Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
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Volume 47, Issue 1
Displaying 1-17 of 17 articles from this issue
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The 26th General Meeting of the Japan Gerontological Society: Presidential Adress
The 26th General Meeting of the Japan Gerontological Society: Symposium II: Perspective of ageing
The 51st Annual Meeting of the Japan Geriatrics Society: New insights into genetic factors in elderly patients
Original Articles
  • Clinical analysis of mortality in elderly patients with community-acquired pneumonia
    Naoharu Sakamoto, Eiichiro Sugihara, Soushin Boku, Hiroshi Fukuda, Hir ...
    2010 Volume 47 Issue 1 Pages 47-51
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.47
    JOURNAL FREE ACCESS
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    Aim: Community-acquired pneumonia remains a common and serious disease for elderly persons. The incidence and mortality rates of pneumonia are higher in the elderly. We analyzed the mortality and prognostic factors in 200 elderly patients with community-acquired pneumonia.
    Methods: The subjects were 200 elderly patients aged 65 years or older who needed hospitalization after initial visit to Geriatric Medicine, Juntedo Tokyo Koto Geriatric Medical Center, between January 2005 and December 2006. The subjects were divided into two groups, those who died, and those who survived on admission, we examined mortality rates and compared the background, underlying disease, laboratory data, chest X-ray findings, severity classification using A-DROP, between the two groups.
    Results: The mortality rate was 15.0%. Circulating diseases, cerebrovacscular diseases and dementia were the most common underlying diseases. It took a longer period to enter the hospital in the cases that died. In laboratory findings, total protein, serum albumin and percutaneous oxygen saturation were lower, and BUN was higher in the fatality group. There were many more patients who had extending infiltration shadow on chest X-ray films and severe condition on A-DROP classification in the fatality group.
    Conclusions: We concluded that delay of diagnosis and treatment, dehydration, low levels of protein and albumin were important prognostic factors. The extent of infiltration shadow in chest X-ray findings was also important. A-DROP might be useful for estimating the prognosis in elderly patients with community-acquired pneumonia. We should consider the prognostic factors and severity at the initial stage when treating elderly patients with pneumonia.
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  • Aging changes in muscle mass of Japanese
    Yoshimi Tanimoto, Misuzu Watanabe, Rei Kono, Chika Hirota, Kyosuke Tak ...
    2010 Volume 47 Issue 1 Pages 52-57
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.52
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    Aim: The purpose of this study is To examine the influence of age on muscle mass in a Japanese population for health promotion.
    Methods: Subjects were 4,003 community-dwelling Japanese men and women. We employed four-frequency bioelectrical impedance analysis to estimate upper and lower limbs, trunk and whole body muscle mass.
    Results: Men showed significantly more muscle mass in all parts of the body compared to women. There was a curvilinear relationship between age and muscle mass in both men and women. For all parts of the body, the slope of the regression line between age and muscle mass was greater in men than women. The changes in muscle mass with advancing age were different in each part of the body. In the upper limbs, there was little change with advancing age in both men and women. In the lower limbs, the decrease in muscle mass began after two decades, with the reduction in this muscle mass the greatest of all parts of the body with advancing age. In the trunk, the slope of the regression line increased from the second to the fifth decade, after which the slope decreased.
    Conclusions: These findings indicated that lower limb muscle mass was the first to begin to decrease and also showed the greatest decrease. For health promotion, it was seen as important to maintain muscle mass from at least middle age, with particular emphasis on the lower limbs.
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  • Efficacy of tissue plasminogen activator in older patients
    Shingo Mitaki, Satoshi Abe, Akira Shirasawa, Ryukichi Matsui, Genya To ...
    2010 Volume 47 Issue 1 Pages 58-62
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.58
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    Aim: To evaluate the efficacy, outcome, and side effects of tissue plasminogen activator for cerebral infarction in patients aged 75 years or older.
    Methods: Subjects consisted of 30 patients who had been treated with tissue plasminogen activator between October, 2005 and March 2009, in Shimane University Hospital. We divided the patients into two groups: those less than 75 years old and those 75 years old and older, and evaluated the pattern of disease, therapeutic efficacy, side effects of bleeding, and factors affecting the modified Rankin Scale on discharge.
