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ʀਕ͹Ҳਫ਼ͳ߶ྺं͹ఈٝʀ߶ྺं͹ಝ௅

ʀ߶ྺ͗Ξ‫͗͗ं׳‬Ξ࣑ྏͶ‫غ‬ଶͤΖ΍͹࣑ྏβʖϩ͹અఈ͗ඉ߶ྺंͳҡ͵Ζͳ͞Θ͍͗ΖʀʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ͹٠࿨͖Δ

߶ྺं͹͗Ξ࣑ྏͶ͕͜Ζ‫ؽ‬೵඲ՃɼϖϩηΠΤφΩϞ඲Ճ͹՟ୌસਫ਼ଚ‫߃݊ͳؔغ‬थໍʤղ‫ޤ‬ϓϨʖਫ਼ଚ‫ؔغ‬ʥʀ‫ݺ‬ਕࠫ͹୉͘͏߶ྺं͹૱߻‫ؽ‬೵඲Ճʤ*$&*$ʥͳ͗Ξਏྏʤ࣑ྏʥ

࢚ճ‫౐ښ‬୉ָ୉ָӅҫָ౹‫ܯ‬ਫ਼෼৚ๅָ
ਁీ ஒࢻ

‫گ‬द

ࠕೖ͹͕࿫͢ͺɼ޲ਫ਼࿓ಉ঴Ռָ‫͗ ڂݜ‬Ξଲࡨਬ਒૱߻‫ۂࣆڂݜ‬઎ਫ਼ʰ߶ྺं͗ΞਏྏࢨਓࡨఈͶචགྷ͵‫خ‬൭੖ඍͶ‫ͤؖ‬Ζ‫ڂݜ‬ʱʤ‫ڂݜ‬େනీଞ࿪෋ɼ೧ʥ

ʰ߶ྺं͗ΞਏྏΪ΢χϧ΢ϱࡨఈͳͨ͹෕‫ٶ‬͹ͪΌ͹‫ڂݜ‬ʱʤ‫ڂݜ‬େනࠦതय़দɼ೧ʥ

Ͳ‫ڂݜ‬ʀ٠࿨͢ͱͪ͘੔ՎΝ΍ͳͶɽෳԮ୉ָ ໌༬‫گ‬दࠕೖ͹࿫͢Ͷ‫ͤܐؖ‬Ζཤӻ૮ൕͺ͵͢

ీଞ࿪෋

Ӻָ

Ӻָ

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ೖຌਕ͹͗Ξࢰ๤ི⏕ᾭ䛷䛜䜣䛷Ṛஸ䛩䜛☜⋡䛿⏨ᛶ26䠂䠄4ே䛻1ே䠅䚸ዪᛶ17䠂䠄6ே䛻䠍ே䠅೧ࢰ๤ं਼

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೧υʖνʥࠅཱི͗Ξ‫ڂݜ‬ιϱνʖ͗Ξ৚ๅγʖϑηʰ͗Ξ౹‫ܯ‬ʱʤਕ޳ಊସ౹‫ܯ‬ʥ
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஋੓

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䛜䜣䛿䚸㧗㱋⪅䛾៏ᛶ⑌ᝈ䛷ⱝᖺ⪅䛿⛥䛷䛒䜛ࠅཱི͗Ξ‫ڂݜ‬ιϱνʖ͗Ξ৚ๅγʖϑηʰ͗Ξ౹‫ܯ‬ʱʤ޲ਫ਼࿓ಉ঴ਕ޳ಊସ౹‫ܯ‬ʥ᭗ᱫᎍỉཎࣉ

ே䛾୍⏕䛸㧗㱋⪅䛾ᐃ⩏Ὁ ‫ݤ‬ԡί˷ԡὸầჺẟ⏕⌮ⓗ䛺ᶵ⬟పୗ⑓Ẽ஦ᨾὉ ಮẉễ́‫܍‬၌धửஊẲềẟỦ㐠ື䞉ㄆ▱ᶵ⬟పୗ⮚ჾᶵ⬟పୗ

ᚰ㌟叏ᶵ⬟⑓ⓗ䛺ᶵ⬟పୗ

ᅇ᚟Ὁ ဃྸႎỆᐥ֥ೞᏡầ˯ɦẲềẟỦίᎊ҄ྵᝋὸᵌ␗ᖖ䛺ᚰ㌟䛾ᶵ⬟పୗ⮬❧䛧䛶⏕ά䛷䛝䜛ᏤࢊࣱẆểẪỆẆᵖᵓബˌɥỂဃྸႎೞᏡỉ˯ɦỆợỦᏤࢊࣱỉ‫ف‬ьᵌ

IADL䛾పୗ

䝃䝫䞊䝖䛜䛒䜜䜀䛒䜛⛬ᗘ⮬❧䛧䛯⏕ά䛷䛝䜛Ὁ ௿᫱ᨦܹẆἇἽἅἬἝỴ

Vulnerable䠄䝥䝺䝣䝺䜲䝹䚸⬤ᙅ䠅Ὁ ᛐჷೞᏡᨦܹẆạếỉ‫ف‬ь

FrailὉ ᅈ˟ὉኺฎႎỆСᨂầẝỦ

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110ṓ

㉸㧗㱋⪅

޲࿓Ռ‫ݜ‬ʰ߶ྺं͗ΞਏྏࢨਓࡨఈͶචགྷ͵‫خ‬൭੖ඍͶ‫ͤؖ‬Ζ‫ڂݜ‬ʱʤɼీଞൟʥ

KWWSMDVFFMS

6XSSOHPHQW߶ྺ͗Ξ‫ं׳‬͹ࢾ‫ݩ‬੔੹ʤΦϑυϱηʥͺঙ͵͏ʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱͯ͹:*Νઅ஖͢ͱ‫ݗ‬౾ᶅ ૱࿨ɼ߶ྺं‫ؽ‬೵඲Ճᶆ ಼Ռ࣑ྏᶇ ֐Ռ࣑ྏᶈ ๎ࣻત࣑ྏᶉ ࢩ࣍ʀ؉࿪ҫྏᶊ ҫྏ‫ࡃܨ‬,PDL(+\SHUWHQV 5HV 

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ʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ૱࿨ʖ߶ྺं‫ؽ‬೵ϭʖΫϱήήϩʖϕช‫ࡩݗݛ‬ʤೖຌਦॽ‫ڢؙ‬ճʥͳϪϑϣʖ͖Δ߶ྺं͗Ξҫྏ͹‫ݳ‬য়ͳ՟ୌΝ4 $͹‫Ͳܙ‬ΉͳΌΖ੮ओʤϕϪϓϪ΢ϩɼϲΟϩϋϧϔϩʥ͵߶ྺ͗Ξ‫ं׳‬ͶଲͤΖҫྏɼͳ͚ͶਏྏͶ‫ؖ‬ͤΖΦϑυϱη͗ໃ͏

GFR=175㽢(ᖺ㱋)-0.203㽢(⾑Ύ䜽䝺䜰䝏䝙䞁್)-1.154
x0.741⏨ᛶ 䜎䛯䛿 x 0.742ዪᛶ

Kennedy BJ. Aging and cancer.
Comprehensive Geriatiric Oncology, Taylor & Francis,
London 2004, p3-10.

