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Volume 42, Issue 4
Displaying 1-14 of 14 articles from this issue
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Kenji Toba2005 Volume 42 Issue 4 Pages 383-391
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Current topics and perspectivesEmiko Senba2005 Volume 42 Issue 4 Pages 392-398
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Teiryo Maeda2005 Volume 42 Issue 4 Pages 399-402
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Kiyoko Izumi2005 Volume 42 Issue 4 Pages 403-405
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Yasuyo Tanaka2005 Volume 42 Issue 4 Pages 406-408
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Akira Honma, Kastuya Urakami, Shin Kitamura, Masahito Yamada, Masahiro ...2005 Volume 42 Issue 4 Pages 409-410
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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Asae Oura, Masakazu Washio, Hisako Izumi, Mitsuru Mori2005 Volume 42 Issue 4 Pages 411-416
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSThe present study was conducted in October 2003 to investigate the factors related to psychological stress and the heavy burden of caregivers taking care of frail elderly persons in the northern part of the Onga district, Fukuoka Prefecture, Kyushu, Japan. A total of 40 caregivers were assessed using a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) and thus described their own caregiving situation. J-ZBI research had been done on a yearly basis for the previous 5 years and the results of each investigation regarding Center for Epidemiologic Studies Depression Scale (CES-D), and incidence of depression, ADL and dementia were compared prior to and after initiation of public long term care insurance for the elderly (LTCI). Compared to caregivers with a middle or light burden, heavily burdened caregivers were more likely to have a higher J-ZBI, and CES-D. Compared to caregivers with a light burden, heavily burdened caregivers were more likely to 1) be in poor condition, 2) complain of their economical situation, 3) spend a longer time with care talker. Compared to caregivers with a middle burden, heavily burdened caregivers more frequently used short-stay services (i.e., temporary nursing home assistance).
J-ZBI and ADL were compared to before LTCI, and 4 years after LTCI had been started. Scores for both were lower after 4 years. Compared to before LTCI, day-care and day service were used less frequently 3 and 4 years after LTCI.
After LTCI, caregivers showed a lower J-ZBI score, but the incidence of depression among caregivers was higher, compared to the general public. It is suggested that a government agency should be created to support not only the frail elderly but also their caregivers.View full abstractDownload PDF (928K) -
Hiroshi Fujimaki, Yutaka Kasuya, Sachiko Kawaguchi, Shino Hara, Shiro ...2005 Volume 42 Issue 4 Pages 417-422
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSAim: Refusal of dialysis is not uncommon in elderly patients with chronic renal failure. In this study, we retrospectively inspected our dealings with patients who refused our offer to initiate dialysis. In addition, we discussed how to grasp the meaning of this phenomenon.
Methods: We treated 152 patients with advanced chronic renal failure aged 60 years and over at Tokyo Metropolitan Geriatric Hospital. The patients fulfilling the following two criteria were considered to be refusal cases. The first criterion was that an acceptance of the initiation of dialysis could not be obtained in spite of repeated counseling. The second criterion was that a definite outcome was precipitated by the development of severe uremic symptoms. In every refusal case, clinical characteristics and household members were surveyed. Verbal expressions of the reasons for refusal were retrieved from medical charts. The outcome was also studied.
Results: The two criteria were fulfilled in 7 cases. The male/female ratio was 5:2. The age was 78±7 years (mean±standard deviation). All but one cases were ambulatory, and all cases had normal cognitive function. Four cases were married, and the other cases had lost their partners. The number of household members was 3.9±1.8. We speculated that every case could maintain a good quality of life even after the initiation of dialysis. Representative expressions of the reasons for refusal were “I have already lived fully” and “I would prefer to accept death rather than dialysis”. The outcome was urgent initiation of dialysis (five cases) and death (two cases). The time between initial counseling and the outcome was 115±37 days.
Conclusion: Accepting or refusing dialysis therapy is a selection related to life or death. We must make an effort to obtain consent to initiating dialysis if patients are assessed as suitable for dialysis.View full abstractDownload PDF (1031K) -
Mizue Suzuki, Atsuko Uchida, Masao Kanamori, Hajime Ooshiro2005 Volume 42 Issue 4 Pages 423-431
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSAim: The aim of this study was to develop the Dementia Quality of Life Instrument-Japanese version (DQoL-Japanese Version).
Methods: The subjects were 72 elderly patients, 19 men and 53 women (Vascular Dementia: 66, Senile dementia Alzheimer type 6) using day care and day services who had obtained approval for participation in the investigation. The interview survey was conducted from October 2002 to January 2003.
Results: In the subscales of the DQoL-Japanese Version, “negative feelings” scored the highest and “affirmative feelings” the lowest. There was a significant correlation coefficient between the test and those of a conducted 2 weeks later, ranging from 0.730 to 0.857 (p<0.05). The internal consistency reliability for the five scales ranges from alpha 0.66 to 0.864. There was a significant correlation coefficient between the Geriatric Depression Scale (GDS) and DQOL sub-scales such as “self esteem, ” “positive affect”, “negative feelings” and “feeling of belonging”. On the other hand, there was no significant relationship between the GDS and “aesthetics” of the DQoL-Japanese Version.
