Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 40 , Issue 5
Showing 1-22 articles out of 22 articles from the selected issue
  • Yoshihiko Yamada, Hisahiko Sekihara
    2003 Volume 40 Issue 5 Pages 421-428
    Published: September 25, 2003
    Released: March 02, 2011
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  • Toru Hunabashi
    2003 Volume 40 Issue 5 Pages 429-438
    Published: September 25, 2003
    Released: March 02, 2011
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  • Akihisa Iguchi
    2003 Volume 40 Issue 5 Pages 439-444
    Published: September 25, 2003
    Released: February 24, 2011
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  • Nobuo Yanagisawa
    2003 Volume 40 Issue 5 Pages 445-451
    Published: September 25, 2003
    Released: February 24, 2011
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  • Yo-ichi Nabeshima
    2003 Volume 40 Issue 5 Pages 452-454
    Published: September 25, 2003
    Released: February 24, 2011
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  • Kozui Kida
    2003 Volume 40 Issue 5 Pages 455-458
    Published: September 25, 2003
    Released: February 24, 2011
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  • Yasufumi Hayashi
    2003 Volume 40 Issue 5 Pages 459-462
    Published: September 25, 2003
    Released: February 24, 2011
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  • Teruhiko Higuchi
    2003 Volume 40 Issue 5 Pages 463-465
    Published: September 25, 2003
    Released: February 24, 2011
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  • Toshiki Ota
    2003 Volume 40 Issue 5 Pages 466-469
    Published: September 25, 2003
    Released: February 24, 2011
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  • Seiji Yasumura
    2003 Volume 40 Issue 5 Pages 470-472
    Published: September 25, 2003
    Released: February 24, 2011
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  • Mikio Shoji
    2003 Volume 40 Issue 5 Pages 473-475
    Published: September 25, 2003
    Released: February 24, 2011
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  • Toshihiko Iwamoto, Akihiro Kiuchi
    2003 Volume 40 Issue 5 Pages 476-479
    Published: September 25, 2003
    Released: February 24, 2011
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  • Iwao Kuwajima
    2003 Volume 40 Issue 5 Pages 480-483
    Published: September 25, 2003
    Released: February 24, 2011
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  • Naoakira Niino, Rumi Kozakai, Maki Eto
    2003 Volume 40 Issue 5 Pages 484-486
    Published: September 25, 2003
    Released: February 24, 2011
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    The purpose of the present study was to report the prevalence and circumstances of falls among community-dwelling elderly people in order to contribute to prevention of falls in the community. The subjects were 2, 774 elderly people who participated in health examinations conducted by Tokoname-shi, Aichi Prefecture in 2002. The variables investigated in the present study were demography and history of falls in the past one-year. Circumstances of falls, e. g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall.
    The prevalence of falls among 2, 774 subjects was 13.7%. It was significantly higher among women (17.2%) than men (8.3%, χ2=48.1, p<0.001). Prevalence increased as subjects get older. Circumstances of falls were assessed in 655 subjects. The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 10% of all falls caused fracture.
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  • Yoshinori Fujiwara, Hidenori Amano, Koji Takabayashi, Shu Kumagai, Yuk ...
    2003 Volume 40 Issue 5 Pages 487-496
    Published: September 25, 2003
    Released: February 24, 2011
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    Overestimation or underestimation of functional capacity in community-dwelling older people with cognitive impairment was evaluated between the responses of subjects and family members (proxies) by cognitive function level. Out of all the residents aged 65 years and over living in Yoita town, Niigata Prefecture in 2000 (n=1, 673), 1, 544 voluntarily participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items (2000/11). According to the age of the subject and MMSE score, we defined cognitive decline (MMSE scores<1 SD below age-specific means, n=371). 158 pairs among 371 subjects with cognitive decline and their proxies participated in a follow-up survey (2001/11). The subjects themselves underwent MMSE again. 136 subject-proxy pairs reported any complaints of memory-related problem and evaluated higher-level functional capacity (TMIG-IC, Tokyo Metropolitan Institute of Gerontology Index of Competence). We established criteria at follow-up survey as follows: control (n=29), MMSE scores>1 SD below age-specific means and CDR (Clinical Dementia Rating)=0: mild cognitive decline (MCD) (n=54), 21≤MMSE scores>1 SD below age-specific means or CDR=0.5); and severe cognitive decline (SCD) (n=53), MMSE scores 20≤or CDR>0.5. SCD subjects significantly overestimated total and Instrumental Self-Maintenance scores in TMIG-IC more than control or SCD subjects. Multiple logistic regression analyses indicated that complaints of memory by the proxy, response by spouse, and higher levels of education were extracted as significantly independent variables affecting overestimation for functional capacity. On the other hand, aging affected underestimation.
