[in Japanese]

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[in Japanese]

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Actual age and biological age are not always proportional. To find out indices of aging, other than actual age, we investigated relationship between aging and four hepatic fibrosis markers: hyaluronates, type IV collagen, type IV collagen 7s and P III P.
The subject of this study were 78 patients of inpatients and outpatients of our hospital. They were divided into four groups of very eldery (over 80-year-old), eldery (70-79-year-old), non-eldery (50-69-year-old), and non-eldery (20-49-year-old), and these four groups were compared.
The results were as follows: regarding hyaluronates value were 86.3±46.7ng/ml in the patients in the very elderly group, 58.9±37.4ng/ml in the elderly group, 48.7±71.9ng/ml in patients aged between 50 and 69 years old, and 22.6±26.1 ng/ml in patients aged between 20 and 49 years old. Regarding type IV collagen value were 134.6±27.8ng/ml in the very elderly group, 131.1±46.5ng/ml in the elderly group, 135.1±102.1ng/ml in patients aged between 50 and 69 years old and 92.8±21.8ng/ml in patients aged between 20 and 49 years old. Type IV collagen 7s value were 4.4±0.9ng/ml in the very eldery group, 4.4±0.6ng/ml in the elderly group, 4.8±1.6ng/ml in patients of between 50 and 69 years old, and 4.3±0.6ng/ml in patients between 20 and 49 years old. P III P value were 0.70±0.31U/ml in the very elderly group, 0.64±0.34U/ml in the elderly group, 0.59±0.43U/ml in patients aged between 50 and 69 years old, and 0.46±0.14U/ml in patients aged between 20 and 49 years old.
The results indicated that three markers: hyaluronates, type IV collagen, P III P increased with the aging. Especially, hyaluronates were remakably increased. Next, we studied 159 patients (78 patients added to 81 patients who visited our hospital for health checkup), and investigated the fluctuation of hyaluronate values by the aging. The results showed a definite increase of hyaluronate values with age. A correlation was recognized between ages and hyaluronate values (correlation coefficient: r=0.64, p<0.001).
Furthermore we investigated effect on aging of various items including fibrosis markers, immunoglobulin or serum albumin by using multiple factor analysis, and found that hyaluronates influenced most strongly on aging (p<0.0002, p<0.00002). Thus, hyaluronates could be considered to be an index other than actual ages to evaluate progress of aging.

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We examined the effect and safety of combination therapy with low-dose diuretics (hydrochlorothiazide: HCTZ) and angiotensin II receptor antagonist (losartan) in elderly cases of hypertension, using ambulatory blood pressure monitoring (ABPM). Elderly hypertensive patients (mean age 75±2 years) were treated with either losartan (25-50mg/day) or HCTZ (12.5mg/day) for at least 4 weeks, and then 24-hour blood pressure (BP) was measured by ABPM. Combination therapy with addition of other drug was initiated in 14 patients whose 24-hour systolic BP or daytime systolic BP was over 140mmHg (160mmHg for the patients of 80 years or older). After 4 weeks of the combination therapy, ABPM was repeated. Blood cell count and blood chemistry were also done before and after initiation of combination therapy. In the losartanpreceding group (n=9), the combination therapy with HCTZ reduced 24-hour BP by 19.3±2.3/6.6±2.3mmHg. Similarly, daytime and night time BP decreased by 21.4±4/8.4±2.8mmHg and 15.2±4/4.2±2.4mmHg, respectively. In the HCTZ-preceding group, the combination with losartan also decreased 24-hour BP by 12.2±4.8/3.4±1.4mmHg. The decreases of day time and night time BP were 13.8±6.6/4±1.1mmHg and 10±4.7/3±2.4mmHg, respectively. Heart rate did not change with combination therapy in the losartan-preceding group, while heart rate during daytime tended to decrease by addition of losartan in the HCTZ-preceding group (3.8±1.7/min). Serum electrolytes, uric acid, lipids, renal function and body weight did not change during the study period. Thus, combination therapy of losartan/hydrochlorothiazide seems useful in the treatment of elderly hypertension, showing additive BP lowering effect without metabolic adverse effects.

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Clinical trials have shown that beta-blockers can produce symptomatic improvement and decrease the risk of death in chronic heart failure patients. However, the side effects of beta-blockers including worsening heart failure, AV-block, contracting peripheral vessels and unfavorable effects on glucose and cholesterol metabolism tend to make physicians hesitate to prescribe beta-blockers for elderly patients. Carvedilol is a novel non-selective beta-blocker without intrinsic sympathomimetic activity (ISA) and has vasodilating effect through blocking alpha 1 receptor. We examined the effects of carvedilol on cardiac parameters in order to clarify whether beta-blocker may affect left ventricular function in elderly Japanese patients with hypertension, angina pectoris, or both.
We examined the hemodynamic effect of carvedilol in 16 patients with hypertension, angina patients or both, aged 65 and over (75.5±5.6y.o.). After 12 weeks treatment with 10-20mg daily oral administration, echocardiography was performed and hemodynamic parameters were calculated to evaluate their cardiac functions.
Blood pressure was significantly decreased, especially in systolic pressure (163.8/87.6±15.6/11.2mmHg to 141.6/76.9±16.6/11.7mmHg, p<0.001/p<0.01, respectively). Ejection fraction increase (65.8±11.8% to 71.2±11.4%, p<0.05) accompanied heart rate decrease (72.0±16.1bpm to 63.9±11.4bpm, p<0.05).
Carvedilol increased ejection fraction and decreased blood pressure safely in elderly patients with hypertension, angina pectoris, or both. Taking the condition of each patient into consideration, alpha-beta-blocker can be beneficial in elder patients.

