多研究中均指出照明差及由於階梯設計不良所造成的跌倒與 意外 Architect John Templar documents these in a multivolume book. • Population based studies show consistent relation between visual acuity and contrast sensitivity and measures of gait and history of falls and hip fractures. • 以人口統計性的研究顯示,視覺敏銳度、對比敏感度、步態量測、 跌倒的經驗、髖關節骨折 有一致性的結論。 • Klein BEK, Klein F, Lee KE, Cruickshanks KJ Performance-based and self-asssessed measures of visual function as related to history of falls, hip fractures and measured gait time: Beaver Dam Study Ophthalmology 1998; 105: 160 -164.

Discussion questions: Use of technology for changes in strength 問題討論:使用科技於改善力量 • How much muscle Discussion questions: Use of technology for changes in strength 問題討論:使用科技於改善力量 • How much muscle strength is lost over the life span? 一生中有多少的肌力會喪失? • Does it interfere with functioning in old age? 是否會於年紀大時干擾生理功能? • Is the loss reversible? 肌力的損失是可回復的嗎? • How can technology help reverse loss? 科技要如何幫助損失的肌力回復? • How can technology compensate for loss of strength? 科技要如何補償損失的肌力? • How can technology help people who cannot move themselves? 科技要如何幫助無法自主行動的人? • These questions will be considered in the next few slides 上述這些問題將會在下面幾頁討論

Balancing prevention and compensation interventions 平衡預防與補償措施 Fozard JL. Enabling environments for physical aging: A Balancing prevention and compensation interventions 平衡預防與補償措施 Fozard JL. Enabling environments for physical aging: A balance of preventive and compensatory interventions. In Schaie KW, Wahl H-W, Mollenkopf H, Oswald F. Aging independently: Living arrangements and mobility (pp. 31 -45). New York: Springer, 2003. (photocopy) 物理性老化的有利環境:平衡預防與補償措施 The author classifies physical aging into three dimensions: structural, control and information. He then discusses both personal and environmental interventions for each of the three dimensions. Interventions include changes in lifestyle and health of individuals and in the living and working environments. Aging has a longtime course, so the optimal timing of the interventions is critical. 作者將物理性老化區分成 3維度:結構、控制與資訊。作者也分別 討論個人與環境上各3維度上的介入措施。介入措施包括改變個 人的生活型式與健康,及改變生活與 作環境。由於老話是 一長期的課題,所介入措施的最佳時間點是一關鍵!

Balancing prevention and compensation interventions 平衡預防與補償措施 • How do people adapt to functional limitations Balancing prevention and compensation interventions 平衡預防與補償措施 • How do people adapt to functional limitations of physical aging? (pp 32 -33) 人们如何去適應由於物理性老化所造成的功能性限制? • In your own words, what are three dimensions of physcial aging? (pp. 33 -34) 用你意自己的方式說明何謂3維的物理性老化? • What are the major preventions proposed for the structural and control dimensions? 在結構與控制兩維度中主要的預防目的為何? • We will discuss the interventions for the information dimension later in the course. 我們會於下幾節課來討論有關於資訊維度的介入措施。

Preventing or delaying age-related limitations in physical functioning 預防或延緩與年齡相關之生理功能性限制 • Technology can contribute to Preventing or delaying age-related limitations in physical functioning 預防或延緩與年齡相關之生理功能性限制 • Technology can contribute to the monitoring of agerelated changes in physical functioning • 科技可以對監控因年齡而變化之相關生理功能有所助益。 • Technology can contribute to motivating people of any age adopt healthy life styles that prevent or delay limitations in functioning 科技可以給予任何年齡層的人刺激,去追求健康的生活型 態,可以預防或延緩生理運作上的限制。 – Diet, weight control, exercise, substance abuse – 飲食控制,體重控制,運動,藥物濫用 Example will deal with exercise and loss of strength 所舉的例子將會以運動與力量的喪失為主題

Old Adults need more of their strength capacity to perform ADLs than young adults Old Adults need more of their strength capacity to perform ADLs than young adults 老年人比年輕人需要更多的精力 去面對ADLs Hortobagyi T, Mizelle C, Beam S, Da. Vita P. J. Gerontology: Medical Sciences, 2003, 58 A, 453 -460.

Purpose/Methods 目的/方法 • Walking, going up and down stairs and rising from chair requires Purpose/Methods 目的/方法 • Walking, going up and down stairs and rising from chair requires relatively higher percentage of maximum reserve capacity in older than younger adults--True for cardiovascular and muscle function 步行、上下階梯及從坐椅起身等動作,相對於年輕人,老人來說需要較高比例 之最大身體儲備能力(maximum reserve capacity ) – 由於心血管及肌肉功能。 • Study measured relative effort to perform these tasks by assessing maximal leg strength on a machine and by the force used when going up or down stairs or standing up from a chair. Force was measured by special recording plate embedded in the floor or steps 研究量測 作是以一量測儀器評估最大腿力,並執行上下階梯及坐椅起身等 動作。力量測儀器由特殊之設計將紀錄板植入於地板或階梯中。 • Participants were healthy women in two age groups mean ages 22 and 74 years. 參加受測人員可分為兩年齡組,平均年齡為 22及74歲。

相對力量去執行ADLs(以最大力量之%表示) Relative effort (%) of maximum strength required to perform ADLs TASK項目 AGE 年齡 相對力量去執行ADLs(以最大力量之%表示) Relative effort (%) of maximum strength required to perform ADLs TASK項目 AGE 年齡 Ascending Stairs 上階 Descending Stairs 下階 Rising from Chair 從坐椅起身 22 55 35 35 74 80 88 80

Long-Term Consequences of Age Differences in Strength 年齡差異於力量之長期影響 • Midlife strength predicts functioning 25 Long-Term Consequences of Age Differences in Strength 年齡差異於力量之長期影響 • Midlife strength predicts functioning 25 years later 25歲以上之功能性力量預測。 • Grip strength measured at age 45 to 68 in Japanese-American men. 握力量測對象為 45至 68歲之日裔美國男性。 25 years later speed of walking, ability to stand up from chair, and self-reports of difficulty lifting 10 lbs, doing housework, etc were measured. 同時亦量測 25歲以上 步行速度、從坐椅起身能力、舉10磅重的自我感 覺報告、做家事等項目。 • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999; 281: 558 -560

Proprioception, Balance and Movement: Prevention 3 • Grip strength divided into thirds: <37, 37 Proprioception, Balance and Movement: Prevention 3 • Grip strength divided into thirds: <37, 37 -42, >42 kg; outcome measures included – Walking speed<0. 4 m/s (6. 2%) 步行速度<0. 4 m/s (6. 2%) – Chair rise without using arms (2. 2%) 不用扶手從椅子站起來(2. 2%) – Difficulty doing housework (18. 2%) 做家事有困難(18. 2%) – Difficulty walking up 10 steps (14. 1%) 上十階階梯有困難(14. 1%) • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999; 281: 558 -560