Aim: We investigated the relationship of metabolic syndrome (MetS) and insulin resistance (IR) with microalbuminuria in senior citizens of rural communities in Japan. Method: The subjects were 338 senior citizens (age 65 or older) who underwent medical examinations in the towns of Tanno and Sobetsu, Hokkaido in 2005. The following participants were excluded: those with missing data, those with type 2 diabetes (fasting plasma glucose ≥126 mg/dl and/or those who were on medication for diabetes), those who were on medication for hypertension and those with macroalbuminuria (urinary albumin creatinine ratio (ACR) ≥300 mg/g·Cr). The subjects were divided into two groups according to the Japanese criteria of MetS: a MetS group and a non-MetS group. The percentages of subjects with microalbuminuria (ACR ≥30 mg/g·Cr) in the two groups were compared. We also investigated the relationship between IR and microalbuminuria using homeostasis model assessment (HOMA-R). Result: The percentage of subjects with microalbuminuria was significantly higher in the MetS group than in the non-MetS group. Multiple logistic regression analysis showed that there was a significant relationship between MetS and microalbuminuria (relative risk: 3.09, 95%CI: 1.18-8.07) and that there was also a significant relationship between HOMA-R and microalbuminuria (relative risk: 1.91, 95%CI: 1.14-3.20). Conclusion: It may be important for prevention of microalbuminuria in patients with MetS not only to manage blood pressure and blood glucose but also to manage IR, which is part of the background of accumulation of these risk factors.
Purpose: The purpose of this study was to analyze relationships between the history of falls, tripping, sway, and knee extensor muscle strengths as a tool for fall risk assessment in elderly people. We examined effective fall prevention measures. Methods: We investigated 102 elderly volunteers in the community. The subjects were classified according to history of falls, tripping, sway and 5 performance tests conducted to assess fall risk including Timed up-and-go test (TUG), Functional Reach test (FR), Hand grip and Reaction time (RT). In addition, the time serial data of the knee extensor muscle strength were acquired using a hand-held dynamometer. Results: In comparison to the non-faller group, the faller group showed a significantly higher incident rate of tripping and sway. A frequency analysis using the Maximum Entropy Method revealed that the fallers group showed lower peak frequency (p=0.025). Also, the slope of the logarithmical spectrum was less steep in the fallers group (p=0.035). Also results from analysis of the peak force latency from the beginning of measurement to 50%, 80%, and 100% muscle strength, also showed that the faller group took more time for maximal voluntary contraction. Conclusions: The frequency analysis of the time series date of peak force latency of knee extensor muscle strength revealed that the muscle activity differs in faller compared to non-fallers. This study suggested that knee extensor muscle isometric performance could possibly be used as a new tool for fall risk assessment. We concluded that exercises to raise maximal muscle strength and muscle response speed are useful for the prevention of falls.
Aim: To evaluate whether the frequency, volume, and type of urinary incontinence (UI) correlated with physical fitness and self-rated health, and to assess the risk factors associated with frequency and volume of UI, and self-rated health in elderly community-dwelling women with UI. Methods: The subjects were 957 women aged 70 or older who participated in a comprehensive health examination which included a face-to-face interview and physical fitness tests. In order to evaluate the differences in the physical fitness and the interview data with the frequency, volume, and type of UI we used student t-test for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with frequency and volume of UI, and self-rated health. Results: The prevalence of UI was 43.5% in elderly women. The high frequency and large amount of UI, and the urge and mixed UI were significantly associated with a lower level of balance, muscular strength, walking ability, and higher BMI. According to the logistic model, self-rated health (odds ratio (OR)=0.49, 95%confidence intervals (CI)=0.26-0.92), urge (OR=2.04, 95%CI=1.04-4.06) and mixed UI (OR=4.07, 95%CI=1.94-8.70), BMI (OR=1.10, 95%CI=1.01-1.21), urination frequency during the daytime(OR=1.25, 95%CI=1.10-1.44), maximum walking speed (OR=0.25, 95%CI=0.08-0.71) were independent variables significantly associated with frequency of UI, the volume of UI was significantly associated with urge (OR=2.27, 95%CI=1.08-4.91) and mixed UI (OR=3.02, 95%CI=1.33-6.98), and the self-rated health was significantly associated with frequency of UI (OR=2.18, 95%CI=1.28-3.68) and urge UI (OR=2.28, 95%CI=1.30-4.06). Conclusions: The high frequency and urge UI was significantly associated with a lower level of physical fitness and self-rated health. Our findings suggest that active lifestyle, which was focused on a decreased BMI and increased walking ability, may contribute to the prevention of UI.
