Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 40 , Issue 4
Showing 1-22 articles out of 22 articles from the selected issue
  • Takashi Orui, Mutsuo Yamaya, Hiroyuki Arai, Hedetada Sakaki
    2003 Volume 40 Issue 4 Pages 305-313
    Published: July 25, 2003
    Released: March 02, 2011
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  • Yoshiomi Takagi, Rie Komori
    2003 Volume 40 Issue 4 Pages 314-318
    Published: July 25, 2003
    Released: March 02, 2011
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  • Shunya Takizawa
    2003 Volume 40 Issue 4 Pages 319-321
    Published: July 25, 2003
    Released: February 24, 2011
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  • Takeshi Yamashita
    2003 Volume 40 Issue 4 Pages 322-324
    Published: July 25, 2003
    Released: February 24, 2011
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  • Toshifumi Matsui, Takae Ebihara, Takashi Ohrui, Mutsuo Yamaya, Hiroyuk ...
    2003 Volume 40 Issue 4 Pages 325-328
    Published: July 25, 2003
    Released: February 24, 2011
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    Pneumonia is a common cause of death in elderly people. A series of our studies have demonstrated that pneumonia in the elderly is characterized by silent aspiration, impaired swallowing and cough reflex, partly due to cerebral infarctions at basal ganglia. These infarctions probably induce the disruption of the specific central neurotransmitter system including dopamine and substance P, which plays an important role for swallowing and cough reflex. Use of ACE inhibitor and stimulation of the oral cavity by simple oral care, which are effective in increasing substance P, reduced the incidence of aspiration pneumonia. Moreover, use of a dopamine agonist such as amantadine hydrochloride and a folic acid supplement that are known to potentiate dopaminergic neurons also prevented aspiration pneumonia. For patients bedridden due to lowered ADL, it is essential for them to keep an upright position a few hours after meals to prevent aspiration pneumonia caused by the reflux of ingested foods. Also, administration of neuroleptics may cause aspiration pneumonia by suppression of dopaminergic neurons.
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  • Yayoi Katoh
    2003 Volume 40 Issue 4 Pages 329-331
    Published: July 25, 2003
    Released: February 24, 2011
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  • Koichi Node
    2003 Volume 40 Issue 4 Pages 332-335
    Published: July 25, 2003
    Released: February 24, 2011
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  • Tomohiko Urano
    2003 Volume 40 Issue 4 Pages 336-338
    Published: July 25, 2003
    Released: February 24, 2011
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  • Kiminori Goto
    2003 Volume 40 Issue 4 Pages 339-340
    Published: July 25, 2003
    Released: February 24, 2011
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  • Hiroshi Hosoda, Kenji Kangawa
    2003 Volume 40 Issue 4 Pages 341-343
    Published: July 25, 2003
    Released: February 24, 2011
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  • Takashi Sakurai, Bo Yang, Koichi Yokono
    2003 Volume 40 Issue 4 Pages 344-347
    Published: July 25, 2003
    Released: February 24, 2011
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    Neuronal cells usually utilize glucose as a principal metabolic fuel and monocarboxylates including lactate and pyruvate are alternative energetic substrates in the central nervous system. In the present study, we investigated the synaptic utilization of lactate/pyruvate in the hippocampal slices from adult and aged guinea pig brains. Synaptic activity was estimated in terms of the amplitude of field population spikes (PS) recorded in the granular cell layer of the hippocampal dentate gyrus. Replacement of extracellular glucose with lactate suppressed the synaptic activity, followed by spontaneous recovery of PS amplitudes in the slices from 3-4-weeks old guinea pigs. In the presence of chelerythrine, an inhibitor of protein kinase C (PKC), substitution of lactate for glucose did not maintain synaptic activity. In contrast, application of H-89 and lavendustin A, inhibitors of cAMP-dependent protein kinase and tyrosine kinase, respectively, did not influence the synaptic utilization of lactate. In the hippocampal dentate gyrus from 24-months old guinea pigs. extracellular lactate did not sustain the synaptic function. These results indicate that the PKC-dependent metabolic process is involved for the synaptic utilization of lactate in the adult brain, and that lactate metabolism in synapse is impaired in the aged brain.
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  • Toshio Miyata, Yasuhiko Ueda, Masaomi Nangaku
    2003 Volume 40 Issue 4 Pages 348-351
    Published: July 25, 2003
    Released: February 24, 2011
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  • Kikuo Okamura, Katsushi Nagahama, Takatoshi Usami, Hirohiko Nagata, Ta ...
