Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 42 , Issue 1
Showing 1-29 articles out of 29 articles from the selected issue
  • Tetsuo Shimizu
    2005 Volume 42 Issue 1 Pages 1-8
    Published: January 25, 2005
    Released: March 02, 2011
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  • Taihei Fukuyama, Hisakazu Ogita, Yoshimi Takai
    2005 Volume 42 Issue 1 Pages 9-14
    Published: January 25, 2005
    Released: March 02, 2011
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  • Takayuki Kuriyama
    2005 Volume 42 Issue 1 Pages 15-17
    Published: January 25, 2005
    Released: March 02, 2011
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  • Hajime Orimo
    2005 Volume 42 Issue 1 Pages 18-20
    Published: January 25, 2005
    Released: March 02, 2011
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  • Shigeki Kuzuhara
    2005 Volume 42 Issue 1 Pages 21-24
    Published: January 25, 2005
    Released: March 02, 2011
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    Aged people are frequently the victims of iatrogenic diseases, especially adverse effects of drugs since they are affected by many age-related diseases and are given many drugs. Geriatric medicine in Japan has a bitter history of having produced many victims by adverse effects of cerebral vasodilators and cerebral stimulants; they included parkinsonism and depression induced by flunarizine and cinnarizine, and Reye-like encephalopathy induced by calcium hopantenate. Parkinsonism induced by sulpiride, tiapride, metoclopramide or atypical anti-psychotics, dyskinesia induced by anti-parkinsonian drugs or anti-psychotics, and psychotic symptoms induced by anti-parkinsonian drugs, anti-cholinergic drugs, anti-depressants or histamine H2 antagonists are still very common. Wernicke encephalopathy caused by intravenous glucose infusion without thiamine, central pontine myelinolysis by too rapid correction of hyponatremia are important though infrequent. Iatrogenic Creutzfeldt-Jakob disease by dura grafts is a warning against the easy use of medical materials produced with human organs or blood. Iatrogenic diseases are preventable, and geriatricians have to pay attention to the information on adverse effects of drugs and medical materials and carefully observe the early signs of iatrogenic diseases.
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  • Katsutoshi Terasawa
    2005 Volume 42 Issue 1 Pages 25-26
    Published: January 25, 2005
    Released: March 02, 2011
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  • Arata Azuma
    2005 Volume 42 Issue 1 Pages 27-30
    Published: January 25, 2005
    Released: March 02, 2011
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    Idiopathic pulmonary fibrosis (IPF), a chronic form of idiopathic interstitial pneumonia, has a poor prognosis with an average life expectancy of 3-4 years from the time of diagnosis. Although patients with IPF have been treated with steroids or immunosuppressants to control the inflammation that occurs earlier in the course of disease, these drugs have not improved the survival of patients with IPF.
    Recently, several clinical studies of antifibrotic drugs have been conducted in patients with IPF. In Japan, we demonstrated that pirfenidone prevents deterioration of pulmonary function and significantly decreases the incidence of acute exacerbation of IPF in a well-designed, placebo-controlled, double-blind, randomized study. We have also adopted a new system for evaluation of dynamic pulmonary function, which involves measuring the lowest SpO2 level during a 6-minute walk at a constant speed and assessing the pulmonary capacity of patients with IPF. In a study of patients with pulmonary fibrosis associated with Hermansky-Pudlak syndrome in the United States, pirfenidone slowed the decrease in %FVC in patients with a %FVC of>60%, but had no significant effects on patients with a %FVC of≤60%. Large-scale clinical studies of INF-γ in patients with IPF in North America and Europe have reported decreases in the mortality of patients with mild IPF with a FVC of>60%, although percentages of patients with disease status rated as ‘exacerbated’, ‘unchanged’ and ‘improved’ after treatment did not differ between the INF-γ and placebo groups.
    This presentation reported important future strategies for the treatment of IPF.
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  • Yasuo Takeuchi, Masami Taniguchi, Kazuo Akiyama
    2005 Volume 42 Issue 1 Pages 31-33
    Published: January 25, 2005
    Released: March 02, 2011
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  • Takashi Ohrui, Katsutoshi Nakayama, Takeyasu Fukushima, Hiroshi Chiba, ...
