Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 42 , Issue 3
Showing 1-26 articles out of 26 articles from the selected issue
  • Takayuki Tsuneda, Hiroshi Inoue
    2005 Volume 42 Issue 3 Pages 261-270
    Published: May 15, 2005
    Released: March 02, 2011
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  • Harumi Hotta
    2005 Volume 42 Issue 3 Pages 271-278
    Published: May 15, 2005
    Released: March 02, 2011
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  • Masatoshi Takeda, Toshihisa Tanaka, Takashi Kudo, Masayasu Okouchi, Ko ...
    2005 Volume 42 Issue 3 Pages 279-281
    Published: May 15, 2005
    Released: March 02, 2011
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  • Toru Kita
    2005 Volume 42 Issue 3 Pages 282-284
    Published: May 15, 2005
    Released: March 02, 2011
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  • Akihisa Iguchi
    2005 Volume 42 Issue 3 Pages 285-287
    Published: May 15, 2005
    Released: March 02, 2011
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    In 2001, the Japan Geriatrics Society released its position statement regarding the terminal care of the elderly. In the statement, it is stated as a technical issue that any medical practice implemented in terminal care should warrant its profit to the patient (position 6). Standardization of all medical practices and methods of care for dying patients is desired, and should be based upon scientific evidence regarding the profitability of the practice for the patient. The standardization of care should aim to exclude physicians' arbitrariness and to endorse patients' autonomy.
    However, healthcare systems and related scientific evidences that warrant patients' autonomy have not been sufficiently established in Japan. Under the circumstances, we have been engaging in research into the terminal care for older adults from 1997 to date by formulating a research team working under the scheme of comprehensive research project for longevity sciences funded by the ministry of health, labor and welfare.
    This article reviews findings achieved mainly from the research carried out by the members of the research team.
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  • Takashi Inamatsu, Yoshishige Masuda, Yoriko Kosugi, Keiko Adachi, Yasu ...
    2005 Volume 42 Issue 3 Pages 288-290
    Published: May 15, 2005
    Released: March 02, 2011
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  • Hidetoshi Endo
    2005 Volume 42 Issue 3 Pages 291-293
    Published: May 15, 2005
    Released: March 02, 2011
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    Acute hospital has to have a good community relationship because of looking for a services and settings after discharge for elderly patients. In particular, physicians should have good relations with other physicians, visiting nurses, and care managers, because elderly patients had to go to facilities or nursing homes instead of their own homes. We must obtain information concerning care services and build networks between hospitals and the community in order to provide good services. To enable this we established a good discharge support team. We also have to educate the staff and care managers to take good care of patients.
    A comprehensive geriatrics and team approach is important for geriatric medicine in the community through care conference.
    So geriatricians must take part in care conferences and take a leadership role in networks for people with care needs. Finally our national center for geriatrics and gerontology has to take a role of the future achievement in geriatric field and provide information related research and clinical activity for the elderly.
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  • Takao Suzuki
    2005 Volume 42 Issue 3 Pages 294-297
    Published: May 15, 2005
    Released: March 02, 2011
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  • Makoto Tanaka
    2005 Volume 42 Issue 3 Pages 298-301
    Published: May 15, 2005
    Released: March 02, 2011
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    Here we report the current status and problems in collaboration between a local medical community and a university hospital. It is important for the university hospital to clearly define its role in the local medical community, collaborate with local medical and welfare institutes and establish a local medical and care network that supports patients and their families. For this purpose, the social service department is expected to play a role as a coordinator between the university hospital and the local medical community so that the patients can make the best use of medical and care resources.
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  • Hiroyuki Yoshihara
    2005 Volume 42 Issue 3 Pages 302-305
    Published: May 15, 2005
    Released: March 02, 2011
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    By sharing medical information safely and appropriately with in a region, we constracted a system which provides an increase in efficiency of patient service, and improvement in the quality and efficiency of medical treatment. Even if a patient consults two or more hospitals, medical chart information is unified in the center and the continuity of the medical records is ensured. Patients can peruse their own charts from home, which is useful for informed consent.