೧ྺΓΕ΍੮ओ੓͹༙ໃͳͨ͹ఖౕ͗॑གྷᗎᩥ 㧗㱋⪅ࡢࡀࢇデ⒪ࡢ
ᇶᮏⓗ࡞⪃࠼᪉ࠖ➨❶ 㧗㱋⪅ࡀࢇࡢ≉ᚩ࡜ホ౯➨❶ ෆ⛉⣔἞⒪⥲ㄽ➨❶ ᨭᣢ࣭⦆࿴་⒪➨❶ እ⛉⣔἞⒪⥲ㄽ➨❶ ᨺᑕ⥺἞⒪⥲ㄽ➨❶ ప౵く἞⒪㸦,95࡜ෆど㙾἞⒪㸧⥲ㄽ➨❶ ⢭⚄⛉ⓗ἞⒪➨❶ 㧗㱋⪅ࡀࢇᝈ⪅ࡢ♫఍࣭⤒῭ⓗࢧ࣏࣮ࢺࢣ࢔➨❶ 㧗㱋⪅ࡢ⮫ᗋ⸆⌮⭈ᶵ⬟‫ٶ‬ᆔ᫏ỉᕤдử஌ဇẲềẟỦί‫ٶ‬ᕤᵇ೶ɼಆᰏ෨ɼ೗๬ɼ഑ɼভԿ؇
،஀ᢆɼൽ೚ʀਫ਼৫‫ح‬ɼଆ݄‫ح‬૱࿨ͺଠ͹͗Ξझͳ΍‫ڠ‬௪ͤΖ͹Ͳ়ղۜ‫ݬ‬ड़൝೧݆

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ీଞ࿪෋ʀଠʁʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ૱࿨ʀ߶ྺं‫ؽ‬೵඲ՃͶ‫ͤؖ‬Ζ఑‫ ݶ‬3DUW 3DUW
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䛜䜣䜢ᶆⓗ䛸䛧䛯἞⒪㛤ጞ๓䚸㧗㱋䛾䛜䜣ᝈ⪅䛸་⒪⪅䛜ඹពᛮỴᐃ䛻ཧຍ䛧䛶ඹྠព
䠄Shared Decision Making䠖
SDM䠅䜢䛩䜛㝿䛾ྲྀ䜚⤌䜏䚹䛭䛾ෑ㢌䚸䛂䛜䜣἞⒪䛾ೃ⿵䛷䛩䛛䠛䛃䛸䛔䛖question䛸ඹ䛻䚸ᝈ⪅䛾ᖹᆒవ࿨䜢⪃៖䛩䜛䛣䛸䜢ᥦ᱌䛧䛶䛔䜛䚹https://www.nccn.org/homeᖺ㱋ู䞉೺ᗣูᖹᆒవ࿨䠄᪥ᮏ䠅
Iwamoto, Nakamura, Higahi. Cancer Epidemiology 2014;38:511-4

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঱ਜ਼ী峘‫ڭ‬岝রఙ岝ৣਜ਼ী峘‫ڭ‬峼崘嵑崽峕崿嵕崫崰岝峇島峈島岣ফ峘સ峕ૻຎ৓௏೨岤峔ৈೡ঻岣਴಑৓岤峔ৈೡ঻岣ফ峘સ峕૾ଙ峘ப岮岤ৈೡ঻

50ṓ௨ୖ䛾᪥ᮏே䛾⏕࿨⾲䛛䜙ᖹᆒవ࿨䜢⟬ฟᾏእ䛾ᖹᆒవ࿨䛿ୗグURL䜘䜚ィ⟬ᘧ䛜♧䛥䜜䛶䛔䜛Ҳൢਕ͹༪ໍ
KWWSVHSURJQRVLVXFVIHGXVXHPRWRUHVXOWSKSୂӅ‫ޛ‬͹༪ໍKWWSVHSURJQRVLVXFVIHGXZDOWHUSKS

Supplement
2-4

Fried TR et al: Understanding the treatment preferences of seriously ill patients.
N Engl J Med 346:1061-6, 2002ʰ߶ྺंं͹͗ΞҫྏΝΝߡ͓Γ͑͑ʱ೧ ݆ ೖ :HEޮ֋εϱϛζΤϞʛࣆ઴Πϱίʖφ௒ࠬʤߴ໪ʥ
ʴ૥‫غ‬͹͗Ξʀඉ߶ྺंͲͺ࣑ࠞద࣑ྏ͍͗ΕΉͤʵฑ‫ۋ‬༪ໍ͗͗Ξ͹਒ߨͶΓͮͱ๤͚͵ΖΉͲ͹‫ؔغ‬ΓΕ୻͏৖߻ʤͤ͵Κͬɼ͗ΞͲ๤͚͵ΖΓΕ΍઎Ͷथໍ͗ਜ͘Ζ৖߻ʥɼʹ͹Γ͑͵࣑ྏΝणͪ͜͏Ͳ͖ͤʃ

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๑ʥ͍͗Ζ৖߻߇͗Ξ࣑ྏ͹ްՎɼ༩‫ޛ‬ʤਫ਼ଚ‫ؔغ‬ʥΝߡ͓ɼ࣑ྏ๏๑͹મ୔Ͷͯ͏ͱ๮΋΍͹ͺՁͲ͖ͤʃ

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CHFղ‫෈ޤ‬གྷਫ਼ଚ‫ؔغ‬ʻ݊߃थໍ

ᡂே䝕䜲䜿䜰฼⏝⪅ʰղ‫ޤ‬ΝචགྷͳͦͥͶཱིࣙͪ͢ਫ਼‫׈‬ΝૻΖ͞ͳ͹Ͳ͘Ζ‫ؔغ‬ʱ͹ฑ‫ۋ‬གྷղ‫ޤ‬΢ϗϱφʁೖ৙ਫ਼‫׈‬ಊࡠʤBarthel index఼‫఼ݰ‬ʥ

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݊߃थໍ
ʤ'LVDELOLW\IUHHVXUYLYDOɼ')6ʥགྷղ‫ؔغޤ‬ࢰ๤ਕ͹સਫ਼ଚ‫ؔغ‬ਐର‫ؽ‬೵րવ

ղ‫ंޤ‬͹ෝ୴ܲ‫ݰ‬੠ਈ໚͹݊߃

Akishita M, Ishii S, Kojima T, et al: Priorities of health careoutcomes for the elderly. J Am Med Dir Assoc 14:479-84, 2013䞉᭷ຠ䛺἞⒪䜢ᮃ䜐䞉㌟యⓗᶵ⬟䛾ᨵၿ䜢ᮃ䜐䞉௓ㆤ⪅䛾㈇ᢸ㍍ῶ
䞉Ṛஸ⋡䛾ῶᑡ䛿䚸᭱ୗ఩ཱིࣙ੓͹ң࣍ʀ
޴৏˲ղ‫෈ޤ‬གྷ਒ߨ഑‫ؠ‬Ν༙ͤΖ߶ྺंʤ 侔࠿ ʥͶ͕͜Ζ
ೖ৙ਫ਼‫׈‬ಊࡠ্֒͹઴޴͘؏ࡱ‫ ڂݜ‬80,1

