Aim: The incidence of colorectal cancer is increasing. Surgery and chemotherapy for elderly patients are also increasing. We evaluated the characteristics of elderly colorectal cancer to clarify issues related to surgical therapy for elderly patients. Method: We studied 67 patients (38 men, 29 women) over 80 years old on whom we operated for colorectal cancer from 1990 to 2004. We compared them with 130 patients aged from 70 to 74 who were operated on in the same period, examining clinicopathological factors, operative methods, preoperative morbidity, postoperative complications, chemotherapy and postoperative survival ratio. Results: In the elderly patients aged over 80, the rate of Dukes' B was high, whereas the rate of Dukes' A was high in patients aged from 70 to 74. No significant differences were observed in operative methods for colon cancer but Hartmann's operation and transanal local excision were frequent for rectal cancer in patients aged over 80. The rate of lymph node dissection was low in patients aged over 80 with rectal cancer. A significant difference was observed in lymph node dissection of rectal cancer between patients aged over 80 and those aged from 70 to 74, but there was no significant difference in curative ratio. Preoperative morbidity were recognized in 76% of patients aged over 80. Postoperative complications occurred in 51% of patients aged over 80. There were many cases showing delirium, but no differences in other complications between patients aged over 80 and those aged from 70 to 74. There was no operative mortality in patients aged over 80. Conclusion: Even elderly patients can anticipate safe operations without postoperative complications or decreased quality of life, if the appropriate operative procedure is selected with regard to their general condition.
Aim: In the United States, a study has shown that dementia is a significant factor negatively associated with medical treatment. Because the increasing number of the elderly has resulted in cause a rise in patients with dementia or acute myocardial infarction (AMI), or both, we need to know the differences in in-hospital mortality between patients with or without dementia in patients with AMI. Methods: We used data from 13 acute care hospitals including in the data from the Tokai Acute Myocardial Infarction Study (TAMIS), a retrospective study of all patients admitted to these hospitals from 1995 to 1997 with a diagnosis of AMI. We abstracted the baseline and procedural characteristics from detailed chart reviews. A total of 22 patients with dementia and 1,030 with no dementia who were aged 65 and over were included in the present study, and were divided into two groups according to their diagnosis of dementia. We compared the baseline and procedure characteristics and clinical outcomes between the two groups. Results: Patients with dementia were older and more likely to have either a lower body mass index score or ADL impairment. As for medical history, patients with dementia were more likely to have a history of cerebrovascular disease, and less likely to have a history of angina or smoking. Before and after multivariable adjustment, no significant difference was found in in-hospital mortality between patients with or without dementia. Conclusions: Our study demonstrates that AMI elderly patients with dementia were not less likely to be undertreated and did not have a higher in-hospital mortality rate than non-dementia patients.
Aim: Although there are many reports regarding the status of memory clinics in Japan, most are from the clinical departments of psychiatry or neurology, and there are few from the geriatric outpatient clinics. This study aimed to review the status of the memory clinic at the geriatric outpatient unit of a university hospital and also to compare the results with other reports. Methods: Patient records of the memory clinic at the geriatric outpatient unit of the Nagoya University Hospital between January 2000 and June 2006, which included clinical information and neuropsychological profiles were extensively reviewed for statistical analyses. Of the patients who first visited the memory clinic between January 2004 and June 2006, prior written consent are obtained from 232 outpatients, among which 223 individuals who had intact sets of data were subjected to detailed analyses. Results: During the period investigated, we had a total of 778 visits by 577 patients. The characteristics of patients were: age: 74.5±8.3 years; MMSE: 23.8±4.7; education year: 10.7±2.9. Clinical profiles of the patients who visited during the most recent 2.5 years were as follow: cognitively normal, 8.1%; dementia of Alzheimer's type, 45.3%; vascular type, 5.4%; mixed type, 2.2%; frontotemporal dementia, 3.1%; mild cognitive impairment, 15.7%, and others. Conclusion: Compared with previous reports from other institutions, we observed that the visitors to our geriatric memory clinic had a relatively higher educational background with earlier stages of dementing disorders, which also included pre-clinical cognitive impairment.
Aim: Elderly populations are evaluated on their ability to perform instrumental activities of daily living (IADL) using one of three subscales in the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, while the Kihon Checklist-a tool developed to screen for frailty-is designed to measure actual task performance. This study examined the significance of performance-based evaluations. Methods: Using five items from the TMIG Index of Competence assessing ability, and three items included in the Kihon Checklist assessing performance, 124 community-dwelling elderly persons were evaluated in five daily task areas: using public transportation; shopping for daily necessities; handling bank accounts; paying bills; and preparing meals. Physical, psychological and social functioning were also assessed during the evaluations. Results: The study revealed discrepancies between participants' abilities and their performance levels of the same daily tasks. Of the respondents, 12.5% men and 13.4% women reported that "they could perform all three tasks on the Kihon Checklist, but in actuality did not perform at least one of them". This "borderline-performance group" indicated a lower functioning level than those who answered "they performed all tasks" in all three physical, psychological and social domains. However, this group indicated a higher functioning level than those reporting that it was "impossible to perform at least one task" in all three domains. Conclusion: Study findings suggested that borderline-performance was related to the early stage of functional decline. The performance-based IADL evaluation is an effective screening tool for preventive declines in daily task performance.