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The effect of time elapsed after standing on the orthostatic change in blood pressure was investigated. The study subjects were recruited from 237 community-dwelling elderly residents free from any history of cardiovascular disease and not on medication. Basal blood pressure was determined by averaging two determinations of supine blood pressure measured with an automatic oscillometric blood pressure recorder after resting for more than 10 minutes. Orthostatic change in systolic blood pressure (SBP) was determined as more than a 10% increase or decrease in SBP after standing. In the total population, maximum change in SBP was observed at 1 minute after standing-up. However, 8.4% and 7.2% of subjects showed abnormal increase or decrease in SBP only after 3 minutes. These results suggests that orthostatic dysregulation of blood pressure could be evaluated by measuring at 1 minute after standing up. However, if abnormal variation of blood pressure was not observed at 1 minute after standing up, repeated measurement at 3 minutes would be necessary.

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The purpose of this study was to examine the relationship between outdoor-activity areas and physical functions such as muscle strength, postural balance, gait function, and to identify the physical functions related to accomplishment of outdoor activity in elderly persons utilizing outpatient rehabilitation facilities. Furthermore, we investigated the relationship among physical, social and intellectual activities and physical functions. The subjects were 265 elderly persons (average age: 80.3±7.0). They were classified into the indoor-activity group, neighborhood outdoor-activity group and long-distance outdoor-activity group, and functional differences among the three groups were examined. The Barthel index, one-leg standing time, timed up-and-go test and performance-oriented mobility assessment were significantly different among the three groups. These results suggested that physical functions have a close relationship with extension of the activity area. Based on 95% confidence intervals, elderly subjects with more than 95 points on the Barthel index seemed able to do neighborhood outdoor activities. Those who can finish timed up-and-go test in less than 18 seconds, and obtain 26 points in performance-oriented mobility assessment may be able to do long-distance outdoor-activities using a bus. Furthermore, it was found that physical function was largely affected by physical activity such as exercise habituation and house keeping. In conclusion the difference of the activity area as well as extended activities of ADL influenced the physical function, which was critical to prevent functional decline in elderly persons.

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We tested the effects of inhaled β2-adrenergic drug on the physiologic function of the respiratory system and quality of life (QOL) in elderly patients with chronic obstructive pulmonary disease (COPD). We measured the pulmonary function, static respiratory pressures, and ventilation during exercise, before and after inhalation of the β2-adrenergic drug, fenoterol bromide (FB) in 12 male COPD patients (mean age 82.1±0.6 years old). QOL was measured with a St George's Respiratory Questionnaire (SGRQ) in the patients. Forced expiratory volume in one second was increased by the inhalation of FB in the patients, whereas the ratio of residualvolume to total lung capacity was decreased by the inhalation. Maximum inspir atory pressure was significantly increased after the inhalation of FB. Dyspnea sensation during exercise assessed by the Borg scale was reduced by the inhalation of FB. The scores on SGRQ were improved by one-month treatment with FB. These results indicate that treatment with FB is effective for both physiological function of the respiratory system and several aspects of QOL in elderly patients with COPD.

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A 78-year-old woman who had bronchial asthma for 15 years developed dysesthesia, neuralgia, muscle weakness and atrophy in both feet and her left hand. Prednisolone (maximum dose 80mg) was not effective, and she displayed gait disturbance. Laboratory findings showed leukocytosis (neutrophils dominant), renal dysfunction, elevation of CRP and positive P-ANCA. Biopsy revealed vasculitis, and reduced density of myelinated fibers. Although steroid pulse therapy improved neuralgia and renal dysfunction, severe disability of motor function and sensory disturbance still remained. Vasculitis syndrome following bronchial asthma indicated Churg-Strauss syndrome (CSS), while severe renal dysfunction and lack of eosinophilia were symptoms compatible with microscopic polyangiitis (MPA). The present case showed properties of both MPA and CSS.

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There have been reports of cases in which quality of life and loneliness of elderly people have been affected by interaction with the pet-type robot AIBO. In the present comparison between first and 20^th sessions of activity with the pet-type robot, statistically significant improvements were observed in speech, emotional words and satisfaction index. The AKO loneliness scale value was 3.33 at the first session, and was 1.00 at the 20^th session (statistically significant decrease). In a comparison of health-related QOL before and after interaction with AIBO, using the SF-36 survey, role function (RP) was statistically higher at the 20^th session than at the first session. Evaluation by CgA, a mental stress index, showed a statistically significant decrease as the number of AIBO sessions increased.
Case 1: The patient was a 68-year-old woman with chronic rheumatoid arthritis. Her AKO loneliness scale value was 4 on the first session and 1 on the 20^th session. She said, “I do not think about anything while playing with the pet-type robot. It heals my mind.”
Case 2: The patient was a 74-year-old woman with cervical osteochondrosis. Her AKO loneliness scale value was 5 on the first session and 2 on the 20^th session. She said, “The first time, I didn't like playing with the robot because I was depressed. After I had played with the robot several times, I felt good.”
Case 3: The patient was an 84-year-old man with cerebral apoplexy sequelae. His AKO loneliness scale value was 6 on the first session and 1 on the 20^th session. He sang with the robot occasionally. The amount of conversation between him and his children greatly increased.
Unlike animals, a pet robot does not carry the risk of bacterial infection. The present results suggest the possibility of using robots as a substitute for animal-assisted therapy and other psychosocial therapy in aseptic rooms, ICUs, children' s wards, and special care wards for patients with dementia.

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