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  • Hiroyuki Hirakawa
    2005 Volume 42 Issue 3 Pages 306-308
    Published: May 15, 2005
    Released: March 02, 2011
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  • Makiko Oshikawa
    2005 Volume 42 Issue 3 Pages 309-310
    Published: May 15, 2005
    Released: March 02, 2011
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  • Hiroko Kaneda
    2005 Volume 42 Issue 3 Pages 311-314
    Published: May 15, 2005
    Released: March 02, 2011
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  • Ikuro Ishihara
    2005 Volume 42 Issue 3 Pages 315-317
    Published: May 15, 2005
    Released: March 02, 2011
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  • Ryoko Rokkaku
    2005 Volume 42 Issue 3 Pages 318-319
    Published: May 15, 2005
    Released: March 02, 2011
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  • Yuichiro Masuda
    2005 Volume 42 Issue 3 Pages 320-322
    Published: May 15, 2005
    Released: March 02, 2011
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  • Yuki Baba, Shinji Teramoto, Hiroshi Hasegawa, Ayako Machida, Masahiro ...
    2005 Volume 42 Issue 3 Pages 323-327
    Published: May 15, 2005
    Released: March 02, 2011
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    Several bedside portable swallowing tests have been advocated for screening for dysphagia. However, the clinical usefulness and limitation of these tests have not been examined in elderly patients with dementia. We performed the repetitive saliva swallowing test (RSST) and the simple swallowing provocation test (SSPT) in 37 elderly inpatients (81.8±1.2 years old). Simultaneously, cognitive and verbal communication ability were assessed by the Hasegawa Dementia Scale revised version (HDSR) and the Mini-Communication Test (MCT).
    RSST was completed only in 22 patients (59%), whereas SSPT was successfully completed in all cases. Scores of HDSR and MCT were significantly lower in patients who were unable to cooperate with RSST compared to successful examinees (HDSR: 7±1 vs 15±3, p<0.01; MCT: 47±8 vs 81±5, p<0.01). Dysphagia was detected in 14 patients (64%) by RSST and 5 (14%) by SSPT. Patients with dysphagia showed significantly lower cognitive function (p<0.05) and verbal communication ability (p<0.05).
    In conclusion, RSST is more sensitive to detect dysphagia in elderly patients; however, compliance with RSST is strongly influenced by the patient's cognitive function and verbal communication ability. Comprehensive geriatric assessment will help to choose an alternative test for dysphagia such as SSPT which is more specific test for aspiration pneumonia.
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  • Hiroko Miura, Yumiko Arai, Kiyoko Yamasaki
    2005 Volume 42 Issue 3 Pages 328-334
    Published: May 15, 2005
    Released: March 02, 2011
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    The aims of the present study were to investigate satisfaction with verbal communication among the disabled elderly and their family caregivers; and to find the significantly influential factors of satisfaction with verbal communication. The subjects were 85 disabled elderly and 85 family caregivers. For the disabled elderly, satisfaction with verbal communication, demographic, and physical factors were examined using an interview survey. For the caregivers, satisfaction with verbal communication, demographic factors, and some factors related caregiving were examined using a self-administered questionnaire. In the disabled elderly, 82.4% were satisfied with their verbal communication while 55.3% of family caregivers were satisfied. Satisfaction with verbal communication between the disabled elderly and their caregivers showed low agreement (κ=0.17), Bivariate analysis revealed that satisfaction with verbal communication of the disabled elderly was significantly related to ADL (p<0.01), dysphagia risk (p<0.05), and ability of comprehension (p<0.05) while satisfaction with verbal communication of caregivers was significantly related to the gender of the disabled elderly and caregivers' burden. Furthermore, multiple regression analysis showed that the factor most related to satisfaction with verbal communication for the disabled elderly was ability of comprehension (p value=0.032, odds ratio=2.960), and the most related factor for their caregivers was the burden evaluated by J-ZBI_8 (p value=0.004, odds ratio=0.842). These results suggest that satisfaction with verbal communication of the disabled elderly disagrees with that of the family caregivers, and that some related factors for the disabled elderly are different from those in their family caregivers.
