Aim: We examined changes in ability- and performance-based instrumental activities of daily living (IADL) among community-dwelling elderly a year after a baseline survey was taken.
Methods: Community-dwelling elderly in Otama village were interviewed in 2006 and followed for one year. Based on ability- and performance-based IADL assessments regarding 3 daily tasks from the Kihon Checklist (using public transportation, shopping for daily necessities, and managing bank accounts), each was assigned to one of three performance groups: good, borderline, or low.
Results: One year after the survey, the proportion of those assigned to the good performance group decreased, while those assigned to either the borderline or low performance groups increased. Among those assigned to the good performance group, 75.6% remained in that group, 21.1% shifted to the borderline performance group, and 3.3% shifted to the low performance group one year later. Compared to those remaining in the good performance group, those who shifted to the borderline performance group had significantly lower muscular strength, less healthy attitudes, and lower IADL as measured by the Tokyo metropolitan Institute of Gerontology (TMIG) Index of Competence.
Conclusions: Fewer elderly were assigned to the good performance group and more were assigned to the borderline and low performance groups one year after the survey. Shifts from the good to borderline performance group were common among those with lower physical status and less healthy attitudes. We conclude that ability- and performance-based evaluations are important tools to screen those in the borderline performance group requiring preventive care.

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Aim: Mastication ability is well documented as a risk factor for disability in the elderly. The aim of the present study was to assess occlusal force, one index of mastication ability, among elderly Japanese and clarify related factors through both physical measurements and questionnaires.
Methods: Subjects were 372 community-dwelling persons (101 men, 271 women) aged 60-87 years and registered at five welfare centers for the aged in a metropolitan suburb. Occlusal force was measured with dental prescale/occluzer system. Physical measurements and questionnaires were performed to explore related factors.
Results: Occlusal force was 502.4 N in men and 372.2 N in women. In the 60-69 and 70-79 age stratifications, men had significantly higher occlusal force than women. Occlusal force correlated significantly with age (r=-0.2, p<0.01), and number of residual teeth (r=0.6, p<0.01). After adjustment for age and the number of residual teeth, occlusal force had positive partial correlation with handgrip strength in men, and positive partial correlations with usual walking speed and body muscle mass, and negative partial correlation with timed up and go in women.
From the questionnaire, high occlusal force was significantly associated with "can bite hard food" in both men and women; and with lifestyle factors ("walking regularly", "no smoking", and "alcohol consumption") in men; and with psychological factors ("intraoral satisfaction" and "no depression tendency") and physical factors ("can walk 1-km" and "can go out alone to distant places") in women.
Conclusion: Occlusal force was related to physical fitness, ability of movement, and lifestyle.

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Aim: Falls are major risk factors in nursing care and reported to be associated with low vitamin D levels or impaired renal function. It is unknown whether physical function is associated with impaired renal function. The aim of this study was to examine the association between estimated glomerular filtration rate (eGFR) (ml/min/1.73 m²), vitamin D, and physical function in Japanese frail elderly.
Methods: A cross-sectional survey was conducted in two towns (latitude 36 degrees north) from June 2006 to January 2008. Subjects counted of 109 community-dwelling frail elderly, aged 65 years and over (mean±SD: 75.8±5.2 yr) who attended a program for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25 (OH) D), 1,25-dihydroxyvitamin D (1,25 (OH)₂D), and creatinine were measured. eGFR (ml/min/1.73 m²) was calculated using the Modification of Diet in Renal Disease formula. The following functional fitness tests were performed: timed up and go (TUG), a 5-meter walk, functional reach (FR), one leg stance, tandem stance, and grip strength.
Results: Of the subjects, 59.6% experienced falls, 75.2% experienced stumbling at least once during the past year. eGFR was 68.0±14.1 ml/min/1.73 m² in the subjects. The prevalence of eGFR<60.0 ml/min/1.73 m² was 30%. The subjects with eGFR≥60 ml/min/1.73 m² showed significantly better results for FR, one leg stance, and tandem stance than those with eGFR<60 ml/min/1.73 m². Multiple liner regression analysis suggested that FR and tandem stance were significantly affected by eGFR.
Conclusions: Our data suggest that assessment of renal function seems to be significant when we consider balance ability in the frail elderly.