૱࿨ʖ߶ྺं‫ؽ‬೵ϭʖΫϱήήϩʖϕ
2YHUYLHZDQGJHULDWULFDVVHVVPHQWZRUNLQJJURXS 29*$:*&4߶ྺϕϪϓϪ΢ϩ୉ௐ͗Ξ‫ं׳‬͹͗Ξ࣑ྏ͹໪ඬͺՁ͖ʃ$୉ௐ͗Ξ‫ं׳‬Ͷ‫ݸ‬Δͥસਫ਼ଚ‫߃͚݊͵Ͳͫؔ͜غ‬थໍ͹Ԉ৵͗॑གྷͲ͍Ζ݊߃थໍΝHQGSRLQWͳͪ͢ྡজࢾ‫ݩ‬ͺຈʹໃ͏&4߶ྺ͗Ξ‫ं׳‬͹ਏྏͶ͍ͪͮͱҫྏं͗ͳΖ΄͘‫خ‬ຌద͵ࢡ੐ͺՁ͖ʃ$‫ं׳‬͹қࢧͳՃ஍؏Νଜ॑͢ɼҫྏ఑‫ڛ‬͹໪ඬઅఈ͹߻қ‫ܙ‬੔Νߨ͑͞ͳ͗॑གྷͲ͍Ζɽ

&4೟எ্֒͹ٛ͏͍͗Ζ৖߻͹қࢧ݀ఈ೵ྙ͹೼Ѵͳͨ͹ଲԢΝʹ͑ͤΖ͖ʃ$೟எ‫ؽ‬೵඲ՃςʖϩΝཤ༽͢ͱ೟எ‫ؽ‬೵্֒͹༙ໃͳఖౕΝਬఈ͢ɼຌਕ͹࢔ଚ೵ྙΝ࠹୉‫ͱ͖͢׈ݸ‬ຌਕ͗қࢧ݀ఈͲ͘ΖΓ͑ͶࢩԋͤΖɽ

&4౲֚೧ྺ͹ฑ‫ۋ‬༪ໍ͗ਏྏ๏ਓΝ‫ݗ‬౾ͤΖͶ͍ͪͮͱࢂߡͶ͵Ζ͖ʃ$౲֚බ‫غ‬͹୉ௐ͗Ξ͹ྩ੷ਫ਼ଚ‫͗ؔغ‬౲֚೧ྺͶ͕͜Ζਬఈฑ‫ۋ‬༪ໍΓΕ͍͘Δ͖Ͷ୻͏৖߻ͺɼ͗Ξ࣑ྏͶΓΖԈໍ͗ಚΔΗΖՆ೵੓͍͗Εɼ੷‫ۅ‬ద͵͗Ξ࣑ྏΝ఑ҌͤΖɽ Ҳ๏ɼਬఈฑ‫ۋ‬༪ໍ͗߻ญ࣮‫׳‬౵Ͳ໎Δ͖Ͷ୻͏৖߻ͺɼ͗Ξ࣑ྏͶΓͮͱಚΔΗΖԈໍͶ‫ݸ‬ֆ͍͗ΖՆ೵੓͍͗ΕɼΓΕฯଚద͵ଲԢ΍‫ݗ‬౾ͤΖɽ

ీଞ࿪෋ʀଠʁʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ૱࿨ʀ߶ྺं‫ؽ‬೵඲ՃͶ‫ͤؖ‬Ζ఑‫ ݶ‬3DUW 3DUW
ೖຌ୉ௐᡙ໵බճࢿ ʁʁɾ
ɾ ͵Δ;Ͷ ʁʁɾ
ɾ߶ྺं͹،઀ঈྭͶଲͤΖढ़઴඲Ճͳढ़‫ޛ‬͹ཱིࣙ੓͹૗ࣨͶ‫ͤؖ‬Ζ‫ڂݜ‬͹‫ݗ‬౾ౌ࿧ྭྭ‫ڂݜ‬αϙʖφ ྭʤʥ‫ৄݗ‬αϙʖφ ྭʤʥ

߶ྺं͹،઀ঈྭͶଲͤΖढ़઴඲Ճͳढ़‫ޛ‬͹ཱིࣙ੓͹૗ࣨͶ‫ͤؖ‬Ζ‫ڂݜ‬͹‫ݗ‬౾
7DQDND6.DLERULHWDO3UHRSHUDWLYH5LVN$VVHVVPHQWIRU/RVVRI,QGHSHQGHQFHIROORZLQJ+HSDWLF
5HVHFWLRQLQ(OGHUO\3DWLHQWV$3URVSHFWLYH0XOWLFHQWHU6WXG\ $QQ6XUJ HtHढ़઴ɼղ‫ޤ‬γʖϑηΝण͜ͱ͏͵͏ࣙ୒ࡑे͹߶ྺ‫ं׳‬Νଲেʤˀࡂʥ

‫خ‬ຌοΥρέϨηφߴ໪,$'/̑ɼऀճద‫׈‬ಊ̒ɼढ़‫ཱིࣙޛ‬੓૗ࣨ͹ϨηέΝ௒ࠬ೧݆ʛ೧݆،઀ঈྭΝౌ࿧ӣಊ‫ح‬͹‫ؽ‬೵̓ɼӭ཈̐ɼ೧݆ೖ఼࣎Ͳ͹݃ՎΝմੵɽ޳ߤ‫ؽ‬೵̑ɼ೟எ̑

ढ़઴඲Ճߴ໪
ʀ‫خ‬ຌοΥρέϨηφ IUDLOW\ʀ‫خ‬ຌద͵‫ं׳‬ഐ‫ܢ‬ʁ೧ྺɼ੓ɼ‫ڧ؂ेڋ‬ʀ%0, ʀญଚ঳ ʀ͗Ξ͹බྼʀ،઀͹ཀྵ༟ʁ͗Ξɼྒྷ੓࣮‫׳‬ɼγ΢θɼබร਼ʀ،ଃͶ‫ؖ‬࿊ͪ͢ࣆߴʁ،ԎΤ΢ϩη،‫ؽ‬೵ɼ،ߙรɼ&KLOG3XJKʀघढ़‫ؖ‬࿊ʁ$6$ηαΠɼ،઀յ਼ɼ઀ঈν΢ϕΠϕϫʖοʤRSHQYV/DSDURVFRSLF ɼघढ़࣎ؔ
ड़݄ྖɼढ़‫߻ޛ‬ญ঳ɼ೘Ӆ‫ؔغ‬ɼ఺Ӆɼ࠸೘Ӆʤ߻ญ঳ͶΓΖೖҐ಼ʥɼ೘Ӆ஦ࢰ๤ɼೖҐ಼͹ࢰ๤৚ಊʀ͑ͯ̓
،઀ঈ‫ޛ‬͹ཱིࣙ੓૗ࣨ͹ఈٝʀղ‫ޤ‬ฯ‫ݧ‬೟ఈʀϨύϑϨτʖεϥϱබӅ΃͹఺Ӆʀࡑ୒ҫྏʀ‫ؽ‬೵ѳԿͶΓΖೖҐ಼͹࠸೘ӅʀೖҐ಼͹ඉ͗Ξࢰ๤㧗㱋⪅䜢἞⒪䞉௓ㆤ䛩䜛་⒪䞉௓ㆤ⪅䛜་⒪௓ධ䠄἞⒪䠅䛻ᑐ䛩䜛ᮃ䜏䡚12㡯┠䛻䛴䛔䛶䝷䞁䜽௜䛡⪁ᖺ⛉ᑓ㛛་

