We examined the efficacy and safety of electroshock therapy (EST) under general anesthesia in 26 depressed patients (9 males, 17 females, age range 55-79). The scores of the Hamilton Psychiatric Rating Scale for depression were significantly decreased after EST and clinical symptoms such as depressive mood. psychomotor retardation, anxiety, agitation, suicidal tendencies, hypochondria and sleeplessness improved in all of the patients. Complications included amnesia (16/26), delirium (3/26) and transient arrhythmia (1/26) after EST, but neither lethal nor lasting complications were observed. In summary, EST was an effective and convenient method of treatment for senile depression.

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Anti-thrombotic and anti-atherogenic effects of eicosapentaenoic acid (EPA) through the modulation of various cell functions related to thrombogenesis have been reported recently. We previously reported that the administration of EPA at low doses could more effectively elevate the plasma EPA concentration in elderly subjects than in younger ones. Magnetic resonance imaging examination of the brain often reveals lacunar lesions in elderly subjects without any signs or symptoms of cerebrovascular diseases. In this study we clarified the effect of administration of low doses of fish oil concentrate on platelet and RBC function in elderly subjects, compared with younger subjects. Thirty six elderly subjectes (mean age 78) without any signs or symptoms of cerebrovascular diseases, all reciveing the same diet in the same lodging house for the aged, were divided into 3 groups. Different amounts of fish oil concentrate (0.25-0.5g/day of EPA) were administered to the 3 groups, daily for more than 1 month. Changes of plasma fatty acid composition, platelet aggregability, whole blood viscosity and RBC deformability was examined before and after EPA administration. One month after EPA treatment, the plasma EPA content had increased dose dependently, with supression of platelet aggregation and improvement of RBC function. In younger subjects recieving the same amount of EPA, the elecvation of plasma EPA was less than that observed in the elderly. In summary, low dose EPA administration can improve the function of platelet and RBC to an anti-thrombotic state and would be useful to prevent the occurence of cerebrovascular diseases in elderly subjects without any side effects.

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To explore the sociomedical and life-style risk factors associated with the development of senile dementia, we conducted a nested case-control study with the following subjects: cases were those who underwent health examination for the aged in 1979-1980 in a town in Aichi Prefecture and nineteen cases identified as having senile dementia 13-14 years later. Two controls per case were randomly selected from those who underwent the same health examination and were proven not to have dementia up to 1993, with thirty-eight controls matched to each case for sex, age at first examination (±2 years), and residential area. Routine odds ratio analysis demonstrated the following relationships between onset of senile dementia and sociomedical and life-style factors of 13-14 years ago. (A) factors significantly associated with an increased risk of dementia were (1) difficulty in using fingers (odds ratio-12.1; 95% confidence interval-1.54-94.7), (2) alcoholic beverage drinking habits (6.00; 1.07-33.5), (3) use of false teeth (3.50; 1.10-61.6), (4) less frequent chance to converse (3.85; 1.15-12.5), (5) much spare time (3.70; 1.43-25.0), (6) decrease of number of friends (2.77; 1.12-11.1), and (7) inability to calculate subtractions such as 29-17 (3.33-33.3). On the contrary, (B) habitual physical activities significantly reduced the risk of developing senile dementia (0.27; 0.05-0.71). (C) cigarette smokers and regular users of sleeping pills were not at greater risk of subsequent senile dementia, to which such personal characteristics as shyness and nervousness were not significantly linked.

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To clarify the utility of permanent pacemakers in a society composed largely of elderly people, clinical characteristics, pacemaker characteristics, outcome, and quality of life in a total of 116 patients in a community with many (19.6%) elderly people were evaluated after permanent pacemaker implanation. Patients above age 65 accounted for 88.8%, while those above 80 years accounted for 24.1%. Syncope was the most common observation before pacemaker implantation and emergency care was needed in 35% of patients. Sick sinus syndrome and complete AV block were seen in a majority, while atrial fibrillation with bradycardia was seen in a minority of patients. Although the physiological pacing and ventricular pacing mode (VVI) were used in about 50% each, recently the physiological pacing mode has markedly increased. During the mean follow-up of 26.1±16.2 months, only four patients died. NYHA 3 symptom improved to NYHA 1 after pacemaker implantation and 72.5% patients of all cases returned to their jobs. We conclude that the permanent pacemaker is effective in improving symptoms and reducing the death rate in elderly patients.