    2003 Volume 40 Issue 4 Pages 352-359
    Published: July 25, 2003
    Released: February 24, 2011
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    Criteria for general practitioners to assess treatment efficacy are needed to efficiently treat urination problems in the elderly. Recently, criteria have been developed for urologists to assess the efficacy of benign prostatic hyperplasia treatment using the International Prostate Symptom Score (I-PSS), QoL index and maximal flow rates. We examined whether these criteria can be applied to the general urination problems of the elderly men and women, with 85 male and 16 female subjects aged 50 and over. Furthermore, we set Level I criteria using the I-PSS and QoL indices, Level II criteria using I-PSS, QoL index and post-void residual urine in addition to Level III criteria using I-PSS, QoL index and maximal urine flow rate. Correspondence rates among assessments by these criteria of treatment efficacy were investigated. Ninety-nine of 101 patients (98.0%) were assessed properly using the Level III criteria but the efficacy graded as “fair” and “unchanged” in Level III in each patient should be “poor” and “fair” in reality. Our findings suggest that Level III criteria should be useful for assessing the treatment efficacy of urination problems of elderly men and women besides benign prostatic hyperplasia. All of the patients, whose treatment efficacy was graded as “excellent” or “good”, and those with efficacy graded as “unchanged” or “poor”, according to the Level I criteria, were appropriately assessed by the Level III criteria. Of 35 patients whose treatment efficacy was graded as “fair” at Level I, the efficacy of 6 patients was graded as “unchanged” according to Level III. All of the patients, whose treatment efficacy was graded as “excellent” or “good”, and those with efficacy graded as “poor”, according to the Level II, were also appropriately assessed by the Level III criteria. However, the efficacy of 11 and 4 patients of 38 and 35 patients, respectively, whose efficacy was graded as “fair” and “unchanged” at Level II, was graded as “unchanged” and “fair” according to Level III, respectively. We believe that simple criteria including only I-PSS and QoL index are useful for general practitioners to assess treatment efficacy of urination problems in the elderly. It is suggested that patients with efficacy graded as “unchanged”, or “poor” should be referred to a urologist but those with efficacy graded as “exellent”, “good” and “fair” should be treated continuously. However, 17% of the patients with efficacy graded as “fair” by Level I criteria might be judged “unchanged” from the viewpoint of urologists.
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  • Kikuo Okamura, Katsushi Nagahama, Takatoshi Usami, Hirohiko Nagata, Ta ...
    2003 Volume 40 Issue 4 Pages 360-367
    Published: July 25, 2003
    Released: February 24, 2011
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    As the population ages rapidly, we need to establish a cost-effective system to assess and treat urination problems of the elderly. Recently, criteria have been developed for urologists to assess benign prostatic hyperplasia using the International Prostate Symptom Score (I-PSS), QoL index, urination function (maximal flow rates and residual urine volume) and prostate volume. It is suggested that patients with moderate to severe urination problems as measured by these criteria need to be treated but those with mild problems have no need for treatment. We examined whether these criteria can be applied to the general urination problems of elderly men and women, with 112 men and 21 women aged 50 and over as subjects. Furthermore, we set Level I criteria for the elderly themselves, their families or nurses taking care of them, using I-PSS and QoL index, and Level II criteria for general practitioners, using I-PSS, QoL index and residual urine volume, in addition to Level III criteria for urologists (omitting prostate volume in women). Correspondence rates among seventies of urination problems at Level I, II and III, and sensitivities and specificities of Level I and II criteria were investigated. One hundred twenty-one patients of 124 with moderate to severe urination problems at Level III needed to be treated and eight of nine with mild urination problems did not. As a whole, our findings suggested that 129 of 133 patients (97.0%) were correctly assessed at Level III. We found that Level III criteria were valid for general urination problems of the elderly, not just benign prostatic hyperplasia. While 102 and 111 patients were judged as having moderate or severe urination problems, respectively, at Level I and Level II, and all of these were diagnosed as having moderate or severe problems at Level III, 22 (71.0%) of 31 and 13 (59.1%) of 22 patients judged as having mild urination problems at Level I and Level II were diagnosed as having moderate problems at Level III. Although specificities of Level I and Level II criteria were 100%, sensitivities improved from 82.3% (102/124) to 89.5% (111/124), adding residual urine measurement to the I-PSS and QoL scores. Polyuria of more than 2, 000ml per day was noted in 33 patients (24.8%). At Level I, residual urine of 50ml or more was noted in 9 (29.0%) patients with mild urination problems, in 22 (24.2%) with moderate problems and in 4 (36.4%) with severe problems. Assessment criteria for general practitioners should include a frequency-volume chart and measurement of residual urine. When the elderly are judged as having moderate or severe urination problems according to either Level I or II criteria, they need treatment. However, more than half of the elderly, judged as having mild problems according to those criteria, need treatment from the standpoint of urologists.
