The 50th Annual Meeting of the Japan Geriatrics Society: Symposium I: An interdisciplinary analysis and view on geriatric medical treatment and care; Is there a perception gap between policy maker and clinical staff?
Aim: To investigate the incidence of falls and fall-related fractures in disabled elderly people utilizing long-term care insurance, and influence of gender, age, disabled level is examined. Methods: Subjects were 8,335 elderly people (mean age, 82.2±7.4 years). Falls and fractures were investigated retrospectively for the one year study period either via a self-report questionnaire, or via care workers and/or family members when the subjects had cognitive impairments. The care workers gave are a free description about for the fall that had occurred when using the facilities. Results: Men showed significantly higher rate of falls (26.8%) than women (24.6%). In women, there was a significant difference in fall rates between the severely disabled group (26.4%) and the moderately disabled group (23.5%). Women showed a significantly higher rate of fractures (12.2%) than that of men (4.5%). In relationship between fall-related fractures and potential correlates, there was a significant relation between women and the fall-related fractures [OR 2.5, 95%CI 1.7-3.6]. The severely disabled group showed a significantly higher rate of falls in the toilet, on the other hand, the moderately disabled group showed significantly higher rate of falls during exercise and recreation or standing. Conclusion: The rate of falls in women was lower than men in this study population. The result may be affected by the lower proportion of women in the moderately disabled group compared with men. Only gender was significantly associated with the incidence of fall-related fractures in disabled elderly people.
Aim: The purpose of this study was to examine the relationship between exercise capacity and physical fitness in healthy elderly people and elderly subject with chronic respiratory failure and chronic heart failure, and whether that relationship differs depending on level of exercise capacity. Methods: Measurements were made in 15 healthy elderly people, 17 people with chronic respiratory failure, and 15 people with chronic heart failure in the incremental shuttle walking test, timed up and go test, functional reach test, one leg balance test, grip force, knee extension force, half-squat test, step test, and sitting trunk flexion. The correlation between incremental shuttle walking test distance and other variables was compared between the disease groups, and between groups with incremental shuttle walking test distance under and over 450 m, which was the index of physical capacity for heart transplant. Results: In the disease groups, more physical fitness variables correlated with exercise capacity than in the healthy elderly group. The under-450 m group had poorer balance, muscular endurance, and agility than the over-450 m group. In the under-450 m group, exercise capacity was correlated with balance, muscle power, and agility. Conclusions: In elderly people with chronic respiratory failure and chronic heart failure, exercise capacity is influenced by various factors of physical performance. Training to improve physical fitness may be necessary for elderly people with incremental shuttle walking test distance of below 450 m.
The proband is a 69-year-old woman with purpura and subcutaneous hematoma.We investigated this patient with prekallikrein (PK) deficiency, using both standard coagulation study and molecular genetic analysis of the PK gene. In a coagulation study, the prothrombin time (PT) was normal but the activated partial thromboplastin time (APTT) was prolonged. Preincubation of normal plasma with APTT reagent caused shortening of abnormal clotting time. Plasma PK activity was <1%. Her parents were cousins. Molecular genetic analysis showed a homozygous Gly401Glu substitution in exon 11 in the PK gene. This mutation has already been reported in a Japanese patient as PK Tokushima. Gly401 is positioned in PK light chain, which encodes the serine protease domain. The disulfide binding is formed between Cys400 and Cys416, thus Gly401 is located next to His415, which is one of the activation peptides and is important in supporting the correct conformation of proteins. Therefore, we suggest that this mutation may prevent formation of disulfide binding and reduce enzyme activity. In conclusion, in the elderly case with prolonged APTT, we should consider the contact factor deficiency and determine PK activity apart from the abnormality of coagulation factor VIII, IX, XI and XII activities.
A 77-year-old woman, who had a history of rheumatic mitral stenosis with atrial fibrillation (AF), was referred and admitted to our hospital because of a transient ischemic attack at 4: 55 p.m.. She had taken warfarin for over 10 years, but her condition was not well controlled on admission. At 8: 30 p.m., she had acute ischemic stroke with right facial palsy, right hemiparesis and slurred speech. At 10: 35 p.m., she was treated with intravenous tissue plasminogen activator (t-PA) and her neurological deficits almost fully recovered by 0: 05 a.m. (90 min after t-PA started). At 0: 08 a.m., she collapsed due to sudden pulseless arrest. Using advanced life support, she soon recoverd with no complications. After mitral valve replacement and left atrial appendectomy, she was discharged with a modified Rankin scale 0 at day 40. To the best of our knowledge, this is the first case report showing pulseless arrest immediately after treatment with t-PA in an elderly patient with ischemic stroke. Left insular injury seemed to be a crucial mechanism of pulseless arrest in this case.
An 83-year-old woman was admitted to our hospital with dyspnea. A chest X-ray showed cardiomegaly and pulmonary congestion. An echocardiogram revealed severe tricuspid regurgitation and markedly elevated transtricuspid pressure gradient of 103 mmHg. There was no left ventricular systolic or diastolic dysfunction. Laboratory evaluation revealed elevated free T4 and suppressed TSH levels. Serum level of anti-TSH receptor antibody was significantly elevated. A thyroid echogram demonstrated increased internal flow pattern in the thyroid gland. As a result of these findings, she was given a diagnosis of Basedow's disease associated with severe pulmonary hypertension and congestive heart failure. After treatment for hyperthyroidism with thiamazole, propranolol, furosemide, and warfarin, she made good recovery with gradual resolusion of pulmonary hypertension. The severity of pulmonary hypertension in this case was significantly higher than that in previous reports, possibly because of concomitant minor pulmonary embolism, thiamine deficiency and anemia. In summary, we report a rare case of Besedow's disease with severe and reversible pulmonary hypertension that appeared in very old age.