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  • Yumiko Arai, Nanako Tamiya, Eiji Yano
    2003 Volume 40 Issue 5 Pages 497-503
    Published: September 25, 2003
    Released: February 24, 2011
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    The Zarit Burden Interview (ZBI) is the instrument most widely used in North America and Europe for assessing the burden experienced by family caregivers who look after the community-residing impaired elderly. The Japanese version of the ZBI (J-ZBI) is the most widely used in Japan for the same purpose. We used data from 691 caregivers in relation to their caregiver burden with the 22-item J-ZBI. Following a factor analysis, the 8-item short version of the J-ZBI, the J-ZBI_8, was proposed with the following two factors: Personal strain (5 items) and Role strain (3 items). Cronbach' s alpha of the J-ZBI_8 was 0.89, indicating the high reliability of this instrument.
    Pearson's correlation coefficient between J-ZBI and J-ZBI_8 was 0.93, and the same coefficient between J-ZBI_8 and item 22 (a single global burden) was 0.68. These data indicated that J-ZBI_8 had a high concurrent validity. In addition, caregivers who declared that they did not encounter any difficulties in looking after the impaired elderly had a significantly lower J-ZBI_8 score (3.45; SD=4.57) than those who claimed that they had such difficulties (9.31; SD=7.19) by the t-test; this indicated that J-ZBI_8 had a high construct validity. These results indicated that the short version, the J-ZBI_8, had a high reliability and validity. Therefore, the J-ZBI_8 produced results comparable to those of the full version, i. e. the J-ZBI. The shorter yet no less reliable and valid 8 item version will thus lead to easier administration of the instrument for assessing family caregiver burden in clinical settings.
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  • Naoki Mantani, Toshiaki Kogure, Katsuhiko Itoh, Hironosuke Sakamoto, M ...
    2003 Volume 40 Issue 5 Pages 504-508
    Published: September 25, 2003
    Released: February 24, 2011
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    We investigated the opinions of medical doctors and nursing staff about desirable medical treatment for terminally ill geriatric patients. The purpose of the present study is :1) to examine the recent opinion of doctors and nurses, 2) to examine discrepancies of opinions between doctors and nurses on treatment for terminal geriatric patients. Doctors and nurses working in long-term care wards in four hospitals were enrolled. They were asked to fill in a questionnaire which asked about desirable medical treatments for a typical bedridden terminally ill geriatric patient. The difference of answers between doctors and nurses were analyzed. The most common opinion of the 18 doctors and 84 nurses were as follows :1) for the treatment of relapsing pneumonia, they would perform oxygenation, antibiotic injections, and continuous intravenous infusion during the period of discontinuation of enteral nutrition, 2) for the treatment of relapsing urinary tract infection, they would catheterize patients for a brief period and would irrigate the bladder, and would perform antibiotics injection, 3) for chronic anemia, they would perform iron replacement, 4) for decubitus ulcer, they would treat conventionally, and 5) at the final stage just before death, they would avoid special therapy for shock after obtaining informed consent from patient's family. To most questions, the proportion of each answer was almost identical between doctors and nurses; however, there were discrepancies concerning “way of nutrition in patients with relapsing pneumonia” and “irrigation of the urinary bladder” (p=0.0544 and 0.0531, respectively). We expect that the present study will activate a discussion of what constitutes appropriate medical treatment for terminally ill geriatric patients.
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  • Yoshihisa Hirakawa, Yuichiro Masuda, Kazumasa Uemura, Michitaka Naito, ...
