Clinical features of ischemic heart disease in the elderly are different from those in non-elderly patients. The prevalence of female patients, hypertension and co-morbidity was higher in the elderly than in non-elderly patients. Atypical clinical presentation should be taken into consideration, particularly in patients with acute coronary syndrome, because early initiation of coronary reperfusion therapy reduces mortality significantly in elderly patients. In chronic stable angina, risk stratification of patients using stress myocardial perfusion imaging plays an important clinical role. The management of coronary risk factors to prevent cardiovascular events is of utmost importance in the elderly since the mortality of acute myocardial infarction is very high. Among classical risk factors, beneficial effects of the management of blood pressure on hypertensive and/or diabetic patients are enormous. Recent development of percutaneous coronary intervention facilitated coronary revascularization to reduce ischemic burden even in patients aged 80 years or older due to the low invasiveness of the procedure. However, cardiac surgery is still regarded as the first option for the elderly ith associated aortic stenosis, diffuse 3-vessel coronary artery disease, or distal left main trunk disease.
Aim: In the present study our goal was to explore the impact of driving cessation on daily transportation utility in older people with cognitive decline. Methods: A total of 101 older persons participated in our survey of responding of a questionnaire about driving and other methods for traveling, administered at the memory clinic of the geriatric outpatient unit of Nagoya University Hospital. Of this total, 48 (47.5%) still had driving licenses, 16 (15.8%) had licenses that had expired, and 37 (36.6%) had no driving experience. Results: The majority of license holders (77.1%) were active drivers, and we found that license holders tend to utilize public transport loss than older people without driving experience. Furthermore, among those who had ceased driving, there was a contrast in daily transportation utility between those with dementia and those without dementia, with the former accessing public transport less frequently. Conclusion: When clinicians advise drivers with dementia to cease driving, these patients need special attention to assist them in providing alternative ways of transportation.
Aim: We examined the influence of high fall-related self-efficacy on falls due to dissociation with activities of daily living (ADL) among elderly women in nursing homes. Methods: We enrolled 72 female nursing home residents who were 70 years old or over and who scored 18 or higher on the Mini-Mental State Examination (MMSE). Subjects were classified into three groups based on the relationship between ADL and fall-related self-efficacy derived from a scattergram of the Functional Independence Measure (FIM) motor items and Falls Efficacy Scale (FES). The three groups were: group I which had low ADL and high fall-related self-efficacy (n=25); group II which had high ADL and low fall-related self-efficacy (n=30); and group III which had a correlation of ADL and fall-related self-efficacy in the 95% confidence interval (n=17). Then, we investigated the incidence of falls and the number of falls after 6 months in the three groups. The risk factor of falls was also investigated using multiple logistic regression analysis. Results: The incidence and number of falls were significantly different in the three groups after 6 months. Moreover, the incidence of those falling was significantly different between group I and group III. The occurrence of falls was also significantly related with a past history of falls, FES, and group I which had low ADL and high fall-related self-efficacy. Conclusion: These findings suggest that the risk of falling increases in the presence of excessive fall-related self-efficacy dissociated from ADL.
Aim: : The aim of this study was to investigate morning hypertension and self measurement of blood pressure (BP) at home. Methods: Ninety-six patients out of 260 hypertensive (HT) out patients with antihypertensive medication measured their BP at home and data were collected from 60 patients (21 men, 39 women: mean age 74.8 years). The relation between out patient clinic BP and home BP was evaluated in the 60 HT patients. They were requested to measure home blood pressure at morning and evening time. Results: Mean out patient clinic BP, mean morning BP at home, and mean evening BP at home were 136.4/71.1, 133.9/74.7, and 131.7/72.2 mmHg, respectively. As far as systolic BP is concerned, well-controlled BP (out patient clinic systolic BP <140 mmHg and morning home BP <135 mmHg) was observed in 21 patients (34.4%). The rate of masked HT and white coat HT were 24.6% and 16.4%, respectively. Conclusion: It was shown that self measurement of BP at home contributes to the management of BP control in hypertensive patients.
Aim: The aim of this study was to examine the validity of body fat measurement by near infrared spectroscopy (NIRS) in long-term care elderly patients. Methods: The subjects were 59 elderly patients (23 men, 36 women, age 82.0+/-6.6 years) and 38 healthy young persons (19 men, 19 women, age 28.1+/-6.1 years). Percentage of body fat (%BF), body fat mass (BFM), and lean body mass (LBM) were estimated by NIRS and skinfold thickness (SF). Body fat was compared by genders and between the elderly patients and the healthy young subjects. The relationship between NIRS and SF of the elderly patients was compared with that of the healthy young subjects. Results: Means of body fat variables of the elderly patients by NIRS were: %BF 18.6%, BFM 8.8 kg, LBM 37.7 kg for men; and %BF 26.0%, BFM 10.7 kg LBM, 29.6 kg; for women. The %BF and BFM values estimated by NIRS were significantly greater than the respective values measured by SF; LBM estimated by NIRS was significantly less than that by SF. These results show that body fat measured by SF may be undervalued. The correlation between NIRS and SF was significant (r ≥0.49, p ≤0.05), and the regression lines for the elderly patients and the healthy young were not significantly different. Body fat of elderly patients by NIRS may be similar to that of healthy young by SF. Conclusions: The results suggest that NIRS yields higher values than SF in measurement of body fat in long-term care elderly patients.
Objective: The purpose of this study was to evaluate the association between homebound status and newly certificated need of care among elderly in a rural community and to clarify the characteristics of those in homebound status. Methods: The Iwate-KENpoku COhort (Iwate-KENCO) study (26,469 participants) spanned the period from 2002 to 2004 and was conducted in northern Iwate Prefecture, Japan. In the present study, 12,056 elderly (men, 4,751; women, 7,305) participated after being screened for eligibility (≥65 years of age; without certification for need of care; and without a history of stroke, cardiac heart failure, or ischemic heart disease). Being homebound was operationally defined as walking outdoors for less than 5 minutes per day. Cox's proportional hazard model was used to estimate the hazard risk (HR) for newly certificated need of care and the 95% confidence interval (95% CI) after controlling for confounding factors by gender. Results: After a mean follow-up period of 2.65 years, 200 men (4.2%) and 412 women (5.6%) obtained certification for need of care. Homebound status was significantly associated with newly certified need of care in women (HR=1.64, 95%CI=1.29-2.09), but not in men (HR=1.07, 95%CI=0.76-1.52). Homebound status among elderly women was associated with nutritional status, missing teeth, and irregular daily rhythms. Conclusion: These findings suggest that being homebound is a risk factor for elderly women receiving certification for need of care.
A 79-year-old woman was admitted to our hospital, due to acute onset of left hemiparesis and disturbance of consciousness. Although her symptoms improved temporarily, she developed gait disturbance and cognitive deterioration 2 months after the onset. After that, she presented with myoclonus and startle response, followed by akinetic mutism within 8 months after the onset. Serial EEGs revealed no periodic synchronous discharge. Serial diffusion-weighted MRIs showed that high intensity lesions, which initially limited to the right cerebral cortex, gradually spread to the bilateral cerebral cortices and basal ganglia, with relative sparing of central gyri, medial occipital cortices, and hippocampus. Prion protein gene analysis revealed a point mutation (Val→Ile) at codon 180. The result of this patient suggests that this type of CJD might be associated with an atypical clinical course such as stroke-like episode and selective involvement of cortical and subcortical resions.