5䛴䛾㛵㐃ᑓ㛛་௓ㆤ᪋タ་ᖌ

ᡂே䝕䜲䜿䜰䝇䝍䝑䝣̑ͯ͹Ҿࢢ͗ಢཱཱིིͪࣙ͢੓૗ࣨϨηέͳ͢ͱபड़͠Ηͪʤଡรྖմੵʥ
ʀࡂҐ৏

25 &,

ʀ֋෴घढ़

25 &, 

ʀIUDLOW\੮ओ੓25 &,

‫خ‬ຌοΥρέϨηφˀ఼ϨηέҾࢢ͍Ε͹ɼϨηέҾࢢ͗ͨΘͮͪൔ਼ͺཱིࣙ੓Ν૗ࣨͤΖ ˲‫ڂݜ‬αϙʖφ ྭ ‫ৄݗ‬αϙʖφ ྭཱིࣙ੓૗ིࣨ 
ࢩԋʀղ‫͗ޤ‬චགྷͳ͵ΖՆ೵੓͗߶͏
Tanaka S et al. $QQ6XUJ HtH

42/͹րવ་⒪⪅䛿䞉ᝈ⪅䛾QOL䛾ᨵၿ䜢ᮃ䜐䞉Ṛஸ⋡䛾పୗ䛿᭱ୗ఩ਐର‫ؽ‬೵րવ

੠ਈ໚͹݊߃

Akishita M, Ishii S, Kojima T, et al: Priorities of health careoutcomes for the elderly. J Am Med Dir Assoc 14:479-84, 2013㠀ᑠ⣽⬊⫵䛜䜣 IIIB/IV vinorelbine vs BSC૱࿨ʖ߶ྺं‫ؽ‬೵ϭʖΫϱήήϩʖϕ
2YHUYLHZDQGJHULDWULFDVVHVVPHQWZRUNLQJJURXS 29*$:*&4
$ᝈ⪅ Ӎ70ṓ ECOG PS 0䚸1䚸2Vinorelbine 30mg/䟝 1䚸8 ᪥┠䚸3㐌㛫ẖϕϪϓϪ΢ϩ‫ं׳‬͹࣑ྏ໪ద͗݊߃थໍ͹Ԉ৵Ͳ͍Ηͻ࣑ྏ઴‫Ͳޛ‬ਫ਼‫׈‬͹࣯ʤ42/ʥΝͺ
͖Ζචགྷ͍͗Ζɽ඲Ճऊౕͳ͢ͱʹ͹Γ͑͵΍͹͍͗Ζ͖ʃ࣑ྏ઴‫Ͳޛ‬3+4ɼ (257&4/4ɼ)$&7ɼʰͯΔ͠ͳࢩ্͹‫צ‬ஈ‫ܯ‬ʱ౵Ν༽͏ͱ඲Ճͤ

߶ྺ୉ௐ͗Ξ‫ं׳‬͹࣑ྏ઴඲ՃͶ߶ྺं‫ؽ‬೵඲Ճͺ༙༽͖ʃ$͗Ξ࣑ྏͶΓΖ༙֒ࣆেϨηέɼࢰ๤Ϩηέɼ೘Ӆ‫ؔغ‬͹Ԉௗͳ͏ͮͪ༩଎͗Ն೵Ͳ͍Ε
༙༽Ͳ͍Ζɽ

vs best supportive care (BSC)
Primary endpoint: QOL(QLQ-C30, QLQ-LC13䠅QOL
඲యQOL䛿ᨵၿㄆ▱䚸♫఍ⓗ䚸㌟యᶵ⬟䚸⫵䛜䜣㛵㐃⑕≧䠄࿧྾ᅔ㞴䚸တႿ䚸 ⾑⑱䚸⬚③䠅
91෯ࡠ༽Ͷ‫ؖ‬࿊ͪ͢42/ߴ໪ʤѳৼʀᅇృɼสඁʥͺ%6&ΓΕѳ͏΄͘Ͳ͍Ζɽ
&4

Supplement
5350౛ணᐃ䚸191౛䛧䛛Ⓩ㘓䛷䛝䛪䠄BSC䛻ྠព䛩䜛ᝈ⪅䛜ᑡ䛺䛛䛳䛯䠅 э ᪩ᮇ୰ṆԿָྏ๑ࣰࢬͶ͕͏ͱ߶ྺं‫ؽ‬೵඲ՃͶΓͮͱ㧗㱋⪅䛷䛒䛳䛶䜒䛜䜣἞⒪䜢ཷ䛡䚸⑕≧⦆࿴䚸ᘏ࿨䜢ᚓ䛯䛔. BSC䜢ᑐ↷䛸䛩䜛◊✲䛿㞴䛧䛔 .

༩଎Ͳ͘Ζ༙֒ࣆে

Grielli C. The ELVIS trial: Oncologist 2001;6(Suppl 1): 4-7

ీଞ࿪෋ʀଠʁʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ૱࿨ʀ߶ྺं‫ؽ‬೵඲ՃͶ‫ͤؖ‬Ζ఑‫ ݶ‬3DUW 3DUW
ೖຌ୉ௐᡙ໵බճࢿ ʁ

ɾ
 ͵Δ;Ͷ ʁ

ɾ


䠄Elderly Lung Cancer Vinorelbine Italian Study 䚸ELVIS䠅ঘ‫ׇ‬૱࿨ʖ߶ྺं‫ؽ‬೵ϭʖΫϱήήϩʖϕ
2YHUYLHZDQGJHULDWULFDVVHVVPHQWZRUNLQJJURXS 29*$:*߶ྺʤ͗Ξʥ‫ं׳‬͹ಝ௅ʁ୉͘͵‫ݺ‬ਕࠫͳ୻͏ฑ‫ۋ‬༪ໍ߶ྺʤ͗Ξʥ‫ྏ࣑͗ं׳‬Ͷ‫ٽ‬ΌΖ΍͹͗ඉ߶ྺंͳҡ͵Ζͳ͞Θ͍͗Ζસਫ਼ଚ‫ ؔغ‬YV ݊߃थໍʤཱིࣙͪ͢ਫ਼‫͘Ͳ͗׈‬Ζղ‫ޤ‬ϓϨʖਫ਼ଚ‫ؔغ‬ʥ

&4ϕϪϓϪ΢ϩ‫ं׳‬͹࣑ྏ໪ద͗݊߃थໍ͹Ԉ৵Ͳ͍Ηͻ࣑ྏ઴‫Ͳޛ‬ਫ਼‫׈‬͹࣯ʤ42/ʥΝͺ
͖Ζචགྷ͍͗Ζɽ඲Ճऊౕͳ͢ͱʹ͹Γ͑͵΍͹͍͗Ζ͖ʃ$࣑ྏ઴‫Ͳޛ‬3+4ɼ (257&4/4ɼ)$&7ɼʰͯΔ͠ͳࢩ্͹‫צ‬ஈ‫ܯ‬ʱ౵Ν༽͏ͱ඲Ճͤ
΄͘Ͳ͍Ζɽ