Aim: The purpose of the present study was to examine the effect of the size of tablets on the status of swallowing and handling during taking medicine among frail elderly persons. Methods: The subjects of the present study were 73 frail elderly persons. After they conducted simulation taking medicine, they determined the desirable size of tablets using subjective evaluation. Their behavior and the time required for the simulation were examined. We also evaluated their activities of daily living using the ADL20, and swallowing ability using the repetitive saliva swallowing test (RSST). Results: There was a significant difference in behavior during taking medicine between the frail elderly with low swallowing ability and other subjects with normal swallowing ability, that is, the elderly persons with low swallowing ability tend to swallow three tablets after several trials (p<0.05). Also, the required time for simulation taking medicine was related significantly to the size of tablets (p<0.01). Conclusion: The most desirable size based upon easiness of swallowing and handling is 7-8mm. These results suggest that medicine taking behavior was influenced greatly by the decline of swallowing ability and ADL, and the prescriptions for the frail elderly are needed to meet their swallowing ability.
Aim: To examine the distribution of 25-hydroxyvitamin D3 [25(OH)D] levels among the Japanese frail elderly, and to explore any association in these subjects between 25 (OH)D levels and functional capacity or physical performance. Methods: A cross-sectional survey was conducted in a town (latitude 36 degrees north) in June 2005 to September 2006. The 76 participants were community-dwelling elderly aged 65 years and over who attended a class for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of 25(OH)D, intact parathyroid hormone (iPTH) and calcium were measured. The following physical tests were performed: timed up and go (TUG), a 5-meter walk, functional reach, trunk flexion, and grip strength. Functional capacity and physical performance were compared between the subjects with 25(OH)D≥50nmol/L and those with 25(OH)D<50nmol/L. Results: About 52.6% experienced falls, 75.0% experienced stumbling or body sway more than once during the past year, and 20.0% were housebound. The mean 25(OH)D level (±SD) was 60.4±13.6 nmol/L (range: 27.5-87.5). The ratio of the 25(OH)D level below 50.0nmol/L was significantly higher in the group of subjects who had lower mobility or body imbalance or were housebound. The risk factor for stumbling or body sway was 25(OH)D<50nmol/L (OR: 4.41, 95%CI: 1.31-14.86). Conclusion: The prevalence of 25(OH)D<50nmol/L was 21% among Japanese frail elderly, and 25(OH)D deficiency is associated with lower mobility or body imbalance. It is suggested that the level of 25(OH)D should be needed over 50nmol/L for nursing care prevention in the frail elderly and that measurements of 25(OH)D for the frail elderly are needed.
Purpose: To elucidate factors associated with delayed discharge of elderly patients from university hospitals in Japan. Methods: Questionnaires were sent to all 125 Japanese university hospitals during the period from January, 18 through March, 25, 2004. Thirty-four possible reasons for the delayed discharge were analyzed. Results: Family issues were the most common reason for delayed discharge nationwide. Medical treatment was a factor in delayed discharge in metropolitan areas where university hospitals were under pressure to reduce the mean hospital stay. The lack of chronic beds was identified as a factor associated with delayed discharge. However, the low quality of care at institutes in rural areas may possibly cause delayed discharge, despite adequate number of chronic beds. Conclusions: Despite the Japanese government encouraging the care of elderly people at home, the present study shows that the leading cause of delayed discharge is that families cannot accept elderly patients directly from university hospitals. Even if the number of chronic beds were to increase, the quality of care provided would not be adequate to allow a smooth transition of elderly patients from university hospitals to such chronic beds in some areas.
We report a 94-year-old woman, who underwent percutaneous endoscopic Jejunostomy (PEJ) tube feeding for enteral nutrition, developed the intussusception of the small intestine. She suffered from nontuberculous mycobacterium (NTM), and her lung inflammation deteriorated due to aspiration pneumonia and malnutrition. Because of old age, dysphagia, esophageal hiatus hernia, gastro-esophageal reflux and her bedridden condition due to severe osteoporosis, oral nutritional supplementation is nearly impossible. To reduce the aspiration risk, we chose PEJ instead of percutaneous endoscopic gastrostomy (PEG) as the route of tube feeding. Six months after the placement of a PEJ tube, aspiration pneumonia was diagnosed and she was readmitted to our hospital. During hospitalization, she had sudden diarrhea, vomiting, and lower abdominal pain. Abdominal CT scan and radiographs using contrast medium showed small intestinal intussusception related to the PEJ tube. We observed the clinical course without performing surgery, pulling it back towards the stomach and placing an ileus tube, because the small intestine was not completely obstructed. Two months later, although she suffered from aspiration pneumonia once more, she remained in a stable condition without further intervention so that she could move to aother hospital. Recently PEJ has been expected to prevent aspiration pneumonia, but we believe that it can be a risk factor for intussusception. Although the PEJ can be a good parenteral nutrition route for frail elderly with dysphagia, we need to consider possible complications including intussusception.