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  • Yosuke Ooe
    2005 Volume 42 Issue 3 Pages 335-339
    Published: May 15, 2005
    Released: March 02, 2011
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    Prompt notification of recognition of the need for nursing is necessary for smooth application of Long-term Care Insurance Services. The Long-term Insurance Act requires notification of applicants of certification within 30 days. However, recognition of the need actually may be delayed for various reasons.
    To explain the influence of investigation for certification and the doctor's opinion for notification delay, 38, 285 applications were investigated for 2 years in a city close to Osaka. The investigation period was divided into two stages, the first stage (from July 2000 to June 2001) and the second stage (from July 2001 to June 2002).
    The notification rate of the recognition result within 30 days was 42.0% in the first stage, and it improved to 46.8% in the second stage. However, the approximate number of days required for investigation for certification improved from 10.5 to 10.3, and that for the doctor's opinion improved from 20.2 to 19.1. Thus the doctor's opinion is a rate-controlling factor for the notification. By the standard operating procedures of the city, a two-week period is needed to prepare the long-term care requirement certification, thus it is necessary to obtain the doctor's opinion within 15 days.
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  • Hiroshige Fujishiro, Hiroyuki Umegaki, Yusuke Suzuki, Akira Nakamura, ...
    2005 Volume 42 Issue 3 Pages 340-345
    Published: May 15, 2005
    Released: March 02, 2011
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    Recently, the dementia-prevention program hosted by the Ministry of Health, Welfare and Labor has been widely implemented. We administered a questionnaire to 347 elderly adults (mean age: 71, mean MMSE score: 27.2) who attended programs in community healthcare centers. The questionnaire consisted of questions concerning: (1) belongings (2) knowledge about dementia (3) opinions about revealing the diagnosis of dementia to patients (4) anxiety for own onset of dementia. Regarding the knowledge about dementia, 17% of the participants knew about drug therapy, and 13% of them knew about legal guardianship. The results indicated a limited knowledge about facilities where demented people can be placed (home: 39%, hospital: 43%, nursing home: 62%, group-home: 25%). As for revealing the diagnosis, 68% of the participants hoped they would be informed of the diagnosis if they become demented, while 66% of them felt anxiety about having dementia in the future. In terms of difference by age (≥70 v.s.≤69), while the older group had low knowledge about the facilities and felt more anxiety about their own onset of dementia (χ2 test p<0.05, Mann-Whitney U test p<0.05), there were no intergroup difference regarding their expectations of being told about the diagnosis of dementia. Overall, the results of the questionnaire suggest that appropriate education of dementia to older adults may contribute to early diagnosis of the community level, thereby may maximize the effect of therapeutic interventions.
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  • Kenji Toba, Jiro Okochi, Tai Takahashi, Kozo Matsubayashi, Masanori Ni ...
    2005 Volume 42 Issue 3 Pages 346-352
    Published: May 15, 2005
    Released: March 02, 2011
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    Aim: To develop a portable risk index for falls.
    Methods: Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home.
    Subjects: The questionnaire sheet was completed by 2, 439 community-dwelling elderly subjects (76.3±7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls.
    Results: Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers.
    Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls.
    These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve.
    Conclusion: Portable fall risk index is useful for clinical settings to identify high-risk subjects.
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  • Michie Baba, Hiroshi Une
    2005 Volume 42 Issue 3 Pages 353-359
    Published: May 15, 2005
    Released: March 02, 2011
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    This study attempts to clarify the relationship between the long-term care of the elderly and the number of remaining teeth by comparing the remaining teeth of the healthy with that of the disabled elderly.
    A survey was conducted in a town, Fukuoka Prefecture. The disabled group consisted of 62 persons with level of disability of 4-5 according to the Long-term Care Insurance categorization. Controls were selected randomly from healthy elderly residents, one for each in the disabled group, matching gender and age (less than ±1 year old).
    Public health nurses conducted interviews using a questionnaire to determine the cause of disease, medical history, lifestyle and period of long-term care, and counted the remaining teeth.
