A Visual analogue scale of happiness (VAS-H) was applied to elderly population in a community to evaluate their subjective quality of life. The study population consisted of 313 elderly people aged over 75. Using a 20cm visual analogue scale (VAS), VAS-H was measured by asking subjects to place a single vertical mark on a horizontal line at a point corresponding to their current subjective degree of happiness judged from health condition and psycho-social background as awhole; The VAS-H was anchored on the left and with the words “-100%; unhappiest” and on the right end with the words “+100%; happiest”. The scores of VAS-H (%) were obtained by multiplying the distance (cm) from the zero point to the vertical line by 10. To determine the characteristics of VAS from the standpoit of the quality of life, we compared VAS with scores of two kinds of established depression scale, because the mood which was assessed by these scale was supposed to be an important factor of the quality of life. The results of the simultaneously assessed Geriatric Depression Scale (GDS), and Zung's depression scale (SDS) which was obtained 1 year before for the same subjects were compared with that of VAS-H. The score of VAS-H had a significantly negative correlation with both GDS and SDS. In conclusion, VAS-H was a simple and useful method to evaluate degree of subjective happiness which was one factor of quality of life in the elderly people.
The effects of activity of daily living (ADL), physical conditions, social environmental factors and neurobehavioral functions on subjective happiness were investigated in 313 elderly subjects. The degree of subjective happiness was measured using visual analogue scale of happiness (VAS-H). There was significant relationship between VAS-H and ADL. The VAS-H score had weak but significant correlation with physical conditions and neurobehavioral functions. The social environmental factors, especially economical conditions, family relationships and group behavior had a significant correlation with VAS-H. In conclusion, in apparent healthy elderly people, the subjective degree of happiness was not related to ADLs, but to social environment and information physical conditions.
Visual analogue scale of happiness (VAS-H) was applied to elderly Himalayan highlanders to investigate the influence of life-style and socio-cultural background on subjective happiness. The score of “VAS-H” and neuropsychological function tests in 733 Himalayan highlanders who belonged to 5 separate villages were compared with those in 313 Japanese elderly subjects. The places of study consisted of 4 villages (Khalimabad; K, Gulmit; G, Pasu; P, Shimshal; S) in Hunza area in Pakistan, and Namche Bazar; N in Nepal. Degree of modern civilization was highest in K, followed by N, G, P and lowest was that in S by historical and sociological aspects. The mean VAS-H sore in Himalayan highlanders and the degree of modern civilization in the area was in inverse proportion. Himalayan elderly women showed a significant lower score on VAS-H compared with elderly Himalayan men or elderly Japanese subjects. The VAS-H score in the Japanese elderly correlated significantly with the stability of posture and walk, and that of Himalayan highlandes correlated significantly with mannual skill. In conclusion, the life style or socio-cultural background strongly affected subjective happiness in the elderly. The VAS-H was useful in comparing subjective happiness in different cultures.
Due to increasing number of the elderly, cases of hematemesis and melena in the aged have been increasing. The authors evaluated 69 such cases over 60 years old in whom emergency endoscopy of the upper digestive tract was carried out because of hematemesis and melena. Twenty cases are diagnosed as gastric ulcer (29%), 12 cases as esophageal ulcer and esophageal erosion (17.4%), 9 as duodenal ulcer (13.0%), 7 as gastric cancer (10.1%), 6 as Mallory-Weiss syndrome (8.7%), 6 as esophageal and gastric varices (8.7%), 4 as acute hemorrhagic gastritis (5.8%), 3 as Dieulafoy's ulcer (4.3%), and one case each of chronic pancreatitis (hemosuccus pancreaticus) and hemorrhage due to gastric angiodysplasia (1.4%). Of these cases, blood transfusion was performed in 46 cases (66.7%), and shock occurred in 27 cases (39.1%). The endoscopical hemostatic procedure was effective for detection of underlying diseases in the aged. Surgery was often impossible because of the rapid deterioration of the systemic condition due to the hemorrhage of the digestive tract.
A 10-year experience with 2, 441 patients over 65 years of age undergoing operations for non-upper gastrointestinal tracts was reviewed to evaluate both the incidence of postoperative upper gastrointestinal bleeding and the clinical risk factors associated with the complication. A total of 18 (0.7%, 7 males and 11 females) patients had overt postoperative upper gastrointestinal bleeding of non-variceal origin documented by endoscopic findings or blood transfusions. Of these, the complication developed in 10 (1.5%) of 646 patients after an operation for biliary or pancreatic disease, 1 (1.5%) of 64 for aneurysmal or obstructive arterial disease, 5 (1.1%) of 43 for colorectal cancer and 2 (0.3%) of 916 for hernia. The incidences of bleeding after an operation for obstructive jaundice (3.8%), for biliary or pancreatic malignanncy (4.5%), and of unavoidable diversion colostomy for colorectal anastomosis (3.1%) were significantly higher than for non-jaundice (0.6%), for non-malignancy (1.1%) and of postoperative upper gastrointestinal bleeding in the present study. The origins of bleeding were gastric ulcer in 11, acute gastric mucosal lesion in 4, duodenal ulcer in 1 and other in 2. All cases of bleeding were treated and met success in hemostasis using H2-blockers. Of these, however, 5 patients died of multiple organ failure despite discontinued hemorrhage. prophylactic use of H2-blockers showed a decrease in occurrence of postoperative upper gastrointestinal bleeding in the present study.
