The quality of life has been shown to decline with advancing age, being affected by health status, physical symptoms due to multiple chronic diseases, and the level of remaining activities of daily living of the elderly. In the pharmacologic treatment of the elderly, attention must be paid to such backgrounds and adverse side effects of drugs must be considered in order to maintain the QOL of the elderly which has already been jeopardized. Therefore, prescriptions should be consist of drugs concerning the effects on the QOL have been established. Physicians and medical personnels treating or caring for the elderly should take into account the balance between the quantity and the quality of their remaining life.
To estimate the change in health-promoting activities among elderly people affected by community organizing environments, we examined the relationships among health-promoting activity, going out and perceived transportation problems. A questionnaire was sent to 567 men and women aged 60 years old and over living in a small town in Kanagawa prefecture between July 27 and August 12 in 1995. The questionnaire consisted of 42 items concerning health, social ability of daily living (including the desire to participate in social activities), attitude toward health-promoting activities, and perceived transportation problems. A total of 397 people responded and the answers from 368 people were analyzed after excluding responses from those unable to go out by themselves and those who seldom went out. Single regression analysis and multiregression analysis were used with the sum of responses for each question representing factors related to health-promoting behavior. A probability level of 5 percent was considered significant. The reliability of the data was examined with Cronbach's coefficient alpha. Coefficients of determination for health promoting behavior were 42% in men and 48% in women. In both men and women, age, social ability of daily living and attitudes toward health-promoting behavior were related to health-promoting activity. In women, more actively going out was related to more active health-promoting activity. Higher perception of transportation problems had a negative effect on going out. In men, neither of these factors had any relationship with health-promoting activity. In men, poorer health conditions were related to more active health-promoting activity, but in women, there was no relationship between those factors. These results show that there are gender differences in the relationships among the factors related to health-promoting activities in elderly people. In women, a higher perception of transportation problems restrained actively going out and health-promoting activity.
The purpose of this study was to investigate the life satisfaction and the help needs in post-stroke patients. A totaled 109 post-stroke patients were discharged from the rehabilitation ward of the Dokkyo University Hospital during two years from April 1995 to March 1997. The postal questionnaire was sent to 104 patients of them. The questionnaire was composed of two parts, one for the patients and one for their family members. The patients were asked about perceived improvement after discharge, outdoor activities, locomotor activities, and life satisfaction with their present state. Life satisfaction was assessed by using a visual analogue scale (VAS). The family members were asked about objective improvement of the patients after their discharge and their help needs. The distribution of the patients' life satisfaction showed a peak at around 50% by the VAS. While the perceived improvement and life satisfaction showed a significantly positive correlation, 9 patients (15%) recognized some improvement but marked their life satisfaction less than 50%. In help needs assessment, most family members classified them at a level of situational dependence or more. Only three cases were classified as dependence on individuals other than their family such as home help, which may suggest lack of social resources in their community. Logistic regression analysis revealed perceived improvement, going outdoors and age as significant adherent factors of life satisfaction, and objective improvement and age as those of help needs. Statistical analysis revealed a close association between perceived improvement and life satisfaction which have been suggested useful for QOL evaluation, but they must be interpreted as independent indicators.
In order to simply express the results of comprehensive geriatric assessment (CGA) for elderly disabled patients, we tried to develop a CGA system using a radar chart method in 50 patients (age 73-101, mean 85±5.4) admitted to our hospital during May 1997. Our clinical database for CGA included 7 major factors (diagnosis, mental function, physical function, nutritional state, complication, coronary risk factors, social background). Finally, the radar chart was made from the results of 6 scored factors other than diagnosis and the correlation was examined statistically between these factors. This study suggests that; (1) the radar chart method display of CGA is useful for all medical staff to understand the results of CGA for elderly disabled patients and the characteristic patterns of each disease, (2) because significant positive correlations were found between 3 factors (mental, physical, nutritional) in patients with cerebrovascular disease (CVD), a more global strategy for medical care planning, especially for treatment, nursing care and rehabilitation program is necessary in patients with CVD, (3) in patients with Alzheimer's disease (AD), significant positive correlation was found only between physical and nutritional factors; mental factors showed significant negative correlation only with the duration of morbidity and as a result, quality of life is a more important problem for planning care of patients with AD, (4) for elderly disabled patients, nutritional assessment and nutritional care planning are very important as well as mental and physical care planning.
Levofloxacin-induced neurological adverse events such as convulsion, involuntary movement (tremor, myoclonus and chorea-like) and visual hallucination in two elderly patients are reported. A 67-year-old man with minor alcholism and a past-history of gastrectomy and cholecystectomy was given 300mg/day of oral levofloxacin and fulfenamic acid for an upper respiratory infection. On the 4th day, he reported gradual exacerbation of hand tremor which resembled chorea-like involuntary movement and gait disturbance. He also experienced visual hallucinations. On the 7th day, he suffered generalized convulsions and was admitted. Serum concentration of levofloxacin at this time (3hours after last administration of a 100mg tablet of levofloxacin) was 3.6μg/ml. Cessation of the agents promoted complete recovery of these neurological adverse effects within a week. Another 85-year-old man with chronic bronchitis and slight renal impairment received long term administration of 200mg/day of levofloxacin. On the 68th day of administration, gradual exacerbation of gait disturbance, dysarthria and chorea-like involuntary movement occured. On the day of admission, 76 days after the start of administration, the serum level of levofloxacin was 2.55μg/ml and that of spinal fluid was 1.12μg/ml (3hours after the last administration of a 100mg tablet of levofloxacin). Cessation of the agents promoted complete recovery of these neurological adverse effects within the next two weeks. Both patients had no apparent neurological disorders except age-related brain atrophy. Age-related renal and brain impairment might have contributed to the neurological adverse effects of levofloxacin.