Urinary tract infections (UTIs) in the elderly are common. The pathophysiology of increased susceptibility is multifactorial. Age-related changes include a decline in cell-mediated immunity, neurogenic bladder dysfunction, structural urinary tract abnormalities (e.g., benign prostatic hyperplasia), systemic diseases (e.g., diabetes mellitus) and increased incidence of urethral catheter placement. Catheter-associated bacteriuria is the most common hospital-acquired infection. Many elderly patients, including those with catheter-associated bacteriuria, are asymptomatic. Escherichia coli remains the most common uropathogen. However, polymicrobial infection is more common among the elderly. The use of antimicrobial agents needs to be guided by current surveillance studies of targeted uropathogenic bacteria before being implemented. However, UTIs in the elderly may lead to severe renal infections. Therefore surgical intervention may be needed in these infections.
Aim: We investigated the correlation between age, telomere length of peripheral blood leukocytes and blood laboratory data of women with mild hypertension, to identify laboratory data that may reflect the biological aging process of individuals. Methods: The subjects were women with mild hypertension who were being treated with a low dose of amlodipine and who regularly visited the outpatient clinic of the Department of Cardiovascular, Respiratory, and Geriatric Medicine at Kyushu University Hospital. The laboratory data of patients were collected and the telomere length parameters in their peripheral blood leukocytes were determined by Southern blotting. We assessed the laboratory data and the telomere length parameters to determine any correlations. Results: The telomere length of the patients correlated positively with high-density lipoprotein cholesterol, albumin, hemoglobin levels and red blood cell counts, but negatively with globulin levels. Conclusion: Among the analyzed laboratory data, the albumin/globulin rates were the best candidate indicators for individual somatic genomic aging.
Aim: To conduct a survey on medical accident cases (MACs) in a mixed-care geriatric hospital. Methods: We extracted the data on 339 MACs of 1,374 incident/-accident reports in a 1-year study period between January 2009 and December 2009. The incidences of MACs and accident-related factors were investigated and compared among medical care areas in our hospital (acute care unit: AU, long-term care unit: LU, convalescent rehabilitation unit: CU, palliative care unit: PU, and other medical care areas). Results: In 339 MACs, epidermal exfoliation (E), bruises (B), cuts or lacerations (CL), and fractures (F) were the most common episodes, and E was most frequent (183 cases: 54.0%). However, in 33.9% of E cases the cause could not be clarified. A comparative study demonstrated that the incidence of E was higher in the LU than in the other medical care unit, or B or F in the CU, or CL in the AU. E was caused mainly by nursing care, especially during transfers. The mean total functional independence measure (FIM) score in the LU (38.8±21.3), where E occurred most frequently, was significantly lower than that in the AU (61.4±34.4, p<0.01), CU (58.9±25.2, p<0.05), and PU (72.8±22.9, p<0.05) Conclusions: E, B, CL, and F were frequently found in a mixed-care geriatric hospital. E had the highest frequency among all of the accident episodes, and appeared related to nursing care, such as transfer, and reduced ADL level.
Aim: The objectives of this study were to examine the relationship between a screening score for frailty in the elderly, the Basic checklist, and physical function, and to investigate the factors associated with the effects of exercise intervention in community-dwelling frail elderly in Japan. Methods: We enrolled 44 subjects aged 65 years and older (average age 73.9±5.1) in this study. The subjects participated in exercise intervention, including high-intensity muscle strength training, twice a week for three months. The Basic checklist and functional performance measures (walking ability, balance functions, flexibility, leg strength), psychological tests (Geriatric Depression Scale (GDS), Modified Fall Efficacy Scale (MFES), and health-related quality of life test (SF-8)) were administered at the start and end of the intervention. We evaluated the correlation between the Basic checklist and other measurements at baseline. In addition, we evaluated any relationships between the Basic checklist and improvements in physical function. We used partial correlation analysis and multiple linear regression analysis to evaluate those relationships. Results: The Basic checklist was significantly correlated with GDS, functional reach and one leg standing measurements at baseline. Functional performance measures were significantly improved after exercise intervention. Although there were weak negative relationships between the basic checklist and the amount of change in functional reach tests, we could not find a relationship between the Basic checklist and the improvement of physical function. Conclusion: These results suggest that there was little relation between the Basic checklist and physical functions, in particular the improvement of physical functions. Therefore, we should consider how we can assess the improvement of physical function. These results strongly support the need to assess physical function before exercise intervention.
Aim: The study objective was to cross-sectionally examine the relationships among leisure-time, household, and occupational physical activity with physical functions in Japanese older adults. Methods: We randomly enrolled 189 community-dwelling older adults, aged 65 to 85 years, as subjects from the Basic Resident Register of Kasama City, Ibaraki prefecture. Physical activity was assessed by the Physical Activity Scale for the Elderly. Analysis of covariance was performed to determine the relationships between physical activity and physical functions, after adjustment for age and sex. Results: Leisure-time physical activity significantly correlated with one-leg balance with eyes open, sit and reach, timed standing test from along sitting position on the floor, functional reach, 5-repetition sit-to-stand, timed up and go, 5-m habitual walk, choice stepping reaction time, and power in sit-to-stand tests. Household physical activity was significantly related to 5-repetition sit-to-stand and ability in sit-to-stand. Total (leisure-time plus household plus occupational) activity was significantly correlated with one-leg balance with eyes open, functional reach, and power in sit-to-stand tests. Post-hoc testing indicated that the levels of physical functions were higher in the subjects of the third tertile than in those of the first or second tertile. No difference was found in physical functions between the first and second tertile. Conclusion: Leisure-time physical activity was related to many physical functions. Household physical activity was also related to lower-extremity functions. Our data suggest that medium- or high-level physical activity may be necessary for older adults to maintain their physical functions.