&4߶ྺ୉ௐ͗Ξ‫ं׳‬͹࣑ྏ઴඲ՃͶ߶ྺं‫ؽ‬೵඲Ճͺ༙༽͖ʃ$͗Ξ࣑ྏͶΓΖ༙֒ࣆেϨηέɼࢰ๤Ϩηέɼ೘Ӆ‫ؔغ‬͹Ԉௗͳ͏ͮͪ༩଎͗Ն೵Ͳ͍Ε
༙༽Ͳ͍Ζɽ࣑ྏްՎͺ౲ષͫ͗ɼ߶ྺ‫ं׳‬ͺ໎Δ͖Ͷʰਐରద‫ؽ‬೵͹ң࣍ʀրવʱΝ‫ٽ‬Όͱ͏Ζ
˲42/ͺใ‫ׇ‬ద͵඲ՃऊౕͲɼ‫ं׳‬͹གྷ๮͗෈໎ྐͶ͵ΖՆ೵੓͍͗Ζʀʰ݊߃ʱɼཬศͤͳʰ੮ओʱ͹඲ՃΝߨ͑චགྷ ˲Կָྏ๑ࣰࢬ͹ࡏɼ࿟೧ҫָͲ֋൅͠Ηͪʰ߶ྺंʤ૱߻ʥ‫ؽ‬೵඲ՃʱΝԢ༽߶ྺं‫ؽ‬೵඲ՃͶΓͮͱ

JHULDWULFDVVHVVPHQW *$ FRPSUHKHQVLYH*$ &*$ʥ༙֒ࣆে͹ළౕʤౕ॑ʥ

ʀ*$&*$Ͳ໎Δ͖Ͷ͵ͮͪ‫ؽ‬೵্֒ͶଲͤΖղ೘͗༩଎Ͳ͘Ζʀ*$&*$݃ՎΝ߶ྺं͹͗Ξ࣑ྏΠϩβϨθϞͶൕӫీଞ࿪෋ʀଠʁʰϕϪϓϪ΢ϩ߶ྺ୉ௐ͗Ξ‫ं׳‬͹ͪΌ͹ྡজద఑‫ݶ‬ʱ૱࿨ʀ߶ྺं‫ؽ‬೵඲ՃͶ‫ͤؖ‬Ζ఑‫ ݶ‬3DUW 3DUW
ೖຌ୉ௐᡙ໵බճࢿ ʁʁɾ
ɾ ͵Δ;Ͷ ʁʁɾ
ɾ㧗㱋䛜䜣ᝈ⪅䛾
἞⒪䜰䝹䝂䝸䝈䝮

䛜䜣ᝈ⪅Ӎ65ṓ 䠄ᛴᛶⓑ⾑⑓Ӎ60ṓ䠅㧗㱋⪅⥲ྜᶵ⬟ホ౯䠄CGA䠅 ᖹᆒవ࿨ vs 䛜䜣≉ᐃⓗ⏕Ꮡᮇ㛫Fit 䛸 Unfit 䛾㚷ู䡚㧗㱋⪅䠄⥲ྜ䠅ᶵ⬟ホ౯[ (Comprehensive䠅 geriatric assessment (GA) ]䞉㌟యⓗഃ㠃㌟యᶵ⬟ADL䠄᪥ᖖ⏕άάື䠅

Fit 䝣䜱䝑䝖
Fit䠖ᶆ‽἞⒪䛷䛝䜛≧ែ௓ධ䛻䜘䜚CGA䛾ၥ㢟Ⅼᨵၿ

IADL䠄ᡭẁⓗADL䠅䠅

Unfit䠖ᶆ‽἞⒪䛜ᅔ㞴䛺≧ែ

㌿ಽ䞉㦵ᢡ

ྜే⑕

Frail 䝣䝺䜲䝹

Vulnerable ⬤ᙅ䛺≧ែపᰤ㣴䠄䜰䝟䝅䞊䛻ྜే䠅

ᰤ㣴≧ែ

඲㌟⾶ᙅ

⸆๣

἞⒪ᙉᗘ䜢ᙅ䜑䛯ᢠ䛜䜣἞⒪䛺䛧䠇

䞉⢭⚄䞉ᚰ⌮ⓗഃ㠃ᢠ䛜䜣἞⒪䠇㈇ᢸ䛾ᑡ䛺䛔

ㄆ▱ᶵ⬟㞀ᐖ

ᨭᣢ䞉⦆࿴་⒪ᨭᣢ䞉⦆࿴་⒪

ᢚ䛖䛴
25

♫఍ⓗၥ㢟

ㄆ▱䞉⢭⚄

ᅜ❧䛜䜣◊✲䝉䞁䝍䞊ᮾ⑓㝔䚸ᑠᕝᮅ⏕་ᖌ䜘䜚౪୚

௓ㆤຊ

26
26

ᶆ‽⩌

CGA⩌

༢๣἞⒪䛜ῶ䜚䚸䝎䝤䝺䝑䝖䛜ቑຍ䚸἞⒪䛧䛺䛔ᝈ⪅䛜4ே䛻1ே䛔䜛䠙BSC

἞⒪୰Ṇ䜎䛷䛾ᮇ㛫䛻ᕪ䛿䛺䛔䠖 primary endpoint䛿㐩ᡂ䛷䛝䛺䛛䛳䛯ᶵ⬟ホ౯䠄CGA䠅䛻ᇶ䛵䛟๭䜚௜䛡䞂䜯䝹䝛䝷䝤䝹

ㄆ▱䞉ᢚ䛖䛴

㧗㱋⪅⥲ྜᶵ⬟ホ౯䜢౑䛳䛯㧗㱋⫵䛜䜣๓ྥ䛝௓ධヨ㦂䡚἞⒪ຠᯝ

Primary end point: TFFS䠄๭䜚௜䛡䛛䜙᪩ᮇ἞⒪୰Ṇ䜎䛷䛾ᮇ㛫䠖PD䚸ẘᛶ䚸᪩ᮇṚஸ䠅䠄Treatment failure free survival䠅

䝣䜱䝑䝖

ㄆ▱⑕
ពᛮỴᐃ⬟ຊ
䝉䝹䝣䜿䜰⬟ຊ䜰䝗䝠䜰䝷䞁䝇
䠄≉䛻⤒ཱྀᢠ䛜䜣⸆䠅♫఍ᨭ᥼䝋䞊䝅䝱䝹䝃䝫䞊䝖㧗㱋⪅⥲ྜᶵ⬟ホ౯䜢౑䛳䛯㧗㱋⫵䛜䜣๓ྥ䛝௓ධヨ㦂ᶆ‽἞⒪䠖ᖺ㱋䠇PS䛾䜏䛷๭䜚௜䛡

