Although it is well-known that moderate and severe visual and/or hearing impairments in elderly persons reduce their activities of daily living (ADL) and their quality of life (QOL) , most elderly people, their caregivers and even nurses/doctors do not care about those disturbances considering them as normal aging. We studied 1,874 commnity-dwelling elderly (813 men, 1,061 women, mean age; 76±9 yrs. ) and demonstrated that apparently healthy older persons with slightly reduced function clarified by self-reported questionnaires do not only have lower scores of ADL and VAS (QOL) , but also higher score of GDS 15, that is, they have a more depressive state, compared to those without visual and/or hearing impairments. Therefore, because visual and/or hearing functional impairments in the elderly, even if slight, affect their ADL impairments, QOL and mood, we should assess whether the older persons have visual/hearing disturbance (s) in functional screening and should give them some kinds of assistance to succeed in achieving on enjoyable elderly life.
Aim: Patients in nursing homes are becoming more and more elderly and also prone to infectious diseases. It is important to select proper antimicrobial agents in treating such patients because of the increase in drug-resistant bacteria in recent years. Methods: Pathogenic aerobic bacteria were isolated from cultures of the pharyngeal swab obtained from patients with acute febrile episodes and those with chronic febrile conditions with a repetition of fever or continuing low-grade fever. Isolation of pathogens was also carried out in patients with a urinary tract infection that was resistant to treatment. Isolated bacteria were tested for sensitivity to commonly used antimicrobial agents. Results: Pathogenic bacteria were isolated from 33% of the patients with acute febrile episodes, while they were isolated from 75% of the patients with chronic febrile conditions. The number of major pathogenic bacteria from 85 isolates were methicillin-resistant staphylococcus aureus (MRSA) 13, methicillin-sensitive staphylococcus aureus (MSSA) 6, Streptococcus pneumoniae 8, β-hemolytic streptococcus 5, Klebsiella pneumoniae 10, and Enterobacter cloacae 6. Only two isolates of Streptococcus pneumoniae were penicillin-sensitive (PSSP) , while the others were penicillin-resistant (PRSP) (1) or penicillin-insensitive (PISP) (5) . Among these 8 isolates, 5 were resistant to levofloxacin (LVFX) . Escherichia coli was isolated from the pharyngeal swab of 2 patients, one of the 2 isolates being resistant to LVFX. Escherichia coli was isolated from 5 patients with urinary tract infection and 5 of the 6 isolates were resistant to LVFX; with one of them being extended spectrum β-lactamases (ESBL) . Conclusion: The frequency of isolation of antimicrobial-resistant pathogens was extremely high among elderly patients in our nursing home compared to values reported from a nation-wide survey recently carried out in Japan. In particular, attention should be focused on the resistance of bacteria to fluoroquinolones.
Aim: We assessed health-related quality of life (HRQOL) of community-dwelling older people who practiced Tai Chi in a cross-sectional study using the MOS 36-item short-form health survey (SF-36, Japanese version) . Methods: SF-36 and another questionnaire about age, sex, experience with Tai Chi, were distributed to 903 people who were above 65 years old and belonged to the Japan Health Tai Chi Association. Of these, 804 people responded (89.04%) . From the SF-36, we used the sub-scores for physical functioning (PF) , physical role (PR) , bodily pain (BP) , general health (GH) , vitality (VT) , social functioning (SF) , role emotional (RE) , and mental health (MH) . These sub-scores were compared with those obtained from age-matched national standards for groups 60 to 69 years old and 70 to 80 years old respectively (n=1.040) . Results: The 60- to 69-year-old subjects had significantly higher PF (p<0.01) , GH (p<0.05) , and MH (p<0.01) than the national averages. For the 70- to 80-year old subjects, PF (p<0.01) , PR (p<0.01) , BP (p<0.05) , GH (p<0.01) , VT (p<0.01) , RE (p<0.01) , and MH (p<0.01) were significantly higher than the national averages. The number of years and the frequency of practicing Tai Chi statistically significantly correlated with MH and PF, and GH and PF, respectively. Conclusion: The HRQOL of the people who practiced Tai Chi was better than age-matched national standards. Although the number of years and the frequency of practicing Tai chi statistically significantly correlated with the sub-scores of the HRQOL, the adjusted (R2) were low.
