To study travel outside the home by elderly people and perceived problems with such travel, a questionnaire was sent to 238 men and women aged 60-year-old and over living in a small town in Kanagawa prefecture. Public transportation in this town consists mainly of buses, and the bus ride from the nearest train station takes about 50 minutes. A total of 190 people responded (83.3%, after exclusion of those who had died, moved away, or were in the hospital). Of those 190 people, 166 (74 men and 92 women) went out by themselves and their responses were analyzed. About 50% of both men and women said that they go to the hospital once or twice a month and go out for hobbies less than several times a year. The means of transportation differed according to sex and age: 80% of men in their 60s said that they drive alone, but many men in their 70 s and older said that they ride buses or walk. Women in all the age studied said that they ride buses or drive with others. More than 50% of men and women reported problems with transportation: men reported anxiety about driving alone and women reported difficulties with the poor means of transportation or when walking upstairs or uphill. Many men and women in their 80s said that they would rather not be driven places by others or be helped by others while riding trains or buses. These findings show the patterns of travel outside the home by elderly people of different ages, and the problems these people perceive with regard to various modes of transportation. They should be useful in the design of transportation suitable to older people.
Symptoms and other abnormalities associated with serum sodium imbalance were studied in bedridden elderly and healthy elderly subjects. 1. A significantly higher number of the bedrideen elderly suffered from chronic wasting disease. 2. The average serum sodium concentration in bedridden elderly subjects was significantly lower than in healthy subjects, as was the sodium intake and the sodium content in urine, which indicate that the bedridden elderly subjects suffered from chronic sodium deficiency. 3. The bedridden elderly subjects had high levels of plasma PRA and antidiuretic hormone, and their aldosterone levels were low, which indicate that their condition was associated with a decrease in available circulating plasma, hypersecretion of antidiuretic hormone, and a decline in the ability to retain sodium. 4. Measurement of 24-hr creatinine clearance, albumin, and β2-microglobulin in urine revealed that bedridden elderly subjects had high levels of renal dysfunction, the result of which may a disturbance in water excretion. Abnormalities in serum sodium levels in the bedridden elderly subjects were related to a chronic deficiency in sodium intake, which reduced their ability to maintain sodium levels and impaired their renal function. Iatrogenic factors are likely to play an important role in the genesis of this condition, and should be taken into account in during management.
With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. To meet that demand and to improve the curriculum for teaching geriatric medicine and gerontology in Japan, we surveyed medical students' understandings of these specialties. Students at 14 schools with classes in geriatric medicine and gerontology were surveyed. A questionnaire was sent to sixth-year medical students after their classes had ended. Questionnaires were collected from 849 students (60.1%) at ten medical schools (74.1%). One quarter (24.5%) of the students were satisfied with the contents of the classes in geriatric medicine and gerontology taught in their school, whereas 39.4% were not. These specialties encompass many fields of clinical and basic medicine, and many students found the lectures difficult to understand (41.4%). Inter-school comparisons of the results showed that students' strengths and weaknesses in the various areas of geriatric medicine reflected differences in the contents of the classes among the schools. Only 35.4% of students had ever visited hospitals or other health-related facilities for the elderly. Many students (58.8%) had never lived with elderly people. Most students (63.9%) wanted visits to health-care facilities for the elderly to be included in their regular curriculum. Medical students are conscious of the medical implications of the ageing of Japan' s population; 13.2% had volunteered to work with the elderly.
With the aging of Japan's population, physicians need to be aware of advances in geriatric medicine. To assess the status of geriatric medicine in undergraduate education, we surveyed of medical student' s opinions on gerontology and geriatric medicine. A questionnaire was sent to six-year medical students at a total of 20 schools that did not include geriatric medicine in their curriculum. Responses were obtained from 950 students (47.6%) at 16 schools (80%). Almost half of the students (42%) had experiences in health care facilities for the elderly. Ten percent were content with their education in geriatric medicine education and 59% were not. A total of 41.4% felt that geriatric medicine is difficult because it involves many different subjects. Some students had experience as volunteers working with elderly people; they were aware of the aging of Japan's population, and felt that their training in basic geriatrics and in geriatric diseases was insufficient. A total of 56% agreed that all medical schools should have classes in geriatric medicine and 14% did not. Medical students in the schools without classes in geriatric medicine identified dementia (73%), cerebral vascular accidents (51%), cancer (24%) and osteoporosis (19%) as common in elderly people, with no differences between schools. The corresponding data for medical students in schools with classes in geriatric medicine were dementia (77%), cerebral vascular accidents (44%), osteoporosis (29%), and cancer (16%). Undergraduate medical students seem to be exposed to widely differing curricula with regard to geriatric medicine. We found a lack of uniformity in the teaching of gerontology and geriatric medicine to undergraduate medical students in Japan.
To clarify the relationship between non-specific neurological complaints and silent cerebral infarction (SCI), we studied 82 patients (56±8 years old; mean±SD) who presented with at least one complaint (headache, dizziness, forgetfulness) and 76 normal volunteers with no complaints (55±7 years old). All subjects were evaluated with a questionnaire for complaints and with 0.5 T magnetic resonance imaging of the brain for the presence of SCI. Several risk factors for stroke were also studied. SCI was significantly more common in the patients (18%) than in the normal subjects (7%, p<0.05). SCI was more common in subjects with dizziness (40%) and in those with headache (18%) than in those with no complaints (p<0.01, p<0.05, respectively). Dizziness and forgerfulness were closely associated with SCI (p<0.05). Two risk factors for stroke, age and hypertension, correlated with SCI. These results clearly show that non-specific neurological complaints are closely related to SCI.
In patients more than 65-year-old with diabetes mellitus, positive late poentials on signal-averaged electrocardiograms were more common than in normal subjects (p<0.05). This suggests that aged patients with diabetes mellitus are at risk for micromyocardial impairment. Myocardial scintigraphy with 123I-metaiodobenzylguanidine showed abnormally low uptake, in parallel with the data on SA-ECG. Thus, both methods may be clinically useful ways to noninvasively reveal micromyocardial impairment in aged patients with diabetes mellitus. Moreover, trimetazidine hydrochloride may be effective as therapy for micromyocardial impairment: the uptake of 123I-metaiodobenzyl guanidine had increased in some patients when measured 1 year after administration of trimetazidine hydrochloride (18mg/day) and the late potential changed from positive to negative.