The home management of chronic disability in the elderly often relies upon the receipt of family. These caregivers have been shown to experience a considerable burden in providing day-to-day care. It is important that identifying problem areas may result in the need of consider alternatives for the care of an elderly person, identify and mobilize existing community resources to relieve some of the “cost”. We studied the reliability and validity of a Japanese version of the Cost of Care Index (CCI) which was originally developed by Kosberg et al as a case management tool in the assessment of caregivers. Our subject consisted of 27 cases with dementia (mean age 74.5 years), and 15 cases of patients with neurological disorders without dementia (80.7 years), and their caregivers. The test-retest reliability and internal consistency were very good; the coefficient of correlation between CCI scores at the two interviews was 0.83, the coefficient of internal consistency was 0.92. CCI scores correlated significantly with ADL-20 scores, DBD score and caregivers' SDS scores; r=-0.48, r=0.46 and r=0.36, respectively. Our results indicate that the CCI is highly reliable, and may be useful for assessment caregivers' burden.

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COP-BLAM therapy with concomitant G-CSF was performed in patients 65 years of age of older with non-Hodgkin's lymphoma (NHL) and the therapeutic effects and its adverse effects were compared with those in a group not given G-CSF concomitantly. The subjects were 64 patients with NHL, divided into 36 in the G-CSF group and 28 in the non-G-CSF group. In the G-CSF group, complete remission (CR) was achieved in 88.9% and the efficacy rate was 94.5%. In the non-G-CSF group, 89.3% achieved CR, and there was no significant difference between the G-CSF and non-G-CSF groups. The survival time and duration of remission also showed no significant differences between the G-CSF and non-G-CSF groups. The frequency of granulocytopenia as an adverse effects was significantly reduced in the G-CSF group, but the other adverse effects showed no intergroup differences. The occurrence rates of fever of at least 37.5°C and documented infection were significantly less in the G-CSF group. These results indicate that COP-BLAM therapy with concomitant G-CSF achieved a high remission rate, showed few severe adverse effects, especially infections, and can be safely performed in elderly patients.

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Since 1976 medicobiological and sociological surveys have been carried out upon centenarians in Okinawa. Recently dementia and disability have increased among centenarians. In order to determine the statistical significance, ADL (Activities of Daily Living) scores among Okinawan centenarians were compared; 43 subjects were studied from the 1970's (1976-1980), 99 subjects from the 1980's (1986-1988), and 109 subjects from the 1990's (1992-1994). ADL scores of each centenarian were recorded by the same researchers at the University of the Ryukyus Hospital, based on observation and examination of the centenarians where they lived. Five categories of self sufficiency were defined; completely independent, independent but slow, independent with difficulty, partially dependent, and completely dependent. There were seven physical tasks scored; taking meals, bowel and bladder continence, ability to rise from a toilet, ability to stand, extent of general activities, ability to bathe, and ability to dress oneself. Their sensory functions (auditory acuity and eyesight) and cognitive abilities (comprehension and self-expression) were also scored. Declining rates of total ADL scores were more marked between the 1970's and the 1980's than between the 1980's and the early 1990's. It was also more remarkable in institutionalized centenarians than in centenarians living at home. Decline in physical activities was more distinct in institutionalized than in home-living centenarians. On the other hand, cognitive abilities declined more among centenarian living at home than among institutionalized centenarians. The population of centenarians has increased 23 times over the past 22 years in Okinawa. Human life span has been remarkably extended by advanced medical technology, physically easier life style, and improvement in overall social welfare. At the same time, the rate of institutionalization has increased due to the increased demand for care of the disabled elderly. The decline of average ADL scores among centenarians might be a reflection of this increase in institutionalization. Adequate and sufficient care might increase longevity to around a hundred years even in the disabled. However, we have to be careful and realize that all centenarian have their own unique level of ADL and life style that differs from what they might have had before. Otherwise, incorrect conclusions may be derived from research of the elderly. Such being the case, the kind of activities which each centenarian has been and is engaging in, should be part of all research reports on medicobiological studies of centenarians. Therefore, it should be noted that data from centenarians with debilities might be quite skewed due to their physiological conditions. Hopefully, instead of just being an issue of maintaining the health of the elderly, the quality of life for centenarians must also be taken into consideration, as well as their value to society, leading to a better living for centenarian.