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  • Hiroshi Fujimaki, Yutaka Kasuya, Shino Kagami, Sachiko Kawaguchi, Shir ...
    2003 Volume 40 Issue 4 Pages 368-374
    Published: July 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    The aim of the present study is to clarify relevant factors concerning the short-term outcome of elderly patients beginning dialysis.
    One hundred nineteen patients aged 60 years and over who had newly started dialysis at our hospital were studied. The male/female ratio was 70:49. The age was 74±7 years (mean±standard deviation). In all patients, the timing of referral to a nephrologist (early late), the urgency of the initiation of dialysis (non-urgent/urgent), the cause of renal failure (non-diabetes/diabetes), serum albumin concentration, comorbid conditions (cerebrovascular disease, ischemic heart disease, etc.), ambulation, cognitive function, and the outcome (relief/death) were surveyed. Twelve patients did not obtain relief and finally died.
    The influence of the timing of referral on the urgency of the initiation of dialysis was studied. Furthermore the influence of the urgency of the initiationof dialysis on the outcome was studied. The χ2 test was used for statistical comparisons. The need for urgent dialysis was less among early referral cases as compared with late referral cases (p<0.0001). The incidence of death was more frequent in urgent dialysis than in non-urgent dialysis (p=0.016).
    Multivariate logistic regression analysis was performed using background factors as explanatory variables and the outcome as a dependent variable. Statistically significant factors were the urgency of the initiation (p=0.040), serum albumin concentration (p=0.022), and cerebrovascular disease (p=0.002). The most common cause of death was severe infectious diseases (pneumonia, sepsis). It was speculated that background factors associated with the outcome could contribute to the onset and the progression of infectious diseases.
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  • Tomio Hamada, Taishiro Chikamori, Masanori Nishinaga, Yoshinori Doi
    2003 Volume 40 Issue 4 Pages 375-380
    Published: July 25, 2003
    Released: February 24, 2011
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    Recently, it has been reported that hypertension causes not only cerebro-cardiovascular diseases, but also a decline of cognitive function in the elderly. However, it is not clear whether or not aging and hypertension have a latent effect on the cognitive-neurobehavioral and cardiac functions in healthy elderly whose scores of basic activities of daily living (ADL) are fully maintained.
    We evaluated the effect of aging and hypertension on cognitive-neurobehavioral and cardiac functions in 25 healthy community-dwelling elderly subjects (mean age: 69 y. o.) whose scores of basic ADL were fully maintained. Subjects were followed over a 5-year period, and the following examinations were performed before and after a 5-year follow-up; echocardiography, 24-hr ambulatory blood pressure monitoring (ABPM), and cognitive-neurobehavioral function test.
    Left ventricular mass index was significantly increased in the hypertensive (HT) subjects relative to the normotensive (NT) subjects over the 5 years (% change: +5.3% for HT vs. -0.8% for NT, p=0.03). The number of non-dippers significantly increased over the 5 years in the HT group (initially: 20% [2/10] vs. follow-up: 58% [7/12], p=0.04). Visuospatial cognitive performance scale scores for evaluation of higher cognitive-neurobehavioral functions significantly deteriorated in the HT subjects (initially: 2, 344±110 vs. 2, 380±102, ns, and follow-up: 2, 149±181 vs. 2, 356±159, p=0.04). Hypertension contributes to the impairment of the cognitive-neurobehavioral function in the elderly by latently affecting the functions of multiple organs. This occurs even if basic ADL is maintained for 5 years. Therefore, it is important to control BP not only to prevent cardiovascular events, but also to preserve the neurobehavioral function.