Aim: To develop a Japanese version Care Planning Assessment Tool (CPAT) , a comprehensive geriatric assessment instrument for dementia care, originally developed in Australia. Methods: The J-CPAT is composed of 61 items, and 8 domains: Communication, Physical problems, Self-help skills, Confusion, Behavior, Social interaction, Psychiatric observation, and Care dependency. The development of the J-CPAT included translation into Japanese, assessment of item comprehension, back translation, production of final version, and its validity and reliability analysis. Through this process, an item about family interaction was added in the J-CPAT. The participants were 199 clients in residential and day care. Raters were professional carers with 2.5 hours training about the J-CPAT. We assessed the validity of the J-CPAT, using correlation between the scores of the J-CPAT, MMSE, NM-scale, N-ADL, and levels of care needs (Kaigodo). Ten pairs of carers were included in the inter-rater reliability analysis. Fourteen carers participated in the intrarater reliability study. Results: Cronbach's alpha values in each J-CPAT domain were 0.74-0.95. Mean difference of each domain between test and retest was 0.4-3.6%. Weighted kappa values for all items for 10 pairs of raters were over 0.6. The correlation coefficients between the domain score of 'Confusion' in the J-CPAT and MMSE was -0.90 (p<0.01). Those between the domain scores of 'Physical problems', 'Self-help skills', 'Dependency on care' in the J-CPAT, and Kaigodo were sufficient (>0.62), and those between the item scores of the J-CPAT, NM-scale, and N-ADL were relevant (>0.60). Conclusions: The J-CPAT is considered to be an appropriate assessment instrument for dementia care in Japan.
Aim: As summer become hotter due to rapid climate change, older people suffering from heat illness are increasing. The aim of our study was to examine the characteristics of older people who suffered from heat illness. Methods: We analyzed the 65 years or older patients admitted for acute care of Nagoya Ekisaikai Hospital via the emergency department (ED) during the summer seasons of 2006 and 2007. Demographic data, functional status, use situation of care services, climate of the onset day, use of an air conditioners, and cognitive status, length of hospital stay and disposition following their discharge were recorded. Results: During the study period, 104 patients visited the ED because of heat illness. Twenty older patients were admitted for acute care. In hospitalized patients, the mean length of stay was 27.5±18.6days. Sixty percent of patients were discharged to long-term care facilities (12/20). Sixteen patients suffered from heat illness inside their home. Most of the patients had characteristics such as living alone or with their spouses only (14/16), cognitive dysfunction (12/16), lack or no use of an air conditioner (11/16) , no use of care service (11/16) , and preserved functional status (10/16) . Conclusions: Many older patients suffered from heat illness in their home, and their ED visits were associated with prolonged admissions and post-discharge institutionalizations. It is important to give education to prevent heat illness in older people.
A 90-year-old woman was referred and admitted to our hospital because of progressing dementia, decreased appetite, and general fatigue. Blood tests on admission disclosed: white cell count, 2,900 /mm3; hemoglobin 5.6 g/dl; mean corpuscular volume; 139.7 μm3. Based on the presence of pancytopenia, macrocytic anemia, and elevated lactate dehydrogenises, we suspected pernicious anemia. We administered vitamin B12, which improved the blood test results and the signs of dementia. Gastrointestinal tract examination showed type A gastritis. Tests for anti-intrinsic factor antibody and anti-gastric parietal cell antibody were positive, which help confirm a diagnosis of pernicious anemia. Pernicious anemia is an autoimmune disease common among those aged 50-60 years. Cases aged over 90 years are rare. However, the numbers of extremely elderly patients are expected to increase with the growth of the elderly population. Fortunately, pernicious anemia is easy to treat. We need to make an appropriate diagnosis of pernicious anemia in the oldest elderly patients.
A 91-year-old woman was admitted to our hospital with dyspnea. A chest radiograph and chest CT films revealed a large amount of pleural effusion in the right side pleural cavity. After serial thoracentesis, chest CT films showed a mass shadow in the right S6. Adenocarcinoma cells were found in the pleural effusion, leading to a diagnosis of non-small cell lung cancer (stage IIIB). After administration of gefitinib, the mass shadow and pleural effusion reduced and her performance status improved. Gefitinib may be a well-tolerated therapeutic strategy in elderly and poor performance status patients with advanced non-small cell lung cancer.