௓ㆤ㈇ᢸ
䜿䞊䝇䝽䞊䜽

䞉♫఍䞉⤒῭ⓗഃ㠃⏕ά≧ἣ᪥ᮏ䛜䜣䝃䝫䞊䝔䜱䝤䜿䜰Ꮫ఍⦅䠖㧗㱋⪅䛜䜣་⒪Q&A ⥲ㄽ䚸http://jascc.jp/about/publications/

Supplement
8㌿ಽ䞉ADL䞉IADL⪁ᖺ⑕ೃ⩌䚸⪁ᖺᮇ䛾ྜే⑕

Ṍ⾜ᶵ⬟

✚ᴟⓗ䛺
ᨭᣢ䞉⦆࿴་⒪

㌟య

㌿ಽ
௓ධ䛻䜘䜚
CGA䛾ၥ㢟Ⅼᨵၿᶆ‽䛜䜣἞⒪䠇䛜䜣἞⒪䛻క䛖᭷ᐖ஦㇟⾑ᾮẘᛶឤᰁ䞉ᩋ⾑⑕
㠀⾑ᾮẘᛶSupplement6-7๪స⏝䛜ᑡ䛺䛔䝣䝺䜲䝹ᮏヨ㦂䛻౑⏝䛥䜜䛯CGA䛻ᇶ䛵䛟௓ධ䛿䚸἞⒪୰Ṇ䜎䛷䛾ᮇ㛫䜢ᨵၿ䛩䜛䝟䝽䞊䛿䛺䛛䛳䛯䚹䛧䛛䛧䚸἞⒪䝸䝇䜽ᝈ⪅䛾㑅ู䛾᭷⏝ᛶ䛜♧၀䛥䜜䚸᭷ᐖ஦㇟Ⓨ⌧䛾ῶᑡ䛜♧䛥䜜䛯䚹

Corre R et al. JCO 34: 1476-1483, 2016

Corre R et al.
JCO 34: 1476-1483, 201627

28

䛂㧗㱋⪅䛜䜣デ⒪䜺䜲䝗䝷䜲䞁䛃 CQ1䠖߶ྺ͗Ξ‫ं׳‬ͶଲͤΖ࣑ྏʤ༂෼ྏ๑ʥͶࡏ͢ͱɾ߶ྺं‫ؽ‬೵඲Ճʤ*$&*$ʥΝߨ͑͞ͳͺਬও͠ΗΖ͖ʃ䠆䠖primary endpoint䠆⏕Ꮡ⋡䛻ᕪ䛺䛧䚸䠆QOLᨵၿഴྥϪ䚸ϫᮇᅛᙧ䛜䜣 Ӎ70 96౛኱⭠䛜䜣Ӎ70䚸142౛߶ྺं͗ΞਏྏΪ΢χϧ΢ϱ
޲ਫ਼࿓ಉ঴Ռָ‫͗ ڂݜ‬Ξଲࡨਬ਒૱߻‫ۂࣆڂݜ‬ʰ߶ྺं͗ΞਏྏΪ΢χϧ΢ϱࡨఈͳͨ͹෕‫ٶ‬͹ͪΌ͹‫ڂݜ‬ʱʤ‫ڂݜ‬େන ࠦതय़দʥ ‫ڂݜ‬ๅࠄ䠆἞⒪᏶㐙⋡ᕪ䛺䛧䚸⏕Ꮡ⋡䛻ᕪ䛺䛧䚸᭷ᐖ஦㇟ᑡ䛺䛔ഴྥ䠆἞⒪᏶㐙⋡Ĺ䚸⏕Ꮡ⋡䛻ᕪ䛺䛧䚸᭷ᐖ஦㇟ᑡ䛺䛔ഴྥϪ䚸ϫᮇᅛᙧ䛜䜣 Ӎ70 718౛ᅛᙧ䛜䜣 Ӎ65 613౛ϫᮇ㠀ᑠ⣽⬊⫵䛜䜣 Ӎ65 449౛

&4 ߶ྺ͗Ξ‫ं׳‬ͶଲͤΖ࣑ྏʤ༂෼ྏ๑ʥͶࡏ͢ͱɾ߶ྺं‫ؽ‬೵඲Ճʤ*$&*$ʥΝߨ͑͞ͳͺਬও͠ΗΖ͖ʃ⏕Ꮡ⋡䛻ᕪ䛺䛧䚸 䠆᭷ᐖ஦㇟ῶᑡ
⏕Ꮡ⋡䛻ᕪ䛺䛧䚸 䠆᭷ᐖ஦㇟ῶᑡਬও ߶ྺं‫ؽ‬೵඲Ճʤ*$&*$ʥΝߨ͑Γ͑఑ҌͤΖɽʦਬও͹‫͠ک‬ʁɾΦϑυϱη͹‫͠ک‬ʁ%ɾ߻қིʁˍʧ

䠆἞⒪ᡂຌᮇ㛫䛻ᕪ䛺䛧䚸᭷ᐖ஦㇟ῶᑡ
䠆᭷ᐖ஦㇟䛻ᕪ䛺䛧
䠆QOLᨵၿ

㐍⾜ᅛᙧ䛜䜣/NHL Ӎ70 541౛༂෼ྏ๑Ͷࡏ͢ͱ*$&*$Ν༽͏ͪղ೘Νߨ͑͞ͳͲᶅ ਫ਼ଚްՎͶӪ‫ڻ‬Ν༫͓͵͏ʤΦϑυϱη͹‫͠ک‬ʁ%ʥ

䠆QOLᨵၿ䛺䛧ᶆ Կָྏ๑͹༙֒ࣆেΝܲ‫ͦ͠ݰ‬ΖʤΦϑυϱη͹‫͠ک‬ʁ%ʥ

䠆QOLᨵၿഴྥᶇ ݊߃‫ؖ‬࿊42/Νրવ΍͚͢ͺң࣍ͦ͠Ζܑ޴Ͷ͍ΖʤΦϑυϱη͹‫͠ک‬ʁ&ʥ䠆ᝈ⪅䛸䛾䝁䝭䝳䝙䜿䞊䝅䝵䞁Ĺ
QOLᨵၿ䛺䛧

͗ࣖ͠Ηͱ͏Ζ䠆ᑐฎ⋡䞉⤂௓⋡䛾ቑຍ

2022ᖺ
ᖺ9᭶30᪥䛻䝟䝤䝸䝑䜽䝁䝯䞁䝖ཷ௜⤊஢䛧䚸⌧ᅾᑐᛂ୰䠆἞⒪᏶㐙⋡ᕪ䛺䛧*$&*$͹෕‫ౕٶ‬ͺʃ᭗ᱫᎍೞᏡᚸ̖Ŵʼᜱᅦᅍƴ‫ݣ‬ƢǔҔၲᎍƷᛐჷࡇƴ᧙Ƣǔᛦ௹࠰Ʒ၏ᨈƷྵཞᲢμ‫଀׎‬ᚨŴᚮၲᅹᲣ