    Results: There was no significant difference between groups in the improvement level of NIH Stroke Scale (p=0.66), but modified Rankin Scale 2 or lower patients on discharge were significantly fewer (p=0.02). Multivariate analysis found that age was a factor in significant outcome deterioration (p=0.04, OR1.2). In the older patient group, there were significantly more unfavorable outcomes with anterior infarction. However, there was no significant difference between groups in outcome in patients with ASPECTS-DWI (Alberta Stroke Programme Early CT Score-Diffusion Weight Imaging) ≥8. There was no difference in the rate of hemorrhagic side effect between the two groups.
    Conclusion: We can expect effects similar to those in patients younger than 75 years if the ischemic lesions of older patients are narrow when coming to the hospital.
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  • End-of-life care in special elderly nursing home for very elderly adults in comparison with emergency palliative therapy in general hospitals
    Akira Kurita, Naosuke Shinagawa, Eitarou Kotani, Bonpei Takase, Yoshik ...
    2010 Volume 47 Issue 1 Pages 63-69
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.63
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    Aim: Although the facilities for end-of-life care in the special elderly (SE) nursing home are increasing, there are no standard guidelines for end-of-life care interventions. Furthermore, in the SE nursing home, there are not enough data concerning those who have had end-of-life care and/or emergency hospital palliative therapy. Therefore, we compared the clinical outcome of end-of-life care patients and emergency palliative therapy patients.
    Participants: Five end-of-life care patients (99±10 years old) in the SE nursing home, and 48 emergency palliative therapy patients (89±15 years old) in the hospitals.
    Results: All end-of-life care patients are still living after 300±70 days by standard nursing care (mainly fluid diets with small doses of vasodilators and antibiotics) with bed side music. Their average CRP values in terminal end-of-life care patients decreased from 10±12 mg/dl to 1.2±0.5 (p<0.05), serum albumin levels increased from 2.7±1.6 g/dl to 3.5±2.6 and body mass index increased from 16±1.6 to 18.3±0.75 (p<0.05). Among 48 emergency hospitalized palliative patients, 32 patients were discharged to our facility after 120±26 days of hospitalization, whereas 16 patients died in hospital after 100±36 days of hospitalization (aspiration pneumonia: 11 patients, heart failure: 3 patients and G-I causes: 2 patients).
    Conclusion: End-of-life care in the SE nursing home prolonged their life expectancy despite centenarian status. Hospital mortality rates of palliative emergency therapy were higher than usual end-of-life care. These data suggest that end-of-life care interventions, including bed side music, could provide physical satisfaction.
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  • Reproducibility of lower limb loading force in healthy elderly and mobility-impaired elderly
    Tsuyoshi Hara, Akira Kubo
    2010 Volume 47 Issue 1 Pages 70-74
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.70
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    Aim: The aim of this study was to investigate the reproducibility of lower limb loading force measurements by comparing changes of measurement value and the error of measurement value in healthy elderly and mobility impaired elderly.
    Methods: Seventeen healthy elderly (8 men and 9 women aged 71.8±6.1 years [mean±SD]) and 43 mobility impaired elderly (17 men and 26 women aged 80.2±8.7 years) were enrolled in this study. All subjects provided their informed consent to participate in this study. The healthy elderly were Health groups, and the mobility impaired elderly were classified into Low and High groups based on each subject's Functional Independence Measure score. Lower limb loading force was measured three times and the lower limb loading force to body weight ratio was calculated as a percentage. We statistically analyzed the change of measurement value using intraclass correlation coefficients (ICC) and the standard error of mean (SEM), and the error of measurement value using Bland-Altman analysis.
    Results: In all groups, the change of measurement value produced a high ICC value and a low SEM value. Systematic errors in Bland-Altman analysis were observed in Low groups for measurement value of the first and third as well as second and third, and also High groups for that of the second and third.
    Conclusion: This study suggests that reliable lower limb loading force measurements can be obtained. The results also suggest that the reliability of lower limb loading force measurements is independent from the extent or kind of impairment. We advise that one or two measurements be taken in the clinical setting.
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Case Reports
  • A case of squamous carcinoma in the buccal region treated with Mohs chemosurgery in a patient with senile dementia of Alzheimer type
    Kenichi Masuda, Koichi Shin, Hisatomo Oshima, Takashi Morito, Jun Hana ...
