Poor medication compliance is a major issue in the health care of older patients. To identify risk factors for medication noncompliance in the elderly, inpatients aged 65 years and older at Nagoya University Hospital and at Chubu National Hospital underwent a comprehensive geriatric assessment and tests for the assessment of medication compliance. The dependency of medication assistance by a caregiver is associated with low physical function activity, cognitive impairment, depression and communication inability. Medication noncompliance was not associated with the score of any component of comprehensive geriatric assessment. There was a good relationship between patient's knowledge of medications and the frequency of dosage interval, both of which were associated with the score of instrumental ADL, cognitive function and communication ability. The knowledge was also associated with the medication compliance at Nagoya University Hospital but not at Chubu National Hospital. These results may suggest that the elderly patient's understanding of a medication regimen is important but that other factors are also required to maintain their treatment regimen.
We examined the agreement between reports about physical and psychological status obtained from 286 community-dwelling elderly persons aged 65 years and over (subjects) and their family members (proxies). A total of 205 subject-proxy pairs were studied. Information from subjects was obtained by a self-administered questionnaire, and proxy respondents by an interview-administered questionnaire between Nov. 1997, and Feb 1998. Agreement was assessed by percent agreement and statistical kappa values. Percent agreement ranged from a low of 50.8 for anxiety to a high of 90.4 for difficult in swallowing. Kappa values ranged from a low of 0.21 for anxiety to a high of 0.67 for high frequency of falling. Median kappa values were higher in summary measure of physical status (0.52) than in that of psychological status (0.39). Compared to subjects, their partners tended to report higher level both in physical status and in psychological status, except for sleep compliance and introversion. The median kappa was 0.54 for spouses, whereas it was 0.39 for family members other than spouses. Overall, our finding indicated that partners could be aware of the concrete and directly-observable variables of physical status such as constipation, difficult in swallowing, but not so for subjective variables as psychological status such as depressed condition and introversion, Our results also suggested that the degree of agreement of proxy' s perception and understanding of lifestyle of the elderly is closely related to health status of the elderly.
To examine the roles of obstructive apnea (OA) and central apnea (CA) in oxygen desaturation on hypertension and sleep apnea syndrome (SAS), we performed a sleep study on 41 elderly subjects (mean age 69.5±6.8 years, male: female 31:10). Nocturnal oxygen desaturation was documented with a pulse oximeter and apneas (OA and CA) were diagnosed on the basis of results of respiratory inductive plethysmography and oronasal flow. Significant desaturation (SDS, greater than 5% drop in SpO2 from baseline value) and desaturation index (DI; ∑SDS (%)×duration (hour)) were calculated using the continuous nocturnal monitoring system with a pulse oximeter. We defined central type apnea above 50% as the central type group (n=8, mean age 58.6±2.9, mean BMI 21.3±1.0, male: female=7:1), and obstructive type and mixed type apnea above 50% as the obstructive type group (n=21, mean age 70.0±3.2, mean BMI 25.3±1.0, male: female=17:4). Other subjects were assigned to the control group (n=12, mean age 64.3±2.3, mean BMI 23.8±1.2, male: female=7:5). The DI (Δ5%) of the central type was 0.34±0.17, and that of the obstructive type was 1.78±0.7 showing a significant increase in the latter compared to the control group (p<0.02). The DI (<90%) of the central type was 0.14±0.07, and that of the obstructive type was 1.72±0.75, and that of the obstructive type was significantly greater than in the control group (p<0.05) and central type (p<0.05). There were 4 cases (33.3%) with hypertension in the control group and 4 cases (50.0 %) with hypertension in the central type group, but there were 15 cases (71.4%) with hypertension in the obstructive type group. Hypertensive prevalence in the obstructive group was significantly more than in the control group (p<0.05). No significant difference in body mass index or age were seen in the obstructive group and control group. There was a significant correlation between mean blood pressure and apnea index (AI). The AI of the hypertensive group was significantly higher than that of the normotensive group (p<0.001). These results suggest that subjects with significant obstructive apneas may be at greater risk for hypertension than subjects with central apneas and that hypertension in the pathogenesis of SAS may be related to the severity of apneas rather than oxyhemoglobin desaturation.
Life span, which is mainly influenced by pathologic lesions, was compared between specific pathogen-free male Donryu rats fed ad libitum (AL group) and those with dietary restriction (DR group, restricted to 60% of the ad libitum intake). The major age-related lesions observed were pituitary tumor, chronic nephropathy; cardiomyopathy, and myopathy (anterior tibial and masseter muscle). Dietary restriction was effective in slowing the progression of pituitary tumor, chronic nephropathy and myopathy in anterior tibial muscle. Although cardiomyopathy worsened with age, no difference was seen between the AL and DR group. In conclusion, 1) dietary restriction acts to suppress or delay the development of pathologic lesions that occur with age, 2) the onset phase of a pathologic lesion differs with the lesion and organ involved, 3) inhibiting the development of pituitary adenoma and chronic nephropathy can help prolong the life span of rats, 4) for muscle lesions, depending on their anatomical location, the physiological condition of exercise, as well as the relationship with other organs can be involved.
Ischemic colitis has been considered to have relatively high prevalence in the elderly population with underlying vascular disorder such as hypertension. However, this disease has been recently reported increased in the young population so that it is not necessarily limited to the aged. The aim of the present study was to elucidate the characteristics of age-related clinical features in ischemic colitis. The subjects consisted of 30 patients with ischemic colitis admitted to our hospital during the last 5 years. They were divided into the aged group more than 65 years old and the young group aged 65 or less. As a result, there were no significant differences in symptoms, resulted serological examination, endoscopic findings, and treatment period. Lesion sites were more extended in the aged group. Concerning underlying disease and etiologic factors, the vascular factor was important in the aged group, while the peristaltic factor, especially constipation was important in the young group. Ten of the 30 patients had habitual constipation, and the aged group had a high percentage of paralytic constipation, while the young group had a high rate of spastic constipation. Many patients with paralytic constipation had a history of underlying diseases and laparotomy, while the patients with spastic constipation did not have such a history. Therefore, it is presumed that the spastic type of constipation is an etiologic factor in ischemic colitis.
To investigate the determinants of endothelial cell damage in hypertensive elderly patients, we measured the plasma von Willebrand factor (vWF) levels by a recently developed enzyme-linked immunosorbent assay using monoclonal antibody for the functional epitope. Plasma vWF level was markedly increased in the elderly normotensive subjects (n=42) than in younger normotensive subjects (n=39) (127 vs 88%, p<.0001), and was further increased in elderly hypertensive subjects (n=68) (148%, p<.05 vs elderly normotensives). The vWF level was positively correlated with body mass index in younger normotensive subjects (r=0.41, p<.01), with systolic blood pressure (BP) in elderly normotensive subjects (r=0.41, p<.01), and with age (r=0.44, p<.001) and fibrinogen level (r=0.37, p<.01) in elderly hypertensive subjects. In elderly hypertensive subjects (n=150), vWF level had a stronger positive correlation with 24-hr systolic BP measured (r=0.41, p<.0001) by ambulatory BP monitoring than with clinic systolic BP (r=0.33, p<.0001). In conclusion, in hypertensive elderly patients, endothelial cell damage increases with systolic BP and fibrinogen levels, indicating a prethrombotic condition.