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  • Akiko Kuroda, Tadashi Kanda, Noriyoshi Asai
    2003 Volume 40 Issue 4 Pages 381-389
    Published: July 25, 2003
    Released: February 24, 2011
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    The purpose of this study was to identify significant factors influencing health-related quality of life (HRQOL) of caregivers for home care patients with stroke. Subjects were 150 caregivers and 167 stroke patients who required help in activities of daily living (ADL) after discharge. HRQOL of caregivers and patients was assessed using a EuroQol utility score obtained by mailed questionnaire. The questionnaire also included the following items; caregiver's relationship to the patient, age, nursing care hours, family support, patient's functional changes after discharge, stroke recurrence, ADL, public nursing care insurance, care levels, and number of services patients received. The mean QOL score of 0.82±0.18 for caregivers was significantly higher than that of 0.57±0.20 for patients. Multiple regression analysis revealed that the significant factors influencing caregiver's QOL were caregiver's age and family support for caregivers, and anxious/depressed state, pain/discomfort state, and failure of memory of the patients. In addition, a significant correlation of QOL score was observed between patients and caregivers in the pain/discomfort and anxious/depressed states. The results of our study suggested that the alleviation of the patient's depressive state after stroke and the family's active support to caregivers played an important role for improving caregiver's QOL.
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  • Akihiro Hasegawa, Yoshinori Fujiwara, Tanji Hoshi, Shoji Shinkai
    2003 Volume 40 Issue 4 Pages 390-396
    Published: July 25, 2003
    Released: February 24, 2011
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    The purpose of this paper is a) to make a comparative study of the existence of ikigai (reason (s) for living) in elderly people and its relevance to their family structure, physiological situation and functional capacity in both rural areas and metropolitan suburban areas, and b) position basic research into the structure of ikigai in the near future, by clarifying several related factors, from which the concept of ikigai may be defined. The meaning of the word “ikigai” in Japanese is difficult to express exactly, and specialists in gerontology have varying definitions.
    If ikigai were translated from Japanese into English, it could be “reason (s) for living”, “self-actualization”, “meaning of life” and/or “purpose in life”. In this paper, ikigai is used to mean “feeling of being alive now and/or individual motivation for living”.
    As of October 2000, we studied 1, 544 people aged 65 years and over living in town Y of Niigata Prefecture (rural area), and as of January 2001, we studied 1, 002 people in the same age group in town H of Saitama Prefecture (metropolitan suburban area).
    The above investigations revealed the following characteristics: —(a) Regarding the percentages of persons having or not having ikigai, there were no significant differences between the rural area and the metropolitan suburban area. (b) In both areas, the 3 factors of self-rated level of health, intellectual activeness and social roles, were associated with having ikigai. (c) In the rural area, the family structure was strongly associated with having ikigai, but gender or generation were irrelevant. (d) In the metropolitan suburban area, the hospitalization experience of men was strongly associated with ikigai. Furthermore, there was a strong correlation with generation.
    In this regard, while the contents of ikigai are seldom examined in detail, clarification of the structure of ikigai should be worked out in the next stage of the study, using covariance structure analysis. In addition, the development of concrete plans to promote ikigai by municipal organs could be beneficial.
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  • Makoto Mitsunaga, Naoko Miyauchi, Yurika Akiyama, Shigeki Saima
    2003 Volume 40 Issue 4 Pages 397-401
    Published: July 25, 2003
    Released: February 24, 2011
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    There have been some reports of disseminated Strongyloidiasis associated with immunosuppressive therapy around the endemic area. We encountered an elderly patient with Strongyloidiasis hyperinfection during corticosteroid therapy. The case was a 75-year-old man, living in Tokunoshima, Kagoshima Prefecture, who had no remarkable past history. He visited a clinic because of exertional dyspnea and edema of the lower limbs. Laboratory examination showed renal dysfunction, microscopic hematuria and proteinuria. On December 2000, he was admitted to our hospital on a suspected diagnosis of rapidly progressive glomerulonephritis. Further examinations showed normal serum creatinine, severe microscopic hematuria and proteinuria of more than 3g per day. Although we wanted to determine a treatment based on a pathologic diagnosis, considered his age and severe kyphosis, he had 30mg of prednisolone as an empiric treatment. Strongyloides stercoralis were identified from his sputa and stool by microscopic investigation 21 days after initiation of corticosteroid therapy. Subsequently, 6mg of Ivermectin was given twice every two weeks. S. stercoralis were eradicated and his proteinuria improved. This case suggests that S. stercoralis could be the cause of urine abnormality.
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  • Akiko Aoki, Takako Sato, Toshihisa Igarashi
    2003 Volume 40 Issue 4 Pages 402-403
    Published: July 25, 2003
    Released: February 24, 2011
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  • 2003 Volume 40 Issue 4 Pages 404-408
    Published: July 25, 2003
    Released: February 24, 2011
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  • 2003 Volume 40 Issue 4 Pages 409-414
    Published: July 25, 2003
    Released: February 24, 2011
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