[in Japanese]

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[in Japanese]

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In order to maintain and improve the mental health of elderly people living in the community, a cross-sectional survey was conducted to elucidate their depressive state and its background factors. Subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study used the self recording questionnaire sheets used in the Kahoku Longitudinal Aging Study by Matsubayashi et al and the Zung Self-rating Depression Scale (SDS). Out of 2, 379 elderly persons who were able to fill in the questionnaire by themselves in the community, 2, 361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1, 181 (49.6%) (542 males (average age 72.3±5.5) and 639 females (average age 73.0±6.3). Degree of depressive state as evaluated by SDS was normal for 731 persons (61.9%); mild, 240 (20.3%); moderate, 181 (15.3%); and severe, 29 (2.5%). The average age became higher as the SDS became high, of being indicating the seriousness of the depressive state (p=0.0155), with the ratio women significantly higher (p=0.0077). Among those with severe SDS, the ratio of single persons was high (p<0.001) as well as those who were non-drinkers (p=0.0015), without regular habit of walking (p<0.001), or without work (p<0.001). The ratio of those receiving medication regularly was also significantly high (p=0.0022). As for the relation of SDS with various of the scores, the higher the SDS score became, the scores for ADL, information-related function, functional and emotional support network, family relationship, friendship, economic condition became significantly lower (p<0.001, respectively). In logistic regression analysis using the background factors for SDS as explanatory variables, factors such as being women (odds ratio, 1.73; 95% confidence interval, 1.10-2.72), ADL (0.80; 0.69-;0.93), emotional support network (0.88; 0.81-0.96), friendship (0.98; 0.96-0.99) were significant independent contributing factors. As for the relation between SDS and subjective senses, the more serious the SDS score became, the scores for feelings of healthiness and satisfaction became significantly smaller (both p<0.001). For prevention and amelioration of the depressive state of elderly persons living in the community, attempts should be made to improve the background factors which were clarified by the present study by efficiently utilizing health, medical and welfare services and following the future course with a positive attitude.

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The aim of this study was to examine the changes of activities of daily living and with quality of life of patients in a special nursing home founded in 1997 in Tsuwano Town, Shimane. We studied 19 special nursing home patients (age 69 to 96 years, mean age 83.3 years) for one year. To evaluate activities of daily living, mental decline, and quality of life, the Tokyo Metropolitan Institute of Gerontology Competence Index, Hasegawa's dementia rating scale, self-rating depression scale (Zung), apathy scale (Starkstein et al) and PGC morale scale (Lawton, subjective well-being scale) were used.
The total score of the index of activities of daily living, self-rating depression scale, and the apathy score did not significantly change during one year. Although the total score of Hasegawa's dementia rating scale decreased significantly, PGC morale scale significantly improved during one year.
These findings demonstrate that daily active rehabilitation had a beneficial effect on PGC morale scale in a special nursing home.

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The aim of this study is to clarify the relationship between the efficacy of sulfonylureas and duration of diabetes in elderly diabetics. Daily blood glucose profiles were measured in 87 Type 2 elderly diabetic patients on sulfonylureas (tolbutamide, gliclazide or glibenclamide). Plasma glucose concentrations were determined at 08.00 (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00, 08.00 hours. The subjects were divided into 4 subgroups, according to their duration of the diabetes (<10, 10-14, 15-19, 20 or more years). Mean plasma glucose values at 08.00, 10.00, 20.00, 03.00 and 06.00 hours were not significantly different among the four groups. However, mean plasma glucose values at 12.00, 14.00, 18.00, 00.00 hours and mean total blood glucose area under the daily profile (total BG) were significantly different among the four groups and the values in patients with a history of diabetes of 15 years or more increased. Duration of diabetes positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00, 03.00 hours and total BG, and the dose of sulfonylureas positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00 hours and total BG in multiple regression analysis. These results suggest that duration of diabetes and dose of sulfonylureas are important determinants of blood glucose control with sulfonylureas in elderly diabetic patients.

