[in Japanese]

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Global trends of increases in the aging population will continue in the 21st century, and geriatric medicine will be a most important field of medicine. Increase in the aging population naturally causes increases in numbers of patients with geriatric disease. Geriatric diseases are often chronic, slowly progressive, and hard to cure. Medical care expenses for the patients will expand dramatically. Therefore, the most important key for future geriatric medicine is prevention. For prevention, detailed data on normal aging process are required. At the National Institute for Longevity Sciences (NILS), a comprehensive longitudinal study of aging, the NILS-Longitudinal Study of Aging (NILS-LSA) started in November 1997. The subjects of this study were about 2, 300 residents aged 40 to 79 years who were stratified random samples selected from the neighborhood area of the NILS. They are examined every two years at the NILS-LSA Examination Center. The third wave of examinations started in 2002. Examined variables were over 1, 000, including clinical evaluations, medical examinations, anthropometry, body composition, physical functions, physical activities, psychological assessments, nutritional analysis and molecular epidemiology.

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The development of assistive self-support devices was an important strategy for improving quality of life in the elderly. After introduction of care insurance, independence from the physical and metal restrictions was recommended. In order to improve quality of life and independence form restrictions, we have developed several assistive devices. A baby-doll mimicking a baby was made add applied to the therapeutic program. This doll therapy has been used in several facilities for healing elderly, especially dementia patients. To prevent falls, a power-assisted walker was developed to compensate and support elderly gait. A fall detector was used to estimate falling and to develop guidelines for the prevention of fall.

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Oxidative DNA damage has been shown to accumulate with age in the nuclear and mitochondrial genome and cause cancer. Among DNA lesions produced by reactive oxygen species, base lesions and single-strand breaks are most frequently produced and cause mutation and cell death. However, these lesions are effectively repaired by base excision repair, which is very well conserved from bacteria to human. Since many proteins are involved in the repair process, understanding of their functions and the effects of repair deficiency will provide the relation between DNA damage and aging-related diseases. For this purpose we analyzed the proteins involved in the repair of oxidative DNA damage and found novel mechanisms protecting mammals againsto xidative stresses.

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Hypertension and diabetes are risk factors for arteriosclerosis and have a synergistic effect on the progression of arteriosclerosis. The aim of this study was to determine the correlation between complications of hypertension and diabetes and arteriosclerosis as assessed by pulse wave velocity (PWV) in elderly subjects. The subjects of this study were 186 people aged 60 years or older (mean age: 68.8±5.8 years) who were scheduled to undergo health examinations. PWV, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), fasting blood sugar (FBS), total cholesterol (TC), triglyceride (TG) and HDL cholesterol (HDL) were measured in each subject. The patients were divided according to the American Diabetes Association (ADA) diagnostic criteria for diabetes based on fasting blood sugar level into the following three groups: a normal (NGT) group (FBS<110mg/dl), an impaired fasting glucose (IFG) group (110≤FBS<126mg/dl) and a diabetes mellitus (DM) group (FBS≥126mg/dl or receiving treatment for diabetes). Based on the JNC-VI and WHO/ISH diagnostic criteria, subjects who had a SBP of 140mmHg or higher or a DBP of 90mmHg or higher or who had been taking hypotensive drugs were assigned to the hypertension (HT) group, and the other subjects were assigned to the normotension (NT) group. PWV showed significant positive correlations with SBP and FBS (r=0.499 and r=0.300, respectively). The effects of hypertension on PWV were significantly higher in subjects with HT than in subjects with NT in all of the glucose tolerance groups (all p<0.01). Moreover, in the subjects with HT, PWV started to increase from the IFG stage, and PWV was significantly higher in the DM groups than in the NGT group (p<0.01). In multiple regression analysis using PWV as an objective variable, SBP and FBS were selected as significant explanatory variables. The results of this study indicate the need for stricter management of elderly people with slight glucose tolerance impairment and hypertension in order to prevent the occurrence of arteriosclerosis.