    The mean number of remaining teeth presented a significant difference with 3.7 for the disabled group and 9.1 for the control group (p<0.01). A logistic regression analysis revealed that the odds ratio for long-term care to that of the reference with 20 or more teeth was 7.03 (95%CI: 1.15-42.85) for 10 to 19 teeth, 15.61 (2.89-84.26) for 1 to 9 teeth, and 15.11 (2.84-80.48) for no teeth.
    The age group of 65-69 years and 70-79 years in the disabled group had significantly smaller mean numbers of remaining teeth than their control group counterparts by approximately 14 and 12 respectively, but in the age group of 80 years or more, no significant difference was observed between the two groups.
    In conclusion, our results suggested that elderly people with fewer remaining teeth have a high risk for long-term care. Especially, the risk was thought to be strongly associated with the loss of some teeth in middle age.
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  • Yoshiharu Taguchi, Shutaro Takashima, Hiroshi Inoue
    2005 Volume 42 Issue 3 Pages 360-363
    Published: May 15, 2005
    Released: March 02, 2011
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    A 69-year-old woman was admitted to our hospital due to an interval form of carbon monoxide (CO) poisoning one month after acute CO poisoning. On admission, she had disorientation, memory disturbance, apathy, masked face, muscle rigidity, bradykinesia and parkisonian gait. An MRI (FLAIR image) revealed high signal intensity lesions in the bilateral globes pallidus and the white matter of the frontal lobe. Hyperbaric oxygen (HBO) therapy at 2 atmospheres for 60min was given every day, in addition to citicoline, levodopa/DCI and selegiline hydrochloride. Cognitive disturbance and parkinsonism gradually decreased, and abnormal signals in the bilateral globus pallidus and the cerebral white matter were attenuated after the treatment. Neuropsychiatric abnormalities except for a slight gait disturbance disappeared one and a half month after starting the treatment. In addition to HBO therapy, administration of citicoline, lovodopa and selegiline may be useful in the case of the interval form of CO poisoning.
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  • Ichiro Nozaki, Toshio Hamada, Takayuki Ikeda
    2005 Volume 42 Issue 3 Pages 364-367
    Published: May 15, 2005
    Released: March 02, 2011
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    A 64-year-old woman was transferred to the intensive care unit with dyspnea and palpitation on effort. Chest x-ray film showed cardiomegaly and pulmonary congestion. We carefully examined for sarcoidosis as a differential diagnosis of heart failure. Serum lysozyme was mildly high, but human atrial natriuretic peptide (HANP) and brain natriuretic peptide (BNP) were strikingly high. Angiotensin converting enzyme was within normal limit. Chest roentgenogram did not reveal bilateral hilar lymphadenopathy. Atrioventricular conduction block was not observed on electrocardiogram. Echocardiographic examination showed left ventricular global hypokinesis with septal thinning and enlargement. Mitral valve regurgitation was recognized by Doppler evaluation. Coronary arteriography showed normal coronary arteries. Endomyocardial biopsy revealed noncaseous epithelioid granulomas containing Langhans type giant cell accompanied by fibrosis and lymphocyte infiltration.
    From these data cardiac sarcoidosis was diagnosed. Gallium scintigraphy showed diffuse uptake only in the heart. Treatment with oral prednisolone 20mg/day was started. Her symptoms improved by several weeks after the medical treatment. In addition, both the value of HANP and BNP were markedly decreased and echocardiogram showed improvement of cardiac systolic function. In Japan, there is a higher incidence of cardiac sarcoidosis than in the West. The prognosis of this condition associated with cardiac dysfunction is reported to be very poor. When progressive heart failure in older patients is seen, cardiac sarcoidosis should also be kept in mind. Endomyocardial biopsy play an important role as the only accurate technique for the diagnosis of cardiac sarcoidosis.
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  • 2005 Volume 42 Issue 3 Pages 368-378
    Published: May 15, 2005
    Released: March 02, 2011
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  • 2005 Volume 42 Issue 3 Pages 380
    Published: 2005
    Released: March 02, 2011
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