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To clarify the clinical significance of microalbuminuria in elderly diabetic patients, 167 diabetic patients were divided into two groups, 81 elderly patients aged 65 or more (mean age±SD: 72±9, 31 men and 50 women) and 86 middle-aged patients less than 65 years (mean age±SD: 56±8, 49 men and 37 women). We then examined the prevalence of microalbuminuria and other clinical parameters in both groups. The duration of diabetes (10±7 vs 9±7 years), body mass index (24.3±4.1 vs 23.9± 3.5) and the levels of fasting plasma glucose (142±38 vs 144±40mg/dl), HbA_1C (7.4±1.6 vs 7.8±1.6%), plasma chlesterol (203±34 vs 212±46mg/dl) and triglyceride (117±57 vs 121±67mg/dl) showed no significant difference between elderly and middle-aged patients. However, the prevalence of microalbuminuria (30≤urinary albumin level< 300mg/g·Cr), macroangiopathies involving cerebrovascular disease, ischemic heart disease and atherosclerosis obliterans, and hypertension were higher in elderly patients than those in the middleaged patients (43.2 vs 20.0%, χ²=10.39, p<0.01, 29.6 vs 10.5%, χ²=9.66, p<0.01, 42.0 vs 24.4, χ²=5.82, p<0.05, respectively). Microalbuminuria in elderly patients may be caused not only by diabetic glomerular changes but also by glomerular changes due to aging and hypertension. Microalbuminuria, macroangiopathies and hypertension in elderly diabetic patients may develop interrelatedly depending on common vascular damages due to diabetes and aging.

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In order to improve the adequacy and safety of transportation for elderly people, the reasons for, and the after-effects of stopping driving by elderly people were analyzed. The subjects consisted of 500 car manufacturing retirees, aged 60 years old and over, living in Kanagawa prefecture. Of the 500 people questioned, 298 people (59.6%) responded. Of these 196 currently held licences. In this group, 149 still drove, 9 intended to stop driving soon, and 38 had already stopped. Of the 38 people who had already stopped driving, 7 quit before age 55. These people were omitted from analysis because factors other than aging possibly contributing to their stopping driving. We were interested in the 31 people older than 55 and the 9 people who intended to quit soon. The results were the following: I) The main reasons why they had stopped driving were the following: a) anxiety felt because of decreased driving ability and the feeling to need to walk in order to improve their health; b) the needlessness of driving because of availability of other means of transportation; II) The anxiety from decreased driving ability correlated with difficulty with narrow roads and imparied vision making it difficult to observed road signs; III) The reasons for stopping driving correlated with the effects: the needlessness of driving because of use of other means of transportation correlated with decreased frequency of going out for hobby and group activities. These results show that stopping driving also affects the social activities of the Japanese elderly. It was concluded that we should inform the elderly drivers of the effects of stopping driving as well as improving conditions on roads and comfort in automobiles.

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Postoperative delirium and abnormal behaviour were studied in 160 patients aged 60 and over with relation to their QOL assessed before surgical operation. QOL was assessed physically, psychologically, mentally and socially. Physical status was assessed with ability in daily life, seeing, hearing and severity of disease. Psychological condition (depression) was assessed by using GDS (Geriatric Depression Scale by Sheikh), Mentality (dementia) was assessed by using CDR (Clinical Dementia Rating) and HDS-R (Revised version of Hasegawa's dementia Scale). Sociality was assessed by social life and familial enviroment. Postoperatively 37.1% of males and 28.9% of females developed delirium and abnormal behaviour. Abnormal behaviour of demented patients was not defined as due to delirium or as dementia itself, so it was included in the classification “delirium and abnormal behaviour” becouse of the same aspect in terms of practical nursing care. The following factors were found to be statistically related to the occurrence of postoperative delirum and abnormal behaviour: disability in daily life, dementia, disturbance of hearing. Scores of HDS-R was closely related with the possibility of postoperative delirium and abnormal behaviour.

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