Aim: The objective of this study was to evaluate the effect of a community-based group exercise program on physical functioning among elderly people. Methods: This prospective observational study enrolled 494 persons aged 70-84 years who volunteered for the study and completed a baseline measurement in 2006 and were re-evaluated 1 year later in 2007. The exercise regimen consisted of resistance training and recreational exercise for 1.5 hours conducted twice a month. Physical functioning was evaluated by a self-administered questionnaire consisting of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and Motor Fitness Scale (MFS). Decline in physical functioning was defined as a reduction in either TMIG-IC or MFS scores of more than 2 points deviation from the median change of each score. Results: TMIG-IC and MFS results were obtained from 494 and 392 eligible subjects, respectively. After 1 year, 68 subjects (TMIG-IC) and 88 subjects (MFS) reported a decline in physical functioning. After adjustment for confounding factors, the odds ratio of reduced physical functioning, as assessed by the TMIG-IC among the subjects who did not participate in the exercise group and those who did, were 1.00 (control) and 0.15 (95% confidence interval, 0.01-0.75). Similar results were obtained when assessed on the MFS. Conclusion: These results suggest that participation in a community-based exercise group of elderly people was effective in maintaining self-reported physical function.
Aim: The purposes of this study were to develop a new exercise program for the elderly with knee pain, and to evaluate the effects of the program. Methods: The participants in the present study were 37 community-dwelling elderly people (75±7 years) with knee pain who were living in Tokyo. The participants were instructed to do a walking exercise with weights attached to each ankle together with an exercise to develop their ability to recognize pain objectively, at a weekly meeting, with training on alternate days at home. The measurements of this study were: one-leg standing time, functional reach (FR), timed up and go, 5 m walking time, knee extension strength, health-related quality of life (QOL) questionnaire (SF-36) and the Japanese Knee Osteoarthritis Measure (JKOM). Results: The total JKOM scores decreased significantly (p<0.01). Each subscale of the JKOM decreased significantly (p<0.05). Furthermore, knee extension strength and FR increased significantly (p<0.01). Among the SF-36 subscale scores, physical functioning, role physical, role emotional and mental health improved significantly (p<0.05). Conclusion: The current results suggest that the new program introduced in the present study reduces knee pain and improves the activity of participants.
Aims: The present study investigated the current situation of medical decision-making for patients who cannot express their intentions, especially elderly patients. Methods: We sent a questionnaire to 63 medical institutions and 11 individual caseworkers in Miyagi prefecture. The questionnaire was designed to investigate: 1) the use of adult guardianship; 2) the process of obtaining medical consent; and 3) possible systems which would benefit patients. Results: Forty-four institutions (69.8%) and 11 (100%) caseworkers answered our questionnaires. Five institutions and 8 caseworkers had been required to make medical consent for their patients by clinicians. Four patients could not receive medical treatment because clinicians could not identify responsible persons for medical consent. Eighteen institutions and 8 caseworkers suggested an adult guardian would be a possible person to give medical consent if satisfying legal conditions. Conclusions: The present study indicated the urgency of an appropriate system to obtain medical consent when patients cannot express their intentions.
An 80-year-old man had systemic malaise and pollakiuria, which developed about 40 days before admission. He underwent treatment at a urology department, but his symptoms did not improve. Since dry mouth additionally developed, he visited his family doctor. As his casual blood glucose level was 629 mg/dl and HbA1c was 12.4%, the patient was referred to our department and admitted on the same day. Continuous intravenous infusion of fast-acting insulin and saline were initiated after admission, and dietary therapy at 1,520 kcal/day was initiated on the following day. Anti-GAD antibody and anti-IA-2 antibody were positive, confirming that the disease was acute-onset autoimmune type 1 diabetes mellitus. A sliding scale of fast-acting insulin followed by intensified therapy using insulin glargine and insulin aspart was performed in the early phase, but the treatment was switched to twice-daily biphasic insulin aspart 30 injection because no diabetic complication was present, although the patient was already totally blind and required assistance from his family for self-injection and to improve his quality of life (QOL). Blood glucose control was favorable, and the patient was discharged on April 2.
A 76-year-old man was admitted to our hospital because of progressive dyspnea, fever, and consciousness disturbance. Empyema was diagnosed by chest image findings and laboratory findings of pleural effusion and serum. The patient was first given an antimicrobial agent, and chest drainage was performed. Although his general condition improved, his systemic inflammation and chest radiograph findings did not. Then, thoracoscopy under local anesthesia was considered. However, surgery was almost impossible, because he was hemiparetic, with mild conscious disturbance following cerebral hemorrhage. We decided to insert another drain into the thoracic cavity and continued to perform irrigation with saline in addition to the systemic administration of antibiotics for 3 weeks. His general condition gradually improved. Although the volume of drained fluid from the thoracic cavity decreased, the empyema lesions did not completely disappear. We then performed irrigation with saline and urokinase for 3 days, from the 40th hospital day. Irrigation drainage using saline was more effective than previously, before urokinase administration; his symptoms and empyema lesions markedly improved without antibiotics treatment. He was discharged on the 95th hospital day. For the treatment of chronic emypema, surgery using recently developed thoracoscopic techniques should be considered first, but may not be appropriate for frail elderly with severe systemic complications. Conventional intrathoracic irrigation using saline containing urokinase may be a treatment of choice for intractable empyema in frail older patients with hemiplegia caused by cerebral infarction.