Degenerative joint disease and osteoporosis, both of which tend to increase with advance in age, were thought to be essentially different mainly because of the artifactually high lumbar spine bone mineral density (BMD) in the former unlike osteoporosis characteized by persistent decrease of BMD. To clarify the relationship between these two diseases, three-dimensional BMD of the trabecular and cortical bone was measured separately in an area of the radius relatively free of degenerative changes by peripheral computed tomography (pQCT). In addition to radiological assessment of spondylosis deformans, quantification of vertebral deformity was attempted by calculation of standard deviation, coefficient of variation, difference between maximum and minimum density divided by the mean of L1-L4. With advance in age and progress of spondylosis deformans, the standard deviation, coefficient of variation difference between the maximum and minimum density and this difference divided by the mean of L1-L4 increased, but radial trabecular bone density, cortcal density and relative cortical volume decreased, suggesting parallel advance of degenerative joint disease and osteoporosis. Sodium etidronate, an antiresorber commonly used in the treatment of osteoporosis, increased mean lumbar spine BMD and markedly decreased the standard deviation, coefficient of variation, difference between the maximum and minimum density and this difference divided by the mean of L1 and L2 but maintained maximum BMD constant, decreasing vertebral deformity due to spondylosis deformans. It is conceivable that calcium release from bone on increased resorption leads to osteoporosis, and calcium entrance into cartilage, causing its hardening, disappearance and degeneration, direct contact between bones, osteoarthritis and subsequent deformity in a single sequence of events.
Since falling is one of the main causes of morbidity and mortality among the elderly, attention should be paid to prevention. The purpose of the present study was to investigate the risk factors for falls among the elderly by a 5-year longitudinal observation. The subjects were the elderly aged 65 years and over living in a rural community in the eastern part of Honshu, Japan. Of the 852 eligible subjects, 685 persons (278 males and 407 females) received the multidimensional medical examination including physical performance as the baseline of TMIG-LISA (Tokyo Metropolitan Institute of Gerontology, Longitudinal and Interdisciplinary Study on Aging) in 1992. From baseline medical examinations, the following variables were adopted to investigate risk factors for falls (2 or more times during the 5-year follow-up): self-rated health, experience of falling, TMIG-index of competence, visual deficit, anthropometric measurements (height, weight, BMI, total skinfold thickness), lumbar bone mineral density, and physical performance tests (grip strength, finger-tapping rate, one leg standing time with eyes open or closed, preferred and maximum speed walking for 5 meters). A total of 108 subjects experienced falls two or more times during the 5-year follow-up period (43 men and 65 women). There were significant differences in grip strength, preferred and maximum walking speeds between those who fell and those who did not. Multiple logistic regression analysis controled for age, sex and other variables adopted in this study revealed the following variables were significantly and independently related to falling: experience of falling within one year preceding the baseline survey (directly, p<0.0001), preferred walking speed (inversely, p<0.005) and total skinfold thickness (inversely, p<0.01). These results suggest that the walking test as well as the experience of falling have discriminant and predictive validity for assessing the future occurrence of falls among the elderly.
The present study investigated factors influencing the destination following discharge from geriatric intermediate care facilities (GICF) located in a suburb of a metropolis. A set of questionnaires was prepared, and a survey was conducted involving 204 subjects (46 men, 158 women, average age 84 years) of three GICFs and their families. Seventy-two percent of clients were termed bedridden and 84% as having dementia. Furthermore, 63% of them were admitted to GICFs from hospitals, and about half used the GICFs more than twice. Most families cared for the subjects before admission into the GICFs, and were feeling the burden of daily care. The families desired them to stay in the GICFs for as long as possible. Forty-five percent of the families wanted the subject to go back home after discharge. About 30% of subjects returned home, 31% were admitted to a hospital and 40% were placed in GICFs. The following factors were related to discharge and return home: the family wanted the subject to return home, subjects admitted to GICFs from home could return home, good ability to walk, families consulted subjects about the destination following discharge, the cost of staying at the GICF was covered by the subjects' pension, and confirmed administration of drugs was not necessary. These findings suggest that in order for clients at GICFs to successfully return home, the facilities should consider where the family wants the clients to go.
In a total of 46 dementia patients with urinary incontinence, filling cystometry was performed to evaluate bladder function, followed by peroral administration of propiverine hydrochloride. Therapeutic effects were evaluated in terms of changes in cystometric bladder capacity and urinary incontinence. Based on cystometric findings, 58.1%, 35.3% and 6.4% of Alzheimer dementia patients proved to have overactive bladder, normoactive bladder and low compliant bladder, respectively. Similarly, 90.9% and 9.1% of vascular dementia patients had overactive detrusor and low compliance, respectively. As a result of propiverine hydrochloride administrarion for 2 weeks, both bladder capacity and incontinence improved in around 40%, irrespective of the dementia type (Alzheimer vs vascular). It is of interest, however, that patients with overactive bladder demonstrated more satisfactory response to the treatment than those with normoactive bladder. It is accordingly suggested that propiveline hydrochrolide is a promising treatment option for urinary incontinence in demented elderly and cystometry could be useful in predicting treatment outcome.
A 77-year-old man was admitted because of muscle weakness in both upper and lower extremities. Diabetes mellitus was diagnosed in 1988 and he had been treated by oral hypoglycemic agents. He had a common cold at the end of January, 1997. Muscle weakness appeared in the upper extremities, followed by the lower extremities at the end of February. No sensory disturbance or dysuria was recognized. Nerve conduction study revealed distally dominant demyelinating polyneuropathy. Guillain-Barré's syndrome was diagnosed and he recovered completely following immunological absorption therapy (IAT). However, he had quadriplegia again at the end of April. He was treated by IAT combined with corticosteroid and has shown no relapse. In June, 1997, gastric cancer was detected by upper gastrointestinal fiberscopy and subtotal gastrectomy was performed. Judging from this clinical course, this case seems to be chronic inflammatory demyelinating polyneuropathy (CIDP) with acute onset. Many kinds of causes often contribute to the pathogenesis of neuropathy in the elderly. So in cases of progression or worsening, we should consider such possibilities and it is necessary not to exclude treatable causes of neuropathy.
An 86-year-old man, with a history of old cerebral hemorrhage, experienced repeated syncope after the meal. The blood pressure significantly decreased at the onset of syncope, and postprandial hypotension (PPH) was diagnosed. In order to treat the syncope, we administered midodrine hydrochloride, amezinium metilsulfate and dihydroergotamine mesylate. However, each of these drugs failed to prevent PPH and the syncope persisted. Then we administered a combination of amezinium metilsulfate and dihydroergotamine mesylate. This led to the disappearance of the syncope together with PPH. Combined use of these drugs should be further evaluated in the elderly patients with PPH.