Aim: The aim of this study was to evaluate the relationship between maximum opioid dose and body weight, age, and primary site in terminal cancer patients in a palliative care unit. Methods: Medical records of 152 terminal cancer patients were reviewed retrospectively. Body weight, primary tumor site, age, and analgesic state were used as independent variables, and the maximum opioid dose was used as a dependent variable. Results: There was no correlation between body weight and maximum opioid requirement. Selected independent variables were age and location of the primary lesion in the lower gastrointestinal tract. Maximum opioid dose was negatively correlated with age (P ≤0.0001) . Opioid needs of age <65 was 344.2mg/day oral morphine equivalent, but age 65-74 was 168.5, and age ≥75 was 116.9mg/day. Conclusion: Elderly cancer patients required a lower amount of opioid analgesia than younger adults. The ratio for age <65, 65-74, and ≥75 was about 1 : 1/2 : 1/3.
Aim: Care of families attending patients' deathbeds is important, leading to care of the bereaved. However, we have no knowledge of a causal relationship between factors of care of terminally ill patients' families and care of families attending patients' deathbeds. The aim of this survey was to find out which factors of care nurses provide to terminally ill patients' families affect care of families attending patients' deathbeds in a general ward where many terminally ill elderly patients spend their time. Methods: Questionnaire survey of 978 general ward chief nurses working for hospitals with over 100 beds in the Kyushu district. Data were processed through factor analysis and covariance structured analysis. Results: 236 valid responses were analyzed. Four factors regarding chief nurses providing for families of terminally ill patients were identified. These factors were interpreted as first, mediating communication between families and patients; second, providing information; third, promoting cooperation and understanding among families; and fourth alleviating restrictions. The first factor correlates with the third factor. Especially, the first factor strongly affects the provision of care to families attending patients' deathbeds. The relationships of the second and fourth factors with care of families attending patients' deathbeds were not proved. Conclusion: Care of terminally ill patients' families in a general ward consists of four factors: mediating communication between families and patients, providing information, promoting cooperation and understanding among families, and alleviating restrictions. It was revealed that the more nurses promote cooperation and understanding among families, the more they can mediate communication between families and patients and provide care to families attending patients' deathbeds. It suggests that nurses are able to have a positive effect on the grief process of the bereaved by intervening between patients and families.
Objectives: Elderly patients living in nursing homes can easily find themselves unable to carry out their daily activities, once they become ill, even with infectious diseases of a slight to mild degree, and rapid treatment is required to cure them of their malaise. However, treatment is often difficult due to the presence of drug-resistant bacteria. This study was designed to evaluate the efficacy of the selective use of antimicrobial agents based on a sensitivity test of isolated bacteria. Methods: Possible pathogenic bacteria were isolated from cultures of pharyngeal swabs or urine obtained from patients with chronic febrile conditions or urinary tract infections, resistant to antimicrobial treatment. The efficacy of the treatment was evaluated based on release from febrile conditions and improvement of activities of daily living (ADL) accompanied by the disappearance of possible pathogenic bacteria following the use of selective antimicrobial agents. Results: The outcome of 14 cases with sustaining febrile conditions and 3 cases with urinary tract infections was reviewed. Most of them showed a good response to treatment with remarkable improvement in ADL. In some cases, patients were switched from one antimicobial agent to another each time new pathogenic bacteria were detected in the culture. A combination of rifampicin and sulfamethoxazole/trimethoprim (RFP/ST) was found to be the most convenient and effective treatment in patients with MRSA or drug-resistant Streptococcus pneumoniae. Levofloxacin (LVFX) -resistant Escherichia coli were detected together with MRSA in our 3 patients with urinary tract infections, corresponding to the frequent use of LVFX in our community. Conclusions: Identification of possible pathogenic bacteria and the use of proper antibiotic agents based on a sensitivity test are very effective in the treatment of elderly patients with chronic febrile conditions arising from the presence of drug-resistant bacteria. Careful use of fluoroquinolones is required in patients in whom MRSA is or had once been detected. This is beneficial not only for the elderly patients themselves but is also useful in preventing the spread of drug-resistant bacteria.