    2005 Volume 42 Issue 1 Pages 34-36
    Published: January 25, 2005
    Released: March 02, 2011
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    Pneumonia is a major cause of morbidity and mortality in elderly people, especially in those with chronic medical conditions such as chronic heart and lung diseases. We prospectively examined the effect of influenza and pneumococcal vaccinations on the rate of hospitalization for and complications of pneumonia, all respiratory tract conditions and mortality in elderly bedridden patients and found that both febrile days and pneumonia cases decreased. Thus, these results show that it is valuable to vaccinate for influenza elderly people even if they are confined to bed. Furthermore, the tuberculin skin test is an easy method to check the cell-mediated immunity in the elderly people. In the tuberculin skin test, all Japanese over 65 years old should have positive status. A negative result indicates depressed cell-mediated immunity. We undertook a trial to vaccinate tuberculin negative elderly people with BCG vaccine and found that the risk of pneumonia is decreased to a similar degree to that in subjects with positive tuberculin test results. We conclude that vaccination might be an effective strategy for the prevention of pneumonia in elderly people with limited activities of daily living.
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  • Kotaro Higashi, Kengo Ito, Ichiro Matsunari, Yoshimichi Ueda, Takahiro ...
    2005 Volume 42 Issue 1 Pages 37-39
    Published: January 25, 2005
    Released: March 02, 2011
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  • Kazuo Miyanaga
    2005 Volume 42 Issue 1 Pages 40-41
    Published: January 25, 2005
    Released: March 02, 2011
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    The significance of early detection of dementia is that there is some benefit from almost all involved, especially, patients, their family, attending physicans and administration (local financial affairs).
    1) Both patients and their family can recognize that dementia is not ageing but a disease. They can have the hope that early treatment of dementia can improve symptom. Moreover, their family and care givers can look after demented persons more easily by acquiring the knowledge of the official welfare system and how to cope with dementia-related problem behavior. These can reduce ill-treatment.
    2) The improvement or supression of dementia symptoms, and the teaching of how to handle daily life can give attending physican an incentive to treat.
    3) If the onset of dementia can be delayed for 2 years, administration can reduce expenses by 560 billion yen in all Japan, which would benefit the medical economy greatly.
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  • Tokio Tsukioka, Kenichi Suzuki, Yoshikatsu Inui, Keisuke Nishida, Tats ...
    2005 Volume 42 Issue 1 Pages 42-44
    Published: January 25, 2005
    Released: March 02, 2011
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  • Makoto Tanaka
    2005 Volume 42 Issue 1 Pages 45-48
    Published: January 25, 2005
    Released: March 02, 2011
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  • Kazuo Miyanaga
    2005 Volume 42 Issue 1 Pages 49-51
    Published: January 25, 2005
    Released: March 02, 2011
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    Drugs to treat the primary symptoms of dementia are nootropics (anti-dementia medicine). These can be divided into three stage historically. Drugs of brain metabolic improvement and blood expanssion and anti-coagulation drugs used till now, are the first stage. AChE inhibitor and glutamin receptor inhibitors used at present are second generation drugs. The cause of degenerative diseases like Alzheimer's disease is the accumulation of abnormal protein. So, fundamental medicines to prevent such accumulation are the third generation drugs. Anti-inflammation drugs, anti-cholesterol drugs, female hormones, and nerve growth factors used at present are third generation grugs. In truth, only vaccine treatment is the third stage medicine.
    Adjuvant treatment is also available at present. This approach is not based on the elimination of various causes of cell injury, but on increasing resistance to cell injury. These methods include protection of the nerve cell membrane, supply of nerve transmission material, and improvement of brain blood flow.
    Non-medicinal methods of treatment and prevention of dementia include mental training and body movement (exercises). These promote supply of nutrition and oxygen to the nerve cells as a result of increases in brain circulation caused by the various stimuli. In addition to training, nutrition should also be suppled at the same time.
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  • Keiko Yamada
    2005 Volume 42 Issue 1 Pages 52-53
    Published: January 25, 2005
    Released: March 02, 2011
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  • Hirotsugu Ueshima
    2005 Volume 42 Issue 1 Pages 54-57
    Published: January 25, 2005
    Released: March 02, 2011
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  • Masatoshi Fujishima, Yutaka Kiyohara
    2005 Volume 42 Issue 1 Pages 58-60
    Published: January 25, 2005
    Released: March 02, 2011
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  • Kazuo Suzuki
    2005 Volume 42 Issue 1 Pages 61-63
    Published: January 25, 2005
    Released: March 02, 2011
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  • Hiroyasu Iso
    2005 Volume 42 Issue 1 Pages 64-66
    Published: January 25, 2005
    Released: March 02, 2011
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  • Ken-ichi Arita, Ryohei Nishino
    2005 Volume 42 Issue 1 Pages 67-73
    Published: January 25, 2005
    Released: March 02, 2011
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    The majority of our inpatients and outpatients are senior citizens. They are in marked contrast to the majority of current medical workers who are far younger than their patients. We investigated the problems which may arise due to this age gap using a questionnaire asking about viewpoints on “health” and “infectious diseases among the elderly”
    Interest in general health was lower among medical workers than common citizens. Lifestyles which the public may consider to be good for health are more specific and cover a wider range than those of medical professionals. Medical staff thought home care is important for infectious diseases among the elderly. They were concerned with the appearance of resistant bacilli and considered that the type of treatment should vary in accordance with the patient's age and stamina, whereas the elderly citizens cared more strongly about the treatments result. Medical workers should understand that the general citizens have a different way of thinking about health and infectious diseases from their own.