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The records of 38 elderly patients with hip fracture admitted to our hospital between Januarys and December 2002 were retrospectively reviewed to determine the incidence and outcomes of medical complications. The mean age was 84.5±6.83 years old, 32 women and 6 men. 27 patients (71%) suffered from dementia. Of the 38 patients, 33 (86.8%) had one and more underlying diseases: hypertension 29, cerebrovascular episode 7, congestive heart failure 5, diabetes mellitus 4, gastric ulcer or chronic gastritis 3, ischemic heart disease 4, depression 2. Three patients had a past history of hip fracture. Fourteen patients (37%) developed medical complications after hip fracture, most frequently pneumonia (64%). Other complications were dizziness, nausea, congestive heart failure, choledocholithiasis, and GI tract bleeding. Eight patients who suffered pneumonia cancelled elective surgery. Severity of pneumonia was mild in 2, moderate in 5, and severe in 2. Both cases with severe pneumonia died in hospital. Patients with pneumonia (pneumonia group) were significantly older and had more severe dementia than patients without pneumonia (non-pneumonia group). Although there were no significant differences in physical ability between the two groups before admission, physical ability on discharge was lower in the pneumonia group. The pneumonia group had a significantly longer mean hospital stay than the non-pneumonia group. Our results suggest that the prevention of pneumonia is necessary to improve the outcome of hip fracture.

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Age-related changes of phosphatidylcholine hydroperoxide (PCOOH) were investigated in male Dawley rats aged 3 to 18 months, either fed ad libitum or dietary restricted (maintained on 60% of ad libitum food intake). Although there are many reports dealing with age-related changes of lipid peroxidation, they were exclusively results obtained by the non-specific thiobarbituric acid method. In this study, we measured PCOOH as an index of oxidative stress by a specific assay method using high-performance liquid chromatography with fluorometric post-column detection.
The PCOOH levels in ad libitum-fed rat plasma, liver and kidney increased with age. Dietary restriction significantly suppressed the age-related PCOOH accumulation in the plasma. In dietary restricted rat liver, PCOOH levels tended to be suppressed by the restriction. In dietary restricted rat kidney, they were not due to until 12 months of age, but the levels at 18-months of age were suppressed by the restriction.
Life span is mainly influenced by pathologic lesions. The increase in PCOOH levels with age can cause biomembrane damage, and appears to be involved in the development of lesions. Suppression of PCOOH level by dietary restriction appears to suppress the morbid conditions which shorten life span.

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To elucidate the present condition about health, medicine and welfare, and to evaluate factors associated with relief for elderly life in each community, a questionnaire survey was conducted among officers of all the municipalities in Japan. We asked officers about their recognition whether older people can live feeling relieved or not, and other factors about health, medicine and welfare condition in each municipality.
Demographic data of each municipality were also used as dependent variables.
Odds ratios and their 95% confidence intervals for the officers' evaluation of relief for life of the elderly were calculated using unconditional logistic models. Of the 3, 252 municipalities, 3, 059 (94%) responded to the survey. Of the respondents, 2, 957 municipalities (91%) answered questions about relief for elderly life.
“Receiving satisfactory medical home care service”, “cooperative function between medicine, health, and welfare sections”, and “receiving complete welfare service” were associated with their recognition about relief for elderly life in both of cities and rural towns. In addition, “the rate of elderly households” and “the easiness to maintain nursing staff” were associated in the cities.
This study indicated that more arrangements are needed not only about health and welfare aspects, but also about medical service, especially medical home care service systems to support older peoples' life in the community.

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A 81-year-old man, who had been diagnosed in multiple cerebral infarction and Alzheimer's disease, was followed up in his local clinic since 1997. He had been bedridden before admission, but could eat. He was admitted with severe aspiration pneumonia in December 1999. Since severe dementia and dysphagia were noted after admission, he was examined to find out whether or not he could swallow while the treatment of his pneumonia was conducted at the same time. The water swallowing test indicated a risk of aspiration, thus, percutaneous endoscopic gastrostomy was performed on January 26, 2000 after the completion of the treatment for pneumonia. Although the patient's condition was complicated by aspiration pneumonia, enteral feeding through the gastric fistula gradually became successful, and he was discharged in June 2000. His family physician followed him up by visiting at home to examine and observe his general physical condition including consciousness, vital signs, skin and respiration, while taking measures in cooperation with the local health care visiting nurse. The patient, thereafter, was repeatedly admitted and discharged because of exacerbation and remission of symptoms, including coughing, sputum and fever, probably caused by aspiration pneumonia. When he was admitted in December 2001, which was his sixth admission, since there were troubles with the infusion tube and frequent gastroesophageal reflux, the gastric fistula management was judged to be a great burden on the patient. In January 2002, the gastrostomy tube was removed and the patient, whose alimentation was managed using intra-venous hyperalimentation (IVH), was discharged. Besides periodic visits by his family physician, a 24-hour house visit system was introduced to control his IVH and deal with his family members' anxiety. His general condition, thereafter, has not markedly changed. The patient has continuously received medical treatment for 14 months after being discharged and his condition is stable.

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