Conclusions: It was suggested that the DQoL-Japanese Version DQoL is useful to measure subjective QOL of elderly patients with dementia. The subjects who understood the questions of the DQoL-Japanese Version and were able to be interviewed, had a Mini-Mental State score of 13 points or more. It was clarified that DQoL-Japanese Version was reliable and showed evidence of validity as well as the original DQOL.View full abstractDownload PDF (1522K) -
Yumiko Arai, Keigo Kumamoto, Midori Sugiura, Masakazu Washio, Hiroko M ...2005 Volume 42 Issue 4 Pages 432-443
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSAim
To develop a Home Care Quality Assessment Index (HCQAI) that may be used for overall assessment of home care in three areas: 1) conditions of the impaired elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input).
Methods
To develop the HCQAI, a list of items for assessment was drawn up, and the reliability of each item was verified. Reliability was investigated by a) test-retest reliability, and b) inter-rater reliability. Impaired elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. A κ coefficient of 0.4 or greater generally served as the inclusion criteria for test-retest and inter-rater reliability of each item. A factor analysis was conducted for items satisfying the above criteria, using 10 scales.
Results
Cronbach's α showing internal consistency (reliability) for these scales was 0.6-0.9. Two scales corresponded to care within the home: the “barrier-free” and “improvement of water facilities”; three to the caregiver situation: “dressing appropriate for the season, ” “mistreatment by the elderly, ” and “hygiene and assistance”; and five involved conditions of the impaired elderly: “cognition, ” “paralysis, ” “vision and hearing, ” “ADL, ” and “gross motor.”
Conclusion
The HCQAI developed in the present study, consisting of 41 items, can assess quality of home care both objectively and comprehensively, based on professional staff observation. Few indexes of this kind exist worldwide to scientifically assess input, process and outcome in the delivery of quality home care for the impaired elderly.View full abstractDownload PDF (1532K) -
Yoko Hanaoka, Hiroshi Yamamoto, Katsuya Iijima, Eijiro Ohga, Koichi Ko ...2005 Volume 42 Issue 4 Pages 444-449
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 76-year-old woman was admitted to the University of Tokyo Hospital in June 2002 because of fever of unexplained origin. She had suffered a high grade fever (above 39°C) for 2 weeks. Initial evaluation revealed elevated CRP and pancytopenia. Bone marrow aspiration (BMA) was performed, and a diagnosis of pure red cell aplasia (PRCA) was made. One month later, she complained right hypochondrial pain, and aspiration from her enlarged gall bladder was performed. Her fever and PRCA ameliorated, and she was discharged in August, 2002. In April 2003, she was readmitted to our hospital because of the recurrence of high grade fever, elevation of CRP, and pancytopenia. BMA was performed and revealed diffuse large B cell lymphoma. In the case of extranodal lymphoma which only presents pyrexia, differentiation with other diseases is very difficult especially in the elderly. It is necessary to bear in mind the possibility that a hematological malignancy, especially malignant lymphoma, can be latent in elderly patient with fever of unknown origin.View full abstractDownload PDF (2257K) -
Hirofumi Watanabe, Shunji Yasaki, Masahiro Horiuchi, Yoichi Takahashi2005 Volume 42 Issue 4 Pages 450-452
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 75-year-old woman was admitted to our hospital because of sudden onset of paresis in her left arm and face. She had untreated hypertension and hyperlipidemia. When she came back home after playing with children in the park, she felt weakness in her left hand. On admission, physical examination revealed that her blood pressure was very high (200/102mmHg). Only slight weakness in her left arm and left facial palsy were recognized neurologically. An electroencephalogram showed normal findings. Brain CT and MRI revealed a venous angioma near the right central sulcus. Gadolinium-DTPA enhanced MRI showed a group of small radiating veins(so called “the caput medusae sign”) connected to the venous angioma. The remaining symptoms decreased with the normalization of blood pressure. It is suggested the intracranial motor tracts of the face and arm in the precentral gyrus are adjacent to the location of this venous angioma. The dilation of venous angioma due to high blood pressure was thought to cause the paresis of face and arm in this patient.View full abstractDownload PDF (1383K) -
Katsunada Fujimoto, Taishi Harada, Kentaro Watanabe2005 Volume 42 Issue 4 Pages 453-456
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSAn 82-year-old man with extensive small cell lung cancer was treated with 2 courses of low dose CPT-11 (40mg/body, day 1, 8 and 15) and carboplatin (100mg/body, day 1). The reduction in tumor sizes evaluated by two-direction measurement was 88%. His creatinin clearance rates before and after chemotherapy were 20 and 28ml/min, respectively. Temporary leukopenia (900/μl) during the second course of chemotherapy was quickly reversed by the administration of G-CSF, without any episode of infection. Low dose CPT-11 and carboplatin seems to be a promising regimen for elderly patients with small cell lung cancer and renal dysfunction. Cancer tends to increase in old age groups. We consider that it is necessary to examine ideal low dose chemotherapies that can be effective yet preserve quality of life.View full abstractDownload PDF (1600K) -
2005 Volume 42 Issue 4 Pages 457-465
Published: July 25, 2005
Released on J-STAGE: March 02, 2011
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