29*$:*6XSSOHPHQW͞Η͖Δ͹߶ྺं͹͗Ξҫྏʤ఑‫ݶ‬ʥ

60.00%ਕͺՅྺͳ‫ڠ‬ͶঘࣉͶ໯ͮͱ͏͚ͳ‫ݶ‬ΚΗΖɽঘࣉ͗Ξ‫ं׳‬ͺɼྈ਎ɼૈ෗฾͹સ໚ద͵

50.00%

γϛʖφ͍͗ͮͱঘࣉ͗Ξҫྏ͗੔Εཱིͮͱ͏Ζɽಋ༹Ͷɼ߶ྺंͶ͕͏ͱͺɼ͗Ξ࣑ྏͳ

40.00%

ࢩ࣍ʀ؉࿪ҫྏղ‫͗ޤ‬Ҳରͳ͵ͮͱસਕదͶ߶ྺ͗Ξ‫ं׳‬͹࣑ྏʀίΠͶ͍ͪΔ͵͜Ηͻɼ

30.00%

నਜ਼͵͗Ξҫྏ͹ࣰભͺೋ͢͏ɽ

20.00%

߶ྺ͗Ξ‫ं׳‬ɼͳ͚Ͷ੮ओ͵

10.00%

ྭΝ‫؜‬΋ॄ஄Νଲেͳͪ͢
0.00%

ྡজࢾ‫Ͳݩ‬ͺ*$&*$ͳͨΗͶ‫͚Ͱخ‬ղ೘

͵Δ;Ͷਫ਼‫خ׈‬൭Νࢩ͓Ζղ‫ޤ‬ʤղ‫ౕޤ‬ʶղ‫಼ޤ‬༲ͳࣰࢬʥͶͯ͏ͱ‫ݗ‬౾ͤ΄͘Ͳ͍Ζɽ<RVKLGD<7DPXUD.HWDO-SQ -&OLQ 2QFRO Supplement11㧗㱋䛜䜣ᝈ⪅䛾デ⒪䛻䛒䛯䛳䛶᳨ウ䛩䜉䛝䛣䛸䞉 ▷䛔ᖹᆒవ࿨ 䋻 䛜䜣Ṛ䜎䛷䛾ᮇ㛫䛸䛾ව䛽ྜ䛔䜢⪃៖䞉 ኱䛝䛺ಶேᕪ 䋻 ᶵ⬟ホ౯䠄㻳㻭㻛㻯㻳㻭䠅䛻䜘䜛ໟᣓⓗ䛺䠄඲ேⓗ䛺䠅ホ౯䞉 㧗㱋䠄䛜䜣䠅ᝈ⪅䛜἞⒪䛻ồ䜑䜛䜒䛾἞⒪䜢ཷ䛡䜛䛾䛷䛒䜜䜀䛖䜎䛟䛔䛳䛶䜋䛧䛔 䋻 ἞⒵䚸⑕≧⦆࿴䚸ᘏ࿨䛯䛰䚸๪స⏝䛜ฟ䜛䜘䛖䛺䜙 㼚㼛㻌㼠㼔㼍㼚㼗㻌㼥㼛㼡㻍㻍Supplement⥔ᣢ䞉ྥୖ䜢ᕼᮃṚஸ⋡䛾ῶᑡ䚸⏕Ꮡᮇ㛫ᘏ㛗䛻䛿䛣䛰䜟䜙䛺䛔 䋻 ㌟యᶵ⬟䛾⥔೺ᗣᑑ࿨䠄⮬❧䛧䛯⏕ά䛜䛷䛝䜛௓ㆤ䝣䝸䞊⏕Ꮡᮇ㛫䠅䛾ᘏఙ఑‫ݶ‬ʀ݊߃ΠΤφΩϞͳ͢ͱʰਐରద‫ؽ‬೵͹ң࣍ʀրવʱΝ೘ΗΖ ˲೺ᗣᑑ࿨䠄⮬❧䛧䛯⏕ά䛜䛷䛝䜛௓ㆤ䝣䝸䞊⏕Ꮡᮇ㛫 㻩㻌㼐㼕㼟㼍㼎㼕㼘㼕㼠㼥㻙㼒㼞㼑㼑㻌㼟㼡㼞㼢㼕㼢㼍㼘㻘㻌㻰㻲㻿㻘㻌㼚㼛㼠㻌㼐㼕㼟㼑㼍㼟㼑㻙㼒㼞㼑㼑㻌㼟㼡㼞㼢㼕㼢㼍㼘䠅ʀ߶ྺ͗Ξ‫ं׳‬ͺɼ͗Ξͳਏஇ͠Η͖ͪ࣎ΔIUDLOW\Ν඲Ճʀղ‫ޤ‬೟ఈ৻ࠬਅ੧Ν‫ݗ‬౾ͤΖɽ
Ώ͗ͱචགྷͳ͵ΖͲ͍Θ͑ʰࢩԋʀղ‫ޤ‬Ͷͨ͵͓Ζʱ͞ͳΝ‫ש‬ΌΖɽࡂҐ৏͹ஏҮे຿ ೧‫ޛ‬͹ࢰ๤Ϩηέ͹‫ࢋܯ‬
5䛴䛾䝁䝩䞊䝖◊✲䠖16䛾ඛ㐍ᅜ䛸Ⓨᒎ㏵ୖᅜ䛛䜙
3୓5༓ே䜢㉸䛘䜛㧗㱋⪅䛾8.6ᖺ䛾๓ྥ䛝ほᐹ◊✲䛛䜙
10ᖺᚋ䛾Ṛஸ⋡䜢ண 䛩䜛䚹

Supplement2

Supplement䠍QOL䜢
䜢 primary endpoint 䛸䛧䛯㧗㱋䛜䜣ᝈ⪅䛾๓ྥ䛝↓సⅭ๭䜚௜䛡ヨ㦂

೧ྺ
੓
౸೚බ
ৼ࣮‫׳‬
഑࣮‫׳‬
͗Ξ ໃ͢
٦Ԑ
Πϩαʖϩઃख

⮫ᗋヨ㦂䛛䜙
㝖እ䛥䜜䚸᝟ሗ
䛜䜋䛸䜣䛹䛺䛔

%0,ुյҐ৏͹ӣಊ݊߃͹໲ୌͲ೘ཌྷʀεϡϭʖࠖೋ݊߃͹໲ୌͲ਼ϔϫρέิߨࠖೋࠕೖ͹೧݆ೖΝਜ਼֮Ͷ‫͓ݶ‬Ζ͖‫ं׳‬͹ࣙ‫ހ‬ਅࠄͶΓΖ݊߃ౕ

KWWSVHSURJQRVLVXFVIHGXVXHPRWRUHVXOWSKSSupplement3ࡂҐ৏͹೘Ӆ‫ୂं׳‬Ӆ࣎͹য়ସ ೧‫ޛ‬͹ࢰ๤Ϩηέ͹‫ࢋܯ‬ࡂҐ৏͹೘Ӆ‫ୂं׳‬Ӆ࣎͹য়ସͳ೧‫ޛ‬͹ࢰ๤Ϩηέ͹‫ࢋܯ‬̏ɿ੓̐ɿୂӅ࣏࣎͹ࢩԋ͹චགྷ੓͍Ε೘ཌྷʀεϡϭʖ஥଺͓ϗρχ͖ΔҞࢢ΃͹Ңಊφ΢Ϫ͹࢘༽
ৱࣆ͍Ζ͏ͺ‫ܨ‬੫ຼదӭ཈̑ɿৼ෈સ̒ɿൿේ͗ΞΝঈ͚͗Ξ̓ɿ೘Ӆ࣎͹έϪΠοωϱ
̔ɿ೘Ӆ࣎͹Πϩϔϝϱ
KWWSVHSURJQRVLVXFVIHGXZDOWHUSKS