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  • Mizue Suzuki, Masao Kanamori, Shingo Nagasawa, Takayuki Saruhara
    2005 Volume 42 Issue 1 Pages 74-82
    Published: January 25, 2005
    Released: March 02, 2011
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    The purpose of this study was to clarify the efficacy of behavioral, stress and immunological evaluation methods in music therapy (MT) with elderly patients with senile dementia. The MT group consisted of 8 elderly patients with dementia and the control group included 8 similarly matched patients. A total of 25 sessions of music therapy were conducted for one hour, twice each week for three months. The Mini-Mental State Exam (MMSE), Gottfries-Brane-Steen Scale (GBS), and Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) were used to evaluate behavioral changes. Saliva Chromogranin A (Cg A) and Immunoglobulin A (Ig A) were used to assess changes in stress and immunological status, respectively.
    The results of the study were as follows:
    1. In GBS, the mean score of “different symptoms common in dementia” improved significantly after MT.
    2. The mean Behave-AD score of “paranoid and delusional ideation” was also significantly improved (p<0.05) after the intervention.
    3. In the 25th session, mean saliva Cg A was significantly decreased after MT (p<0.05). IgA was slightly increased prior to intervention.
    Our results suggest that a combination of behavioral, stress and immunological evaluation methods were valuable for assessing changes that occurred during MT for elderly patients with dementia.
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  • Shizuru Yamada, Kenji Toba
    2005 Volume 42 Issue 1 Pages 83-89
    Published: January 25, 2005
    Released: March 02, 2011
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    Since the introduction of long-term care insurance, day care services have become popular throughout Japan and many kinds of behavioral approaches have been used. Although there have been many reports on the non-pharmacological effects on cognitive function, case control studies to evaluate the effect of day care services are insufficient. Furthermore, no study has compared the advantages of different behavioral therapies for elderly subjects with loss of cognitive function.
    To clarify these issues, we compared the changes in activities of daily living, cognitive function and vitality/depression among 78 subjects receiving different day care services. Community dwelling subjects using day care (day care group: n=29, 80±7.3 years old) showed an improvement in abnormal behavior (DBD scale; before 8.5±2.1, after 3.2±1.3, p<0.05). Vitality and volition measured by the Vitality Index were significantly preserved in the day care group compared with community dwelling subjects without day care services (n=11, 78.6±9.4y.o.). Comparing the effect of three different behavioral therapies (physical fitness, cooking and gardening), there was no difference in changes in cognitive function or in other comprehensive measurements among the groups. On the other hand, different responses to various therapies were observed among subjects. To determine the advantage of various non-pharmacological therapies for dementia, geriatricians need to perform prospective case-control studies with a large number of subjects, using comprehensive geriatric assessment as the art of a geriatrician.
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  • Hiroko Miyaji, Hirofumi Sakurai, Masayuki Kikawada, Katsuhiko Yamaguch ...
    2005 Volume 42 Issue 1 Pages 90-98
    Published: January 25, 2005
    Released: March 02, 2011
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    The treatment of bedsores is a particular problem in geriatric medicine. We selected standard drugs that may be effective for the decubitus ulcer, and investigated combination therapy to develop efficient treatment.
    The subjects were 16 patients in whom the grade of the bedsore was evaluated as II to IV according to the Shea's depth classification. Treatment was performed while all patients were on air mats. We selected drugs and treatment methods based on the previously established experimental design of Taguchi. Based on this, we created and adapted 16 different component combination treatment programs in accordance with the L16 rectangular cross table. The following component factors were adopted: A: types of covering substances on the wound surface (Elase ointment, isodine sugar, isodine gel, solcoseryl ointment); B: Isalopan powder; C: Spray of 10ml physiological saline containing 500μg of prostaglandin (concentration 0.005%); D: daily number of treatments; and F: presence or absence of tapping. We serially measured the wound surface area as an index of the speed of wound healing, and measured the interval (day) until the area decreased to one half of the original size (T1/2, half life).
