Aim: We examined the prevalence and characteristics of urinary incontinence in community-dwelling elderly individuals. Methods: The participants were 1,783 individuals (768 men and 1,015 women) aged over 70 years who participated in a comprehensive health examination involving a medical examination and interview, plus physical performance tests. Differences in characteristics between individuals with and without urinary incontinence were examined, and multivariate logistic regression models were used to describe the characteristics associated with urinary incontinence. Results: The prevalence of urinary incontinence was 13.4% in men and 23.3% in women. Urinary incontinence was significantly associated with a lower level of physical fitness. Multivariate logistic regression showed that urinary incontinence was significantly associated with a slower walking speed (Odds Ratio (OR) =0.19, 95% Confidence Intervals (CI) 0.08-0.48) and lower serum albumin level (OR=0.40, 95% CI 0.16-0.99) in men, and with a slower walking speed (OR=0.29, 95% CI 0.15-0.56), a higher BMI (OR=1.09, 95% CI 1.04-1.14), depression (OR=3.06, 95% CI 1.40-6.69), and lack of physical activity (OR=0.70, 95% CI 0.50-0.98) in women. Conclusion: The characteristics of urinary incontinence in this cohort of community-dwelling elderly individuals were a low level of physical fitness and poor nutritional state in men, and a low level of physical fitness, a tendency to be obese, a poor mental health state, and lack of physical activity in women.
Background: It has been reported that elderly outpatients take at least 6 different kinds of medication. Purpose: To know which formula will best predict creatinine clearance, because 24-hour urine collection is difficult for elderly outpatients. Patients and Methods: We compared four types of formulae (Cockcroft & Gault, Yasuda, Orita, Walser) to estimate creatinine clearance using serum creatinine of 143 elderly inpatients (73 men, 70 women, mean age 82.9±8.6 years old) including 67 extremely elderly people with various underlying diseases. Result: The formula of Cockcroft and Gault showed the best correlation with creatinine clearance in the extremely elderly subjects (r=0.74) as well as in people under 85 years (r=0.76). However, the estimated values of the extremely elderly women were lower than actual creatinine clearance. Conclusion: The formula of Cockcroft and Gault is the best predictive equation of creatinine clearance, except in the extremely elderly women.
Aim: The aim of this study was to evaluate the relationship between eating disorders and anticipated life span stage and mortality in institutionalized elderly people. Methods: Ninety-eight elderly residents (mean 86.3±5.9 years) at a nursing home were selected for investigation of the date and cause of death. Inclusion was limited to those who died within one week from admission to the institution/hospital. Data on 11 potential prognostic factors were analyzed: underlying disease, activity of daily living (ADL), disorder of anticipatory stage, swallowing function, need for feeding assistance, weight decrease rate in the part 6 months, body mass index (BMI), minimum nutritional assessment (MNA), occlusal status, age and sex. These 11 factors were analyzed by Kaplan-Meier survival curve, and either the log-rank or Wilcoxon test was used to analyze significant differences in survival days in subjects with and without the factors listed above. Moreover, the regression analysis was made using Cox proportional-hazards model, a nonlinear multivariate analysis, to extract factors contributing greatly to short survival days. Results: The survival days showed significant differences in six factors; ADL, disorder of anticipatory stage, swallowing function, need for feeding assistance, BMI and MNA. Three factors were shown to be related to a significantly shorter mortality by the Cox proportional-hazards model: disorder of anticipatory stage (hazard rate=2.85, 95% CI=1.04-7.83), swallowing function (hazard rate=2.90, 95% CI=1.06-7.91) and BMI (hazard rate=2.54, 95% CI=1.00-6.44) were involved in. Conclusion: This study speculated that an appropriate response with a focus on feeding training may possibly contribute to prolong the mortality of elderly people.
Aim and Methods: The cooperation of general practitioners and specialists is crucial to establish comprehensive medical services for demented older adults. In the current study we conducted a survey regarding the attitudes towards referrals between general practitioners and specialists by sending a questionnaire to 1,176 general practitioners. Results: The 39.1% of the general practitioners returned the questionnaire. Of the respondents, 68.8% answered that they did not want referrals of demented patients from specialists, however, when analysis was limited to those who had an internal medicine background, only 26.3% did not want referrals. Difference of subspecialties within internists did not affect the preference for referrals. Regarding the reasons for referring the demented patients to specialists, more than 70% of the general practitioners chose "accurate diagnosis of the cause of dementia" and "decision of therapeutic plans". Conclusion: The majority of general practitioners in Japan may still be reluctant to follow patients with dementia mainly because they regard the practice of seeing demented patients as the subject outside of their specialty. Therefore providing general practitioners with opportunities to receive training programs regarding the practice and care of demented patients, as well as establishing support from specialists is necessary.
Aim: Self-efficacy and outcome expectation are psychological factors influencing performance behavior. Self-efficacy is a person's confidence that one can successfully perform the behavior to produce depend outcomes. Outcome expectation is the estimate that a favorable consequence will be produced by the behavior. These psychological factors are important reasons to perform exercise for health promotion among elderly people, but little is known about the relations among them. Therefor this study examined the relation among exercise for health promotion, self-efficacy, and outcome expectation of elderly people. Methods: This was a prospective study using self answered questionnaire. Data were collected from before and three follow-up investigations at 3 months intervals over a 9 month period. The sample was composed of 43 elderly people who applied for exercise program. Results: A strong correlation (r=0.375∼r=0.412) was observed between self-efficacy and exercise performance after three months. There was a strong correlation (r=0.349∼r=0.665) between outcome expectation and exercise performance at 3 months, 6 months, and 9 months. Conclusion: These findings suggest that self-efficacy and outcome expectation are significant predictors of exercise performance for health promotion in elderly people.
A 76-year-old man was first referred to his local hospital at the beginning of August 2005 with nausea and vomiting, and was admitted on August 15 with progressive fatigue of unknown etiology. Gastrointestinal examination was performed, but no obvious abnormalities were detected in the upper or lower digestive tract. Hematology tests also revealed no abnormalities, except for slight eosinophilia. He developed depression and was given an antidepressant agent. After suffering from hyponatremia and disorientation, he was subsequently admitted to our hospital on August 28. At that time, serum adrenocorticotropic hormone (ACTH) and cortisol levels were low, while both the ACTH and corticotrophin-releasing hormone (CRH) stress tests showed no response. Other stress tests revealed normal responses, so he was given a diagnosis isolated ACTH deficiency and received corticosteroid therapy. In summary, we report an elderly case of isolated ACTH deficiency with nonspecific initial manifestations such as nausea, fatigue, and depression.
A 79-year-old woman had shown a decline of volition nine months before admission. Because she demonstrated a depressive state, she had been treated with an antidepressant for one month before admission. Thereafter, she became incontinent and showed a poor appetite since two days before admission. Plain computed tomography scan showed an extensive low density area in the right frontal lobe. Cerebral magnetic resonance imaging revealed a tumor with edema (3 cm in diameter), which showed heterogeneous enhancement. The solitary tumor was removed by craniotomy. Metastatic carcinoma was suspected on histological examination, but the primary cancer was not able to be detected by a whole body examination, except for colonoscopy, which was refused by her family. She demonstrated intestinal bleeding about five months after the craniotomy. Rectal cancer was discovered by colonoscopy and she underwent Hartman's procedure. Histological examination revealed poorly differentiated adenocarcinoma similar to resected brain tumor. The final solitary diagnosis was metastatic carcinoma from primary rectal cancer. Solitary brain metastasis from colon cancer is extremely rare, however, we should consider the possibility in cancers of the digestive tract.