Supplement
5ᇶᮏ䝏䜵䝑䜽䝸䝇䝖25㡯┠䠄䝣䝺䜲䝹䝏䜵䝑䜽䠅ཱྀ⭍ᡭẁⓗᇶᮏືస䠄IADL)♫఍ⓗADL㐠ືᰤ㣴⬤ᙅᛶ䛾␲䛔

㛢䛨䛣䜒䜚ㄆ▱⑕

1䡚20䜎䛷䛾㡯┠䛾䛖䛱10㡯┠௨ୖ䛻ヱᙜ䛩䜛䜒䛾
6䡚10㡯┠ 3㡯┠௨ୖヱᙜ11ࠥ122㡯┠䛩䜉䛶ヱᙜ13ࠥ152㡯┠௨ୖヱᙜ䛖䛴

G8㧗㧗㱋⪅ᶵ⬟ホ౯吐吆呁呎吢呉吇君呎呂

https://www.mhlw.go.jp/topics/2009/05/dl/tp0501-1f_0005.pdf

Supplement
4

KWWSVHSURJQRVLVXFVIHGXZDOWHUSKS

A 㐣ཤ3䛛᭶㛫䛷㣗ḧ୙᣺䚸ᾘ໬ჾ⣔䛾ၥ㢟䚸䛭䛧䜓䛟䞉ᄟୗᅔ㞴䛺䛹䛷㣗஦㔞䛜ῶᑡ䛧䜎䛧䛯䛛0䠖䠖ⴭ䛧䛔㣗஦㔞䛾ῶᑡ䠍䠖୰➼ᗘ䛾㣗஦㔞䛾ῶᑡ䠎䠖㣗஦㔞䛾ῶᑡ䛺䛧B 㐣ཤ3䛛᭶㛫䛷య㔜䛾ῶᑡ䛜䛒䜚䜎䛧䛯䛛䠌䠖3䟙௨ୖ䛾ῶᑡ
䠎䠖1-3䟙䛾ῶᑡSupplement
6䠍䠖䜟䛛䜙䛺䛔
䠏䠖య㔜ῶᑡ↓䛧C ⮬ຊ䛷䛒䜛䛡䜎䛩䛛䠌䠖ᐷ䛯䛝䜚䜎䛯䛿㌴䛔䛩䜢ᖖ᫬౑⏝䠍䠖䝧䝑䝗䜔㌴䛔䛩䜢㞳䜜䜙䜜䜛䛜䚸Ṍ䛔䛶እฟ䛷䛝䛺䛔䠎䠖⮬⏤䛻Ṍ䛔䛶እฟ䛷䛝䜛E ⚄⤒䞉⢭⚄ⓗ䛺ၥ㢟䛾᭷↓䠌䠖㧗ᗘ䛾ㄆ▱⑕䜎䛯䛿㨚≧ែ䠍䠖୰➼ᗘ䛾ㄆ▱㞀ᐖ䠎䠖⢭⚄ⓗၥ㢟䛺䛧F BMI್

䠌䠖19ᮍ‶
䠎䠖21௨ୖ23ᮍ‶

䠍䠖19௨ୖ21ᮍ‶
䠏䠖23௨ୖ

H 1᪥䛻4✀㢮௨ୖ䛾ฎ᪉⸆䜢㣧䜣䛷䛔䜎䛩䛛

䠌䠖䛿䛔

䠍䠖䛔䛔䛘

䠌䠖Ⰻ䛟䛺䛔

䠌䠊䠑䠖䜟䛛䜙䛺䛔䠎䠖Ⰻ䛔䠌䠖86ṓ௨ୖ
䠎䠖80ṓᮍ‶䠍䠖80-85ṓ

P ྠᖺ㱋䛾ே䛸ẚ䜉䛶䚸⮬ศ䛾೺ᗣ≧ែ䜢䛹䛖ᛮ䛔䜎䛩䛛 䠍䠖ྠ䛨ᖺ㱋

ྜィⅬᩘ 䠄0-17䠅

40

Supplement
7

Supplement8㧗㱋⪅ᶵ⬟ホ౯䛸䝸䝇䜽ศ㢮
Corre R et al. JCO 34: 1476-1483, 2016ᇶᮏⓗ᪥ᖖ⏕άືస䠄ADL䠅ᡭẁⓗ᪥ᖖ⏕άືస䠄IADL䠅䛣䛾1㡯┠䛷䜒

IADL䛻㞀ᐖ䛜ฟ᮶䛺䛟䛺䜛䛸

䛒䛳䛶䜒㍍ᗘ䛷䛒⮬❧䛧䛯䜜䜀䚸ᨭ᥼䛜䛒

⏕ά䛜㞴䛧䛔

䜜䜀⮬❧䛧䛯⏕э 䝣䝺䜲䝹

ά䛜䛷䛝䜛 э㧗㱋⪅ᶵ⬟ホ౯㡯┠䝣䜱䝑䝖䛾ᇶ‽䞂䜯䝹䝛䝷䝤䝹

䝣䝺䜲䝹䝥䝺䝣䝺䜲䝹

Nutritional assessment: BMI䜢䜢ධ䜜䛶䚸9㡯┠䜢ホ౯䠖ᖹᆒ35ศ᫬㛫䜢せ䛩
41ղ‫ޤ‬ฯ‫ݧ‬੏ౕͶ‫͚Ͱخ‬ղ‫ޤ‬೟ఈ

6XSSOHPHQW42

6XSSOHPHQW౨‫ੁ౐ښ‬ดۢɼ2001೧4 ݆1 ೖ఼࣎Ͳགྷࢩԋʀགྷղ‫ंޤ‬͹સҽ10,249໌Ν9೧ؔ؏ࡱͪ݃͢Վ

ղ‫ޤ‬೟ఈ৻ࠬճࣁྋ
KWWSVZZZPKOZJRMSWRSLFVNDLJRQLQWHLGOWH[WBSGIਫ਼ଚ‫ؔغ‬؏ࡱ֋࢟‫ޛ‬ᑂᰝ㡯┠ 57 䠄䜿䜰䝬䝛䝆䝱䞊䛜ᢸᙜ䠅གྷղ‫ ޤ‬೧ໟᣓⓗ䛺㧗㱋⪅ᶵ⬟ホ౯䠄GA䠅䛭䛾䜒䛾䛷䛒䜛གྷղ‫ ޤ‬೧

௓ㆤᗘ䛿GA/CGA䛾surrogate䛸䛧䛶฼⏝䛷䛝䜛ྍ⬟ᛶགྷղ‫ ޤ‬೧᪥ᖖ⏕ά⮬❧ᗘ䠄୺἞་䠅གྷղ‫ ޤ‬೧㞀ᐖ㧗㱋⪅⮬❧ᗘགྷղ‫ ޤ‬೧ㄆ▱⑕㧗㱋⪅⮬❧ᗘ

གྷࢩԋ

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