    We analyzed data on one combination treatment each in 16 patients. Analysis of variance of the above factors showed significant F values for factors A, B, D and F. The contribution rates for factors A, B, D and F were 37.84%, 8.47%, 14.98% and 13.81%, respectively. The error term (e) was 16.37%. Optimal results were seen in the groups in which solcoseryl ointment had been applied twice a day. In this study, prostaglandin, which had been anticipated to be effective, did not show any effects. The error term (e) suggests the presence of other healing factors including individual differences. Concerning this point, it well be necessary to examine a larger number of patients in the future. With ointment treatment alone, without using an air mat, it was confirmed that bedsore area reduction was extremely unstable. Decompression of the affected part may be a basic prevention factor and essential treatment of bedsores.
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  • Misuzu Watanabe, Takemasa Watanabe, Takamaro Matsuura, Keiko Kawamura, ...
    2005 Volume 42 Issue 1 Pages 99-105
    Published: January 25, 2005
    Released: March 02, 2011
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    This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self reported questionnaire regarding demographic characteristics was administered to 2, 046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II, going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85.
    In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (II and IV) exhibited higher incidence of disability than those with social communication (I and III).
    From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.
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  • Maki Eto
    2005 Volume 42 Issue 1 Pages 106-111
    Published: January 25, 2005
    Released: March 02, 2011
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    We have examined the relationship between visual sense information, such as perception data and postural control, and falls among elderly people aged 65 years or over living in Nishibiwajima-cho, Aichi Prefecture. Of 286 participants, 204 were enrolled and analyzed, after excluding those with a visual acuity of less than 0.3, or the activities of daily living (ADL) index of less than 11. In the analysis group, 52 people (25.2%) had already had experience of falls. Two-way analysis of variance showed that intensity of dynamic visual stimulation and the presence or absence of falls had a significant effect on body sway, although no interaction was observed. These results indicate that body sway is increased in those who have experience of falls, and that strong visual stimulation is associated with body sway. This suggests that greater dynamic visual stimulation is likely to increase the risk of falls.
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  • Seigo Miyoshi, Yuji Hara, Akiyoshi Ogimoto, Yuji Shigematsu, Takafumi ...
    2005 Volume 42 Issue 1 Pages 112-115
    Published: January 25, 2005
    Released: March 02, 2011
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    A 67-year-old woman had been examined due to abnormalities on electrocardiography (ECG) at a medical checkup three years previously. When a negative T-wave was seen in leads I, aVL, and V1 to V4, but the abnormal findings were improved at consultation. Echocardiography revealed apical hypertrophy and hypertrophic nonobstructive cardiomyopathy was diagnosed. She felt chest discomfort in September, 2003 and an ECG showed a negative T-wave in leads I, II, III, aVL, aVF and V2 to V6 and an elongation of QT interval. Left ventriculography revealed myocardial hypertrophy at the left ventricular apex and left ventriclar wall motion was normal. Coronary angiography did not show any significant luminal narrowing. I-123 metaiodobenzyl-guanitidine scintigraphy showed marked perfusion defects at the left ventricular apex. After five months, ECG showed an improvement of the QT interval and a decrease in the negative T-wave. We considered that the repeated changes of ECG were caused by Takotsubo-type cardiomyopathy.
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  • Tamami Kono, Akiyoshi Ogimoto, Yuji Shigematsu, Yuji Hara, Takafumi Ok ...
    2005 Volume 42 Issue 1 Pages 116-120
    Published: January 25, 2005
    Released: March 02, 2011
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    A rare case of primary pulmonary hypertension was observed in a 73-year-old man. Angina pectoris was diagnosed at the age of 67 and he received several percutaneous coronary interventions because of refractory restenosis. He also had coronary artery bypass surgery at the age of 69. After 4 years, he again suffered from dyspnea and chest pain upon physical exertion. On admission to our hospital, a chest radiograph showed dilatation of bilateral pulmonary arteries. Moreover, echocardiography showed right ventricular dilatation and tricuspid regurgitation. Continuous wave Doppler imaging revealed a pressure gradient of 82.1mmHg. Pulmonary capillary wedge pressure was normal, but pulmonary artery pressure was elevated upon cardiac catheterization. Because there was no apparent etiology of pulmonary hypertension, primary pulmonary hypertension was diagnosed and appropriate conventional therapy was started.
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  • 2005 Volume 42 Issue 1 Pages 121-126
    Published: January 25, 2005
    Released: March 02, 2011
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  • 2005 Volume 42 Issue 1 Pages 127
    Published: 2005
    Released: March 02, 2011
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