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Gastric cancer in the elderly was evaluated with regard to age-related pathomorphological changes. Resected gastric cancer was studied with regard to location, stage, morphology and histology in male young old (65-74 years old) which were 25 cases and 31 lesions, respectively male middle old (75-84 years old); 104 cases and 120 lesions, male very old (85 years-); 96 cases and 110 lesions, female young old; 22 cases and 31 lesions, female middle old; 91 cases and 106 lesions, femaleyery old; 51 cases and 55 lesions. Multiple gastric cancers were more frequent in female older group. In early cancer the frequency of elevated type increased significantly and that of depressed type decreased in very old group. In advanced cancer Borrmann I type was not so common in very old group. Histologically the frequency of signet ring cell cancer decreased and of tubular adenocarcinoma and of papillary adenocarcinoma increased significantly in female very old group. Hepatic metastasis increased significantly in male very old group. Lymph node metastasis and peritoneal metastasis did not show any change in age-related frequency.

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We conducted a cross-sectional study of elderly outpatients with hypertension to examine the relationship between quality of life (QOL) scores and social background factors. The subjects consisted of 516 outpatients (267 females), age of 60 or over, at nine clinics of major hospitals which participated in the National Cardiovascular Center Research Project. The perceived QOL was evaluated by the QOL scale originally based on Japanese patients with cardiovascular diseases. The scale consisted of the following 5 subscales; difficulty due to disease, psychological stability, independence, satisfaction in daily living and vitality. The background factors included family structure, socioeconomic factors and work status, and physical activity of daily living (ADL). After adjusting for age, sex, administered drugs and complicating conditions such as ischemic heart disease and/or apoplexy, a significant odds ratio of a low score of difficulty due to disease, psychological stability, satisfaction in daily living and vitality was found in the impaired physical ADL group with low socioeconomic class, and a significant odds ratio of low score of independence were found in the impaired physical ADL group who had lost jobs due to illness and had no children.

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Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic disorders characterized by normal or hypercellular but dysfunctional bone marrow. They usually are refractory to empirical therapeutic regimens. Recently the prevalence of MDS in the elderly is increasing and now the syndromes are relatively commonly encountered in elderly patients. Two major causes of death in MDS are progression to acute leukemia (especially in subtypes of RAEB and RAEB in T), and bone marrow aplasia. Since cytoreductive therapy for RAEB or RAEB in T in the elderly is often accompanied by serious adverse complications, such as infection and hemorrhage, special care is necessary. Here we describe successful induction remission in a 74-year-old man with MDS (RAEB in T) by twice daily low-dose cytosine arabinoside injections (10mg/m², s.c.), which was well-tolerated, free of serious adverse effects, and seemed to be a useful therapeutic option for elderly patient with RAEB or RAEB in T.

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We report a 63-year-old female, case of multiple sclerosis associated with lateralization of bone change. In 1969, at age 38 she lost sight in her right eye. After that, she had several episodes of remission and exacerbation. In 1992, left hemiparesis, sensory disturbance and vesicorectal disturbance appeared, and she was admitted to our hospital. Immediately, steroid pulse-therapy was initiated then steroids were tapered. Her muscle strength recovered to some degree. The left upper limb showed low skin temperature, edema and decreased circulation. In January and September of 1993, bone examinations were conducted using multiple scanning X-ray photodensitometry. Osteopenia was observed, especially in the left hand. The bone density in the right hand changed slightly during the 8-month course of the illness, but osteopenia in the left hand became more marked. The asymmetrical bone change suggested that osteopenia results from a disorder of the central nervous system, especially through autonomic disorder.

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