It comes as no surprise that global graying will be one of the most pressing issues of the coming century. The most rapidly growing age group in all developed countries is the one with persons aged 85 and older. Often referred to as the “oldest old”, the aging of the aged reflects a universal concern being experienced in the United States as well as in other industrialized countries, such as Japan. This paper addresses the challenges that such changes present for gerontology and geriatrics. Contextual projections of population trends and of life expectancy, as well as actual health care costs and estimated government health care expenditures will be compared for the United States and for Japan. Among the geriatric challenges being confronted are (1) the need to separate aging from disease, (2) the need for more geriatric centers and available geriatricians to serve the aged, (3) the introduction of health care strategies of prevention and case management, (4) responses to the notion of health care rationing, and (5) the ultimate importance of research ranging from the biological and molecular to the behavioral, social, and health service delivery. Global aging presents a gerontological imperative that may best be understood by examining policy recommendations and future policy decisions.
Quantitative analysis of abdominal aorta calcification by X-ray CT is a useful method for non-invasive diagnosis of atherosclerosis. We recently examined the relationship between the X-ray CT measurement of abdominal aorta calcification and the degree of obesity. For this purpose, the body mass index (BMI) and the subcutaneous fat thickness (determined by X-ray CT at the umbilical level) were analyzed in relation to the abdominal aorta calcification index (ACI) in 845 patients (453 males and 392 females aged 40-79 years). Patients with BMI under 20 were classified as“lean”, those with BMI between 20-26 as“normal”and those with BMI over 26 as“obese”. 1. Among males, the ACI was highest in lean individuals and lowest in obese individuals. The difference in ACI between lean and obese males was significant in the middle aged group (40-65 years). Among females, no relationship was observed between the degree of obesity and ACI. 2. Among males, ACI was higher in individuals with low subcutaneous fat thickness and lower in individuals with greater subcutaneous fat thickness. The difference was significant in the middle aged group. Among females, no relationship was observed between the two parameters. 3. When the visceral fat to subcutaneous fat ratio (V/S) in 85 males and females aged 60-69 years was analyzed in relation to ACI, ACI tended to decrease as the V/S increased, in both males and females. 4. Relationships between BMI and subcutaneous fat thickness, between BMI and lipids and between lipids and ACI were also analyzed.
To examine the metabolism of guanidino compounds in the elderly, we measured the serum concentrations of urea nitrogen, creatinine (Cr), guanidinoacetic acid (GAA) and creatine (CR) in middle-aged and elderly subjects. We also measured muscle mass in the elderly. The elderly subjects tended to have lower serum GAA concentrations than middle-aged subjects. On the contrary, CR concentrations of elderly subjects were higher than those of middle-aged subjects. Bedridden elderly subjects tended to have lower serum GAA concentrations and lighter muscle mass than ambulatory elderly subjects. On the contrary, serum CR concentrations of bedridden subjects were higher than those of ambulatory subjects. CR is an essential substance for muscle energy metabolism. These results indicate that high serum CR concentrations due to low CR metabolism in skeletal muscle might suppress glycine amidinotransferase (GAT) activity, resulting in decreased GAA production in the elderly.
This study was undertaken to investigate several factors influencing standing balance, activity of daily living and ambulation in hemiplegic patients after cerebro-vascular diseases. A statistical analysis of 121 hemiplegic patients with unilateral supratentorial lesions showed that age, severity of muscle weakness of involved or uninvolved extremities, unilateral spatial neglect and the sense of toe position had influence on standing balance, activity of daily living or ambulation. The patients were divided into five groups based on the degree of unilateral spatial neglect, evaluated by their copies of two daisies who omitted more than three quarters, three quarters, half, one quarter and none of the figures were defined as the USN-4, USN-3, USN-2, USN-1 and no involvement groups, respectively. Those who belonged to the USN-2 group had significantly lower scores for activity of daily living than those who belonged to the no involvement group. In the USN-2 group, 7 of the 8 patients could not keep standing for 50 seconds, while in the no involvement group, this was the case in only 1 of the 15 patients. Activity of daily living scores or sway area during standing showed no statistically significant differences between the USN-1 and no involvement groups. These results suggested that severe or moderate unilateral spatial neglect is one of the most important factors influencing standing balance and activity of daily living.
Characteristic electrocardiographic findings of the left septal fascicular block consist of a prominent anterior QRS force. Therefore, the following criteria were proposed for the diagnosis of left septal fascicular block, based on the normal limits of the R and S waves and R/S of V1 and V2. (1) Right ventricular hypertrophy, complete right bundle branch block, preexcitation (Type A), high posterior infarction, hypertrophic cardiomyopathy and abnormality of the thorax or intrathoracic tissues which might cause marked counterclockwise rotation around the longitudinal axis of the heart, should be exluded. (2) One of the following two criteria should be satisfied. (i) R/SV1>2, and RV1≥5mm, (ii) R/SV2>2, and RV2≥15mm, or SV2<5mm The frequency of left septal fascicular block diagnosed by these criteria was 3.5% among all patients of a hospital mainly consisting of elderly patients. This frequency was less than that of the left anterior fascicular block or complete right bundle branch block, but it was higher than that of the complete left bundle branch block or bilateral bundle branch block.
The author investigated factors leading to intellectual impairment in patients with multiple lacunar infarctions. The subjects consisted of 40 patients with multi-infarct dementia (MID) and 17 nondemented patients with multiple infarctions (MI) who showed multiple lacunar infarctions in the deep penetrating arterial territory on CT. MID patients showed more marked and extensive periventricular lucency (PVL), a higher degree of ventricular index (VI) measured on CT, and were of a higher age, and had poorer activity of daily living (ADL) compared with MI patients. There were significant correlations between the PVL score, VI, ADL score, age and Hasegawa's dementia rating score (HDS). However, no significant differences in sex, site of infarct, and the count of low density areas reflected lacunar infarction on CT, and vascular risk factors were shown between MID and MI patients. Multiple regression analysis demonstrated that the PVL score and VI showed the highest partial correlations for HDS, and that the ADL score and age were also independently contributing factors. Our results suggest that deep white matter lesions observed as PVL on CT and ventricular enlargement were the most important factors contributing to intellectual impairment in patients with multiple lacunar infarcts, and that physical factors such as ADL and age can be considered to be related to the development of dementia.
A case of splenic tuberculosis is reported. The patient was a 79-year-old man who was admitted to the Tokyo Metropolitan Geriatric Hospital because of high fever and loss of body weight. Several finger-tip sized superficial lymph nodes were palpable in bilateral inguinal regions. The intermediate PPD skin test was positive. However, there was no evidences of active tuberculosis on the chest roentgenogram. The computed tomogram of the abdomen showed moderate enlargement of the spleen with multiple low density areas and several swollen lymph nodes in the para-aortic region. Although a lymph node of the inguinal region was resected for the pathologic examination, it showed no specific changes. In order to obtain a final diagnosis, laparotomy was performed. The spleen was markedly enlarged and nodular in appearance. No abnormal findings were observed in the other abdominal organs. Splenectomy was carried out. Numerous yellowish nodules, varying from 0.1 to 5cm in diameter, were observed on the cut surface of the resected spleen (20×20×8cm, 700g). The bacteriologic examination revealed acid-fast bacilli. The fever subsided after splenectomy and following antituberculous therapy. Recently, isolated tuberculosis of the spleen has become very rare. Since 1965, only six cases in five reports can be found in the English, French and German literature. The present case is considered to be one such very rare cases of tuberculosis. Although splenic tuberculosis is rare at the present time, splenic tuberculosis should be included in the differential diagnosis of fever of unknown origin with splenomegaly.