In order to measure disability in the elderly with a variety of handicaps a comprehensive activities of daily living (ADL) index is described. This instrument, named the ADL-20, consists of 20 items from four major categories of daily activities: (1) 5 itmes from basic ADL for mobility (BADLm), (2) 6 items from basic ADL for self-care (BADLs), (3) 7 items from instrumental ADL (IADL), and (4) 2 items from communication ADL (CADL). Each activity is scored on a four point scale with values from 0 (total dependency) to 3 (independency). In order to study the interrater reliability of the instrument 40 subjects were examined by a physician and physiotherapist independently at the University of Tokyo Hospital on the same day. Perfect agreement rates on the assignment of the disability score ranged from 70.0% to 97.5% with 85.6% in 800 paired examinations. The kappa values for perfect agreement ranged from 0.52 to 0.88. These results may guarantee a moderate or greater degree of interrater reliability. The correlation coefficients of the Spearman test on the rating scores by the physician and physiotherapist ranged from 0.66 to 0.99 in each activity with 0.97 in total score of 20 items. This scale was employed in 110 patients at the University Hospital and 106 patients staying in the nursing home or long-stay geriatric hospital in order to study its validity. The average age of those 216 patients, 77 males and 139 females, was 76.2 years old. The Cronbach α value concerning the consistency of each item as ADL assessment scale was 0.97. The Spearman correlation coefficient between the total ADL-20 score and the grade of individual home care needs was -0.88. Among the 4 subgroups of ADL, IADL showed the greatest correlation coefficient value. In this validity study the Barthel index (BT) and the Katz index (KI) as well as the ADL-20 were employed in 110 university hospital patients on the same day. The correlation coefficient between BI and the ADL-20 was 0.81 and that between KI and the ADL-20 was 0.80. The correlation coefficient between the mental state assessment and the ADL-20 was 0.75. Among the subgroups of ADL IADL showed the greatest coefficient value in the correlation study between ADL and mental status. This comprehensive ADL index is sufficiently reliable and valid for the assessment of the elderly with a variety of physical or mental disabilities, owing to the IADL category items included.
The purpose of this study was to assess the intellectual ability and activity of daily living (ADL) of 12 centenarians in institutions for the elderly and to compare them with individuals in the 62-99 age group. At the time of our study, 66.7% of the centenarians were severely demented, three quarters of them suffering from Alzheimer's type dementia and the other one quarter the mixed type. There were qualitative differences between non-demented centenarians and the demented elderly in general, particularly in regard to understanding of surrounding objects and the presence or absence of mental symptoms indicating intellectual deterioration. A total of 50% of the centenarians were bedridden, but 41.7% of them could eat without assistance. Intellectual ability and ADL directly decreased with aging. We think centenarians do not present a special case and our clinical observations suggest a continuous process of aging. Five of the centenarians recently died and were autopsied. The agreement rate between clinical diagnoses and pathological findings with respect to dementia was 80%.
In order to clarify the characteristics of elderly patients concerning their attitudes toward taking prescribed medicine, self-reported compliance with prescriptions was compared among different age groups. We performed a survey in 626 outpatients and their attending physicians in 4 of our affiliated hospitals, and analyzed self-reported compliance by the patients to the prescription and their answers to questions related to drug-taking along with the diagnoses and prescriptions reported by the physician. The number of prescribed medicine was 2.3 tablets on the average for patients younger than 40, while 5.1 tablets were prescribed for patients over 70. However, self-reported compliance was best in patients over 70 than in other age groups. Compliance was good in 76% of patients who answered that the amount of medicine was appropriate, while good compliance was lower in those who thought the prescription excessive (67%). Likewise, compliance of patients who had concerns with drug side effects or who were not feeling well under medication was lower than that of patients who felt well under medication. Prescriptions for after lunch were most liable to be forgotten than those for other times of the day. Moreover, a high percentage of elderly patients attended more than 2 departments or medical facilities, and one third of those patients did not inform the physician of the fact suggesting that they were at higher risks of overdosing and unexpected drug interaction. Furthermore, the percentage of patients who did not receive explanation from physicians was higher in the elderly thus demonstrating that elderly patients have quite different characteristics in attitude with regard to medicine from younger age group patients. These results suggest that proper instruction for drug taking in the elderly is necessary to achieve better compliance for the safer medical treatment in this age group.