    2003 Volume 40 Issue 5 Pages 509-514
    Published: September 25, 2003
    Released: February 24, 2011
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    Providing elderly people with nutritional care has become important. The aim of the present study is to clarify the factors limiting the widespread adoption of home visits by dietitians. From September to November 2002, we conducted a questionnaire survey of 211 dietitians belonging to the “Houeiken”, a group devoted to the study of dietician's home visits. We examined the following factors: characteristics of the study subjects, result of the home visits, factors limiting the widespread adoption of home visits by dietitians, and the future of home visits by dietitians. Among the dietitians, 49.7% did nutrition management, 30.5% catering management and 12.8% performed home visits (12.8%). In total, 53.5% of the dietitians had experience with home visits, having visited an average of 1 to 5 people. Typical visits included cooking lessons (27.5%), advice on energy intake (25.3%), sharing new recipes (23.6%), and anthropometric examinations (13.3%). A total of 76.8% thought their guidance was effective and noted significant improvements in terms of caregiver's cooking skills (30.0%), patient's understanding of diet (24.0%), and dietary intake (21.5%). The factors preventing more widespread home visits by dietitians are: few people are aware that this service exists, few people believe that they need this type of assistance, it is largely unprofitable, and the number of qualified dieticians is insufficient. We believe that more medical staff should become involved in dietitian' s home visits. Public policies should be implemented to lower dietitian' s nutritional care fees and increase the education and number of dietitians.
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  • Masayuki Kikukawa, Kouichi Shin, Toshihiko Iwamoto, Masaru Takasaki, R ...
    2003 Volume 40 Issue 5 Pages 515-519
    Published: September 25, 2003
    Released: February 24, 2011
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    An 82-year-old woman was admitted with fever and anorexia. Aggravated pancytopenia and liver dysfunction suggested the presence of disseminated intravascular coagulation. The serum ferritin level increased to 9, 100ng/ml. Bone marrow aspiration showed an increase of histiocytes with phagocytosis and a diagnosis of hemophagocytic syndrome was made. Symptomatic therapy was performed because of her deteriorated general condition. She died of multiple organ failure, 32 days after admission. Autopsy revealed swollen lymph nodes with proliferation of large neoplastic cells containing rich cytoplasm and pleomorphic and multi-segmented large nuclei. The immunophenotype of the neoplastic cells was LCA-, CD3-, CD5-, CD20-, CD79a-, UCHL1-, MT1-, CD15-, p80-. Neoplastic cells were positive for CD30, mainly in Golgi apparati, and also positive for EBV-encoded small nonpolyadenylated RNAs (EBER). This case was diagnosed as anaplastic large cell lymphoma (ALCL) associated with hemophagocytic syndrome. It was estimated that Epstein-Barr virus had played an important role in the development of ALCL in the present case.
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  • Masanori Umeda, Masako Katoh, Chiaki Arai, Kimiko Iijima
    2003 Volume 40 Issue 5 Pages 520-525
    Published: September 25, 2003
    Released: February 24, 2011
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    A 69-year-old man was found to have leukocytosis and a bleeding tendency, when he underwent surgery for hemorrhoids in November 1992, at the age of 69. The patient was referred to our department for further examination, and was admitted on December 4. On admission, he had hepatomegaly (5cm) and splenomegaly (12cm). Laboratory data on admission showed that the leukocyte count was 173, 400/μl, erythrocyte count, 314×104l, hemoglobin level, 10.5g/dl, hematocrit value, 29.7%, and platelet count, 14.4×104l, respectively. Peripheral hemogram revealed neutrophilia with a shift to the left to promyelocytes, and the positivity of neutrophil alkaline phosphatase (NAP) was very low. The bone marrow was hyperplastic with a high M/E ratio (5.8). As the chromosome analysis revealed that he had 9: 22 translocation in all 20 karyotypes, chronic myelogenous leukemia in the chronic phase, was diagnosed. After the daily intramuscular administaration of 9 megaunits interferon α-2b was started on December 9, 1992, his leukocyte count stabilized between 5, 000 and 8, 000/μl. Thereafter, intramuscular administration of IFNα has been continued regularly almost twice a week at the outpatient clinic until now. The leukocyte count ranges from 3, 000 to 6, 000/ml and he is asymptomatic. In April 1995, complete cytogenetic response was achieved 28 months after the start of interferon α therapy. The recent bone marrow chromosomes examination showed Philadelphia-negative metaphases until now. December, 2002, although major bcr-abl still remains positive.
    This case suggests that treatment with interferon a may still be useful in some elderly patients with chronic myelogenous leukemia.
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  • 2003 Volume 40 Issue 5 Pages 526-532
    Published: September 25, 2003
    Released: February 24, 2011
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  • 2003 Volume 40 Issue 5 Pages 532-539
    Published: September 25, 2003
    Released: February 24, 2011
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