    2010 Volume 47 Issue 1 Pages 75-78
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.75
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    An 89-year-old woman was given a diagnosis of senile dementia of Alzheimer type around 2003. In 2006, the patient was examined at a dermatology clinic complaining of tumor in the right buccal region. At the time, possible squamous carcinoma was pointed, but nothing was done for it. In March 2008, home care became difficult due to progression of dementia, and the patient was admitted to our hospital.
    On admission, a protruding skin tumor (20×20×2 mm, cauliflower-like surface) was observed in the right buccal region. Surgical ablation was recommended, however, the family strongly requested to let it follow its in natural course. In December 2008, the tumor increased rapidly to 40×55×25 mm with bleeding and a bad smell, which decreased her QOL markedly. After obtaining consent from the patient and her family, Mohs chemosurgery was performed. As the result, the tumor resolved and the QOL improved. Mohs chemosurgery is considered as a very effective treatments for rapidly advancing progressive skin cancer in patients with severe cognitive impairment.
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  • A case of limbic encephalitis with small cell lung carcinoma in which the cognitive function improved and redeteriorated during tumor therapy
    So Fujimoto, Yasuhiro Yamaguchi, Hiroshi Gotanda, Ryosuke Shiozawa, Ay ...
    2010 Volume 47 Issue 1 Pages 79-85
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.79
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    We report the findings regarding a 70-year-old man with paraneoplastic limbic encephalitis. He presented with a chief complaint of inability to recall any events. He had been well until one month before admission, and then he abruptly began to show progressive amnesia. At admission, the patient's score on the Revised Hasegawa Dementia Scale (HDS-R) showed a decline to 13/30, thus indicating the existence of severe disorientation and an impaired memory. The brain CT and EEG showed no specific abnormalities and an analysis of cerebrospinal fluid showed only a mild increase in the total protein level. A chest X-ray film revealed a mass in the right hilum, while a histological analysis of the biopsied specimen finally established a diagnosis of small cell lung carcinoma. The FDG-PET and the enhanced brain MRI showed a single small metastatic lesion in the cerebellum. After the 1st course of chemotherapy and whole brain radiation, cognitive function, especially the short-term memory, remarkably improved and the HDS-R score increased to 21/30. However, the tumor again increased in size during the 3rd and 4th courses of chemotherapy. Interestingly, cognitive function also worsened again and the score of HDS-R declined to 15/30, 20 weeks after the start of chemotherapy. Limbic encephalitis can be associated with malignant tumors, such as small cell lung carcinoma, and some reported cases have shown a cognitive improvement after tumor therapy. In our case, we also observed a reworsening of the cognitive function in association with the acquired chemoresistence.
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  • An elderly case of chronic myeloid leukemia in which BCR/ABL decreased or disappeared, following imatinib therapy after each episode of blast crisis
    Makoto Saito, Masanobu Morioka
    2010 Volume 47 Issue 1 Pages 86-91
    Published: 2010
    Released on J-STAGE: March 25, 2010
    DOIhttps://doi.org/10.3143/geriatrics.47.86
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    An elderly woman with chronic myeloid leukemia-chronic phase (CML-CP) aged at 67 underwent imatinib therapy. Ph chromosomes gradually decreased, but imatinib was discontinued after 10 months because of aggravated skin eruptions. Three months later, myeloid blast crisis (MBC) occurred. DXR+VCR+PSL chemotherapy and imatinib therapy was administered, and return to CP (RTC) was achieved with the disappearance of Ph chromosomes and a marked decrease of BCR/ABL (FISH). Although imatinib therapy was continued, a second MBC was diagnosed, 13 months after RTC. Chemotherapy, using mainly VCR+PSL was performed and imatinib was discontinued. RTC was achieved, and Ph chromosomes and BCR/ABL again disappeared. One year later, a 3rd MBC developed, and chemotherapy using Ara-C+DNR was performed. A 3rd RTC was achieved, and BCR/ABL decreased. This CML case was resistant to imatinib, but chemotherapy was effective in all 3 episodes of MBC, and BCR/ABL decreased or disappeared.
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