To investigate the frequency and etiology of diabetic osteopenia, we measured spinal bone mineral density (SBMD), total body bone mineral density (TBBMD), total body fat and lean body mass in 69 female diabetic patients (14 IDDMs and 55 NIDDMs). SBMD decreased with age in both IDDM and NIDDM, but when expressed as a percentage of age-matched normal Japanese females, some had lower SEMD, but others had normal or increased SBMD. Postmenopausal IDDM patients had lower SBMD than postmenopausal NIDDM patients. Thirteen out of 69 (18.8%) had an SBMD lower than 90% of age-matched controls. SBMD correlated positively with TBBMD. Those with lower SBMD had poor glycemic control, but there was no relation between SBMD and either duration of diabetes or presence of retinopathy and/or nephropathy. IDDM patients had lower 1.25(OH)2D, osteocalcin than NIDDMs. SBMD correlated negatively with urinary pyridinoline and deoxypyridinoline excretion. SBMD correlated positively with body weight, and those with lower SBMD had significantly lower body mass index, body weight, fat weight and lean body mass than those with normal or increased SBMD. These results suggest that IDDM patients may be at higher risk of losing bone postmenopausally, and diabetic patients with lower SBMD have characteristics of poor diabetic control, lean habitus, low serum 1, 25(OH)2D.
The serum protein-binding of 12 representative cephems (CET, CEZ, CZX, CPZ, CZON, CPM, CDZM, CFX, CMZ, CTT, LMOX, FMOX) was assessed, using sera from young healthy subjects (mean age, 28.6 years old) and elderly healthy subjects (mean age, 69.7 years old), applying equilibrium dialysis under the same conditions in vitro. The protein-binding capacity of 12 cephems in elderly subjects was significantly less than that in young subjects, and marked increase in free drug concentration was observed in elderly subjects. This decrease in the protein binding capacity of cephems in elderly subjects was possibly caused by decreased serum albumin and change in non-esterified fatty acid constitution related to aging. As free-drug concentration participates in the appearance of effects and adverse reactions, the possibility of an enhanced pharmacological effects and increased adverse reactions of cephems due to decrease of protein binding in elderly subjects should be considered.
The phermacokinetics of oral Alminoprofen, a nonsteroidal anti-inflammatory drug, were studied in five elderly patients with rheumatoid arthritis and spondylosis deformans after 200mg (three times a day) repeated dose for 5 days. The pharmacokinetic parameters after oral administration of Alminoprofen were analyzed by the one-compartment open model method. The maximum plasma concentrations (Cmax) were 16.1 ±2.5μg/ml, after dosing on day 1, 25.2±1.6μg/ml on day 3 and 21.6±2.7μg/ml on day 5. The maximum time (Tmax) were about 2 hours after the medication in al cases. The area under the curve in drug concentration in plasma versus time (AUC) were 58.5±6.3μg hr/ml on day 1, 58.5±3.1μg hr/ml on day 3 and 58.1±8.5μg hr/ml on day 5. The biological half-lives (t1/2) were 2.45± 0.35, 2.09±0.82 and 2.49±0.63 hours, after dosing on day 1, day 3 and day 5, respectively. The analysis of moment in pharmacokinetics revealed that the mean residence time (MRT) on day 1, day 3 and day 5 observed were 2.31±0.03, 2.15±0.09 and 2.15±0.07 hours, respectively. The variance residence times (VRT) observed were 0.95±0.05hour2 on day 1, 0.88±0.09hour2 on day 3 and 1.06±0.07hour2 on day 5. The ratios of accumulation calculated were 1.16±0.05 in both the morning medication on day 3 day 5, and it therefore appears that the steady-state equilibrium is established within 3 days after commencement of dosage. The result suggest that Alminoprofen has none or almost no accumulation effect in elderly as well as adult patients.
A 78-year-old man with developmental disturbance of the genital organs and eunuchoidism was reported. He also had a high pitched voice, thickness of the lower lip and kyphosis of the thorax. He seemed to be fretful, but his intelligence was normal. Neurological tests revealed bilateral hemianopsia and decreased tendon reflexes. A plain skull radiograph clearly showed an egg shaped calcified mass extending upward from the sella turcica which resembled a ballooning shape. Brain CTs showed a high density round mass which expanded the sella turcica and raised the floor of the third ventricle. The inner part of the tumor showed irregular high density. T1-weighted MR imaging revealed an iso signal intensity, and T2 showed low signal intensity in the mass. These findings strongly supported the diagnosis of calcificated craniopharyngioma. Endocrinological study showed panhypopituitarism caused by the tumor compressing the pituitary gland and the hypothalamus. The main reasons why there were no apparent symptoms of hypopituitarism were because the receptors were upregulated and secondarily because the thyroid and the adrenal cortical functions decreased while struggling to maintain balance with each other. There was also a possibility that these symptoms might have been masked by normal aging. Benign monoclonal hypergammopathy was also indicated, although we could not find a clear correlation between this finding and others.