Aim: The purpose of this study was to develop the index of functional gait reserve relative to gait endurance and gait conformability, and to examine the relationship between functional gait reserve and activities of daily living (ADL) in elderly individuals. Methods: Subjects comprised 107 community-dwelling elderly individuals (mean age, 72.5 ±5.0 years) . We evaluated gait function using the timed"Up and Go"test (TUG) , 10-m walking time, 6-minute distance (6MD) , physiological cost index (PCI) and ratings of perceived exertion (RPE) , and investigated Tokyo Metropolitan Institute Gerontology-Index of Competence as an index of ADL. TUGs were performed at a comfortable speed (TUGcom) and maximum speed (TUGmax) , and TUG Reserve (TUG-R) was derived from the ratio of the difference between TUGmax and TUGcom as an index of functional gait reserve. Results: Intraday reliability of TUG-R was high (intraclass correlation coefficient (1, 2) =0.82) , and TUG-R was correlated to 6MD, PCI and RPE, which was reflected in gait endurance and gait conformability. Scores for TUG-R were significantly lower in elderly individuals with ADL dependence than in independent elderly individuals. Multiple logistic regression analysis showed TUG-R as associated with performance of outdoor activities. Conclusion: TUG-R offers a reliable and useful index of functional gait reserve related to gait endurance and ADL in elderly individuals.
Aim: The purpose of this study was to examine the effects of copper supplementation on lipid profiles in elderly patients with copper deficiency. Methods: Nine long-term bed-ridden, patients (5 men and 4 women, mean age 83.3±8.7 years old) with severe copper deficiency, who had a serum copper of 15μg/dL or less (normal range 70-140μg/dL) , had their diets supplemented with copper sulfate (3mg/day) over 12 weeks in addition to their diet of only one kind of enteral food with a low concentration of copper. Copper, ceruloplasmin, total cholesterol (TC) , triacylglycerides (TG) , HDL-cholesterol (HDL-C) , c-reactive protein (CRP) , creatinine (Cr) , zinc (Zn) and albumin (Alb) in the serum were measured before, 4 weeks and 12 weeks after copper supplementation. Results: Serum copper and ceruloplasmin were significantly increased at 4 weeks after copper supplementation. TG was significantly increased at 4 weeks after copper supplementation, but at 12 weeks the increase of TG was not significant. TC, HDL-C, CRP, Cr, Zn and Alb were not changed by copper supplementation. Conclusion: TG was transiently increased by copper supplementation in elderly patients with copper deficiency. TC and HDL-C were not changed by copper supplementation.
Aim: We conducted a national survey of senior medical students' attitudes about end-of-life care teaching programs for undergraduate students of Japanese medical schools from April 2004 to May 2006. Methods: Our questionnaire survey focused on the students' attitudes towards the following end-of-life areas: 1) end-of-life topics, 2) teaching methods, 3) putting theories into practice, and 4) overall end-of-life issue. Results: Overall, 1,039 students from 16 medical schools responded to our survey. The students who took part in the program appreciated the class on communication techniques with dying patients or family members of dying patients. As for the students who did not participate in the program, they expressed the wish to join a class concerning these issues. These students also expressed an interest in visiting hospices or conducting interviews with dying patients as part of their training. Most of the students formulated good opinions toward end-of-life issues, but not toward end-of-life practices. Regardless of whether they joined the program or not, most of the students had a positive attitude towards end-of-life education programs. Conclusion: The survey highlighted the need to consider wider implementation and improvement of end-of-life care education in the Japanese curriculum.