We investigated the degree of burden on care-givers and their subjective sense of well being, and studied the factors affecting them. Twenty people who were responsible for at least a year for constant care of elderly or bed-ridden patients under visitation care and nursing supervision of this hospital were registered. Regarding the care-givers, we investigated age, sex, duration of care, the relations between the care-givers and the cared-for, assistant care-givers, profession and hobbies, if any, of the care-givers, the depression scores; the social support, the degree of burden imposed by care, and the subjective sense of well being. As for the cared-for, we investigated their age, disease and degree of ADL. The burden felt by the care-giver became greater if the care-giver was a woman (p<0.05), if the relationship with the cared or the health status of the care-giver was poor (p<0.05, respectively), and if the scores for functional and emotional support networks were poor (p<0.005 and p<0.05, respectively). As for the cared-for, the burden was greater if they were older (p<0.05) and if it was difficult for them to leave bed (p<0.05). The sense of subjective well being of the care-giver was greater if there was an assistant care-giver (p<0.005); if the scores for the functional and the emotional support networks were higher (p<0.05, respectively); and if understanding of information in terms of ADL was not adequate (p<0.05). The present study suggested the importance of improving the emotional and functional support networks for the care-giver in helping them continue care by alleviating the burden and not suffering a loss in the subjective sense of well being.
To protect femoral neck fractures which are the most serious complication of osteoporosis and are increasing in frequency in Japan, an external hip protector (EHP) fixed in special underwear has been proven to absorb a direct impact to the greater trochanter during a fall from standing height. In this study, we investigated compliance concerning the use of EHPs, for six months using two types of EHP, i.e., hard pad type (Hip Protector®, Sahvatex) from Denmark (Fig. 1) and soft pad type (Safety Pants®, Rounomo Oy) from Finland. The subjects were 20 elderly women aged 70 years or more who had at least one experience of falling within the year preceding the baseline survey in September of 1997. The compliance rate is shown in Fig. 2. Though the soft type EHP had relatively better compliance than the hard type EHP, there was no significant difference between them. The main reason for early dropout (one or two weeks after baseline) was “difficulty to remove especially with regard to using the toilet”. The main reason for later dropout was “too tight to wear in winter”. There were no significant differences with regard to anthropometric measurements, physical activity, ADL, and rate of falls between compliers and dropouts except age (73.6 vs 78.5 yrs). Sufficient explanation at baseline and generatively good motivation for wearing the EHP will maintain a high compliance which may result in the effective prevention of hip fractures among the community elderly.
Responses to a questionnaire regarding 1) dying at home, 2) being told of a diagnosis of cancer, and 3) hydration and nutriton, uses of narcotics for pain and dyspnea, oxygen treatment, antibiotics, transfusion and surgery in a near-vegetative state was obtained from 562 outpatients (73.4±8.6 years: mean±SD, men: women=1.0:1.7). Dying at home was preferred by 64% and hospital death by 24%. Sixty and 65% of patients chose to be told of the diagnosis either in the last 3 months or at the early curable stage of the disease respectively, while only 53% wanted to be told precisely about their remaining estimated survival. If their spouse had terminal stage disease, 42% chose to inform the spouse of the diagnosis. Eighty percent chose palliative care, while 9.3% wished for intensive life-sustaining treatment. In a near vegetative state, tube feeding was desired by 8.7% and intravenous drip infusion by 39%; narcotics for pain or dyspnea were desired by 40 and 52%; oxygen or tracheostomy plus a respirator for dyspnea was chosen in 56 and 11% respectively; antibiotics for treatment of infection was desired by 38%; surgery for intestinal obstruction by 36 percent; transfusion for bleeding by 29%; and no treatment in any situation by 21%. Commonly expressed wishes were for a natural death, dying at home, and being told of the status of their disease, while details of palliative care were not well recognized.
In order to obtain the realistic background information on clinical features, and the present status of treatment and outcome in elderly patietnts with acute lymphoblastic leukemia (ALL), we carried out random survey of patients with ALL aged 60 or over who had been admitted to 13 general hospitals in the Nagoya region from January 1990 through December 1995. Among the 20 cases collected, ages ranged from 60 to 88 (median age 68), and the male to female ratio was 11: 9. Nineteen cases were L2 subtype in FAB classification. Among 17 patients, 13 had B cell series surface phenotypes (76%), 2 had T cell series (12%), one had stem cell type (6%) and one had an undetermined phenotype (6%). Ph chromosomes were detected in 4 cases among 15 analized (27%), whereas 5 were found to have no chromosomal abnormality. Half of the patients had some concurrent disease at diagnosis, including two with treatment-limiting complicatioms. Common induction regimens were the combination of adriamycin (ADM)+vincristine (VCR)+cyclophosphamide (CPM)+mitoxdn trone+L-asparaginase [4 patients], ADM+VCR+PSL [4 patients], VCR+PSL [4 patients] and others [8 patients]. The overall remission rate was 55.0% (11/20) without any significant difference according to age. The median survival time (MST) for all cases was 205 days (1-year survivial rate: 17.9%, 2-year survival rate: 10.8%). There was no significant differrence in survival times among patients with the Ph chromosome, those with other chromosomal abnormalities and those without them. All the patients aged 75 or over were treated with attenuated induction therapy, and they had a shorter survivial than those aged less than 75, but with no statistical siginificance [MST; 121 days versus 276 days, p=0.307 (generalized Wilcoxon test)].
We report an autopsy case of an 88-year-old man with idiopathic enlargement of the right atrium which is considered to be the oldest case reported. The patient was given a diagnosis of atrial fibrillation at the age of 75 years, when he developed congestive heart failure. Bradycardia associated with partial atrial standstill was detected and, the patient underwent implantation of a pacemaker at age 77. An echocardiogram revealed marked enlargement of the right atrium and moderate enlargement of the left atrium. Thus, idiopathic enlargement of the right atrium was diagnosed. He had recurrent congestive heart failure before admission to our hospital because of malnutrition and anemia. Although he was treated with high calorie intravenous infusion and blood transfusion, he died of pneumonia and heart failure. Postmortem examination revealed that the heart weighed 430g, and there was marked dilatation of the right atrium which had an extremely thin wall. The annular circumference of the tricuspid valvewas markedly dilated, 170mm, resulting in tricuspid regurgitation. The left atrium was moderately dilated and the right and left ventricles were slightly dilated. Histologically, the free wall of the right atrium was totally replaced by fibrous tissue and atrioventricular valves did not reveal any rheumatic changes. These pathological findings were compatible with idiopathic enlargement of the right atrium. There has been no previous case report of idiopathic enlargement of the right atrium in a patient aged 80 years of age or over.