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An investigation of acute myocardial infarction (AMI) was performed in Obihiro City, Hokkaido from October 1, 1990 to March 31, 1996. Based on the recorded cases, we conducted an investigation on the progress of 194 survivors by questionnaires, and we investigated the factors affecting long-term prognosis of AMI. The mean follow-up period was 1.62 years. The mean age at onset and frequency of hypertension were higher in women than in men. On the other hand, a larger percentage of men smoked and drank alcohol.
Kaplan-Meier analysis showed that survival was strongly influenced by aging, drinking, prior history of AMI or stroke, renal dysfunction, cardiac failure and early rehabilitation. Using Cox's hazard model, it was found that mortality risk increases 1) by 1.5 times for an increase of 10 years in age (2.6-times higher for people over 65 years old), 2) by 2.5 times for people with a history of AMI or stroke, 3) by 4.6 times for people with renal dysfunction, and 4) by 5.7 times for people with cardiac failure of Killip class III or IV. On the other hand, it was found that mortality risk decreases 1) by 0.3 times for people who drink alcohol, 2) by 0.1 times for people who have undergone PTCA, and 3) by 0.3 times for people who have undergone rehabilitation. The mortality risk is high for people who do not drink alcohol and those who have not undergone rehabilitation using Cox's hazard model adjusted all those factors.
In conclusion, prognostic predictor in chronic-stage acute myocardial infarction are aging, drinking, prior history of AMI or stroke, renal dysfunction, cardiac failure, early rehabilitation, and PTCA. The results also indicated that, regardless of the historical and clinical characteristics, early rehabilitation is very important to increase the probability of long-term survival.

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Although sarcoidosis is generally considered a disease of young and middle aged adults, there have been a certain number of cases among elderly. However it is unknown whether sarcoidosis in the elderly is recurrence of prior disease or initial onset at old ages. We present a 77-year-old woman with sarcoidosis the onset of which was considered to be in the last 6 months prior to the initial diagnosis. The patient was admitted to our hospital for further evaluation of bilateral hilar and mediastinal lymphadenopathy (BHL) and uveitis. BHL was not present in a chest radiograph taken 6 months prior to the admission. A clinical diagnosis of sarcoidosis was made by elevated serum angiotensin converting enzyme (ACE) and lysozyme (24.9IU/L and 18.2μg/ml, respectively), negative tuberculin skin test, concomitant presence of uveitis, and a high proportion of lymphocytes (33.2%) in bronchoalveolar lavage fluid with an elevated CD4/CD8 ratio (24.5). This is a noteworthy case of sarcoidosis in which we could confirm elderly onset of the disease.

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An 82-year-old woman was admitted with severe chest pain and orthopnea on January 17, 1997. Physical examination revealed bilateral leg edema and cyanosis at the periphery of the extremities. The serum CK level was 488IU/l on admission and increased to a maximum value of 4, 866IU/l 8 hours after admission. An echocardiogram demonstrated diffuse severe hypokinesis in the left ventricle. Serial electrocardiograms showed transient right bundle branch block, left bundle branch block, and normal sinus rhythm. The patient was diagnosed as having congestive heart failure. Artificial ventilation was performed, and furosemide, isosorbide dinitrate and dopamine were administered. A right ventricular endomyocardial biopsy performed on the 13th hospital day demonstrated moderate hypertrophy and disparity of cardiac myocytes and fibrosis around the myocytes, and few inflammatory cells in the specimens. This biopsy finding was not compatible with acute myocarditis but with the chronic stage of myocarditis. The patient was discharged on the 45th hospital day, but returned because of a recurrence of congestive heart failure. After an improvement of the heart failure, a coronary angiography was performed on the 20th hospital day. The coronary angiography revealed significant stenosis in three vessels. This elderly patient had congestive heart failure and triple-vessel coronary artery disease with transient alternating bundle branch blocks on serial electrocardiograms. Alternating bundle branch blocks and diffuse left ventricular dysfunction was considered to be induced by the aging process, postmyocarditic change of myocytes, and triple-vessel coronary artery disease in this case.

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We report a rare case of idiopathic thrombocytopenic purpura (ITP) associated with acute myocardial infarction (AMI). A 72-year-old woman with hypertension and hemorrhoids was admitted because of chest pain, severe anemia (RBC 340×10⁴/μl, Hb 5.4g/dl, Ht 21.7%) and thrombocytopenia (0.2×10⁴/μl). AMI was diagnosed by electrocardiogram (ST elevation and negative T in V_2-5), echocardiogram (hypokinesis in anteroseptal wall) and laboratory (CPK 470U/l) findings and was treated with only blood transfusion. Chest pain disappeared the day after admission, and neither heart failure nor arrhythmia occurred. Based on bone marrow findings (hyperplasia of erythroblast and megakaryocyte), endoscopic (internal hemorrhoids) and laboratory (antiplatelet antibody positive, platelet associatedIgG 257.8ng/10⁷ cells) findings, iron deficiency anemia and ITP were diagnosed. Anemia improved after blood transfusion, but thrombocytopenia (<1.0×10⁴/μl) without active bleeding continued after steroid and γ-globulin therapy. At discharge, electrocardiogram showed a negative T in I, _aV_L and V_2-5, and Tl and BMIPP myocardial scintigram showed defects in the anteroseptal and apical wall.

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