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Aim: The Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) is a community hospital catering for the health care needs of senior citizens, and 37.5% (120 beds) of its beds are psychiatric beds mostly for those with cognitive impairment. The purpose of this study was to analyze cause of death in a hospital like ours with its particular case mix.
Methods: All patients who passed away in our hospital between June 1st 2002 and November 30th 2007 were surveyed with regard to their age distribution and causes of death were analyzed and compared with available national statistics.
Results: The over 65 age group accounted for 93.5% of the total and consisted of 815 patients, including 461 men (56.6%) and 354 women (43.4%). The most common cause of death was malignant neoplasm, followed by pneumonia, cardiovascular diseases, cerebrovascular accidents, and renal failure. Among those who died from the primary disease diagnosed on admission, malignancy was most common (288 cases, 61.3%), followed by pneumonia, cerebrovascular accidents, cardiovascular diseases and renal failure. As for those who died from non-primary diagnosis on admission (patients dying due to any condition, not the direct reason of their admission), pneumonia was the most common diagnosis on admission (95 cases, 27.5%), followed by cardiovascular diseases, malignant neoplasm, sepsis and renal failure. In the general wards, above half of those who died due to the primary cause of admission was malignant neoplasm. On the other hand, 1/4 of those who died from causes other than the primary diagnosis on admission was pneumonia. In the mental health wards the most common cause of death due to the primary diagnosis was malignant neoplasm, followed by dementia of Alzheimer's type. The most common cause of death other than the primary reason for admission was pneumonia. More non-primary diagnosis deaths occurred in the mental health wards than in the general wards.
Conclusion: In our hospital, malignancy and pneumonia were the most common causes of death, rather than cerebrovascular or cardiovascular diseases, but otherwise, the ranking order of the causes of death was very similar to those in other areas of Japan. Causes of the both in our hospital were closely linked with the high incidence of in-hospital mortality in Japan, accounting for 80% of all deaths. Although the case mix of our in-patients is influenced by a particular distribution of health care institutions and nursing care facilities in our catchment area for secondary care, the study demonstrated that our geriatric service responds to the needs of a wide spectrum of indications suffered by elderly citizens at the end of their life.

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A 72-year-old man had been treated for type 2 diabetes mellitus and gastric cancer. He had been receiving insulin and chemotherapy because of diabetes mellitus and terminal gastric cancer. The dose of insulin was decreased due to the appetite loss, but his general condition deteriorated with disturbed consciousness (JCS I-3), so he was admitted to our hospital in November 2006. On admission, he showed abnormal laboratory data such as WBC 11,070 /μl, Hb 10.2 g/dl, serum BUN 64.1 mg/dl, serum Cr 2.23 mg/dl, serum CRP 16.78 mg/dl, plasma glucose 830 mg/dl, serum osmolarity 360 mOsm/l, and serum total keton body 5,490 μmol/l. However, serum Na (142 mEq/l), serum K (4.5 mEq/l), arterial blood pH (7.368), and the anion gap (15 mEq/l) were within the normal range. He was given a diagnosis of hyperglycemic hyperosmolar syndrome with hyperketonemia. Immediately treatment was started with physiologic saline and regular insulin infusion. After treatment, glucose level and serum osmolarity ameliorated. Though elderly cases with hyperglycemic hyperosmolar syndrome and hyperketonemia are rarely reported, it is important to be aware that elderly patients often have very atypical signs and symptoms. We report this case to show diverse nature of elderly patients.

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A 75-year-old woman was admitted with a history of acute muscle weakness of her legs for two weeks. Physical examination showed no abnormal findings. Neurological examination revealed symmetrical proximal muscle weakness of legs with muscle pain on grasping. Laboratory data showed normal serum creatine kinase level and marked increases in the levels of serum ACE and soluble interleukin 2. Electromyography showed no myopathic changes. MRI T2 weighted imaging (T2WI) imaging for femoral skeletal muscle demonstrated scattered high and low intensity signals. Muscle biopsy from the right rectus femoris muscle showed granuloma with giant cells of Langhans. She was given a diagnosis of sarcoid myopathy, and motor weakness and abnormal intensity signals on T2WI in this patient were dramatically improved with oral administration of prednisolone (40 mg/day).

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