The 51st Annual Meeting of the Japan Geriatrics Society: Symposium III: Importance of risk management to prevent cerebrovascular, cardiovascular, and renal events in the oldest elderly aged over 85 years
Aim: To investigate the recovery process in elderly patients with cerebrovascular disease for 10 months, from beginning 3 months after the onset of disease. This was done according to the evaluation of exercise capacity described in the interim-report on preventive long-term care services in city, town and village model research. Methods: Fourteen patients in whom cerebrovascular disease had been diagnosed within the previous 3 months, and who were still receiving rehabilitation treatment (8 men, 6 women, average age 76.4±8.3, and average number of hospitalization days 164.6±33.1) were enrolled. Evaluation items were: the grip power, one-leg standing time with eyes open, functional reach, timed up and go test (TUGT) and falling bar test. The maximum recovery value of individual measurements in each patient was considered 100%, in order to calculate the recovery rate. Results: The maximum recovery value of the grip power test was obtained on both unaffected and affected body sides 6 months after the onset of disease, but the recovery values of both the unaffected and affected sides decreased to 76.1% and 68.6% respectively, after 12 months. The maximum recovery value of the one-leg standing time with eyes open test was 72.8% 7 months after the onset of disease, but it had decreased to 24.5% after 12 months. The maximum recovery value of the functional reach test was 86.9% 4 months after the onset of disease, but it had decreased to 57.5% after 12 months. The maximum recovery value of the falling bar test was 83.5% 6 months after the onset of disease, but had it decreased to 63.8% after 12 months. The maximum recovery value of the TUGT was 90.4% 5 months after the onset of disease, but it had decreased to 64.1% after 12 months. Conclusions: The TUGT reached the recovery peak level first, however, the one-leg standing test reached the maximum recovery value 7 months after the onset of disease, slightly later than the other measurements. After achieving the maximum recovery value, the grip power test maintained its value in comparison with the other tests, but the one-leg standing, functional reach, falling bar test and TUGT continued to decrease. In particular, the one-leg standing and functional reach tests, which relate to equilibrium function, showed a remarkable decrease in recovery values. Fall-prevention measures are urgently needed because the reduction of equilibrium function level increases the risk of falling, and producing a second any injury after cerebrovascular disease. This suggests that how rehabilitation treatment is performed should be examined after discharge from hospital.
Aim: Recent research suggests that the fear of falling may be a more serious problem than actual falling among frail elderly people. The purpose of this study was to investigate whether or not it is possible to influence the fear of falling among frail elderly people who previously had fallen, by balance exercises under attention tasks. Methods: The subjects were 22 frail elderly people in nursing homes (3 men and 19 women, mean age 83.1±5.2 SD) who had fallen. Written informed consent was given for participation in the study. Subjects were divided into two groups at random: the balance exercise group (the control group) and the balance exercise during an attention task (the attention group). Balance exercise continued for 10 weeks, consisting of one 5 minute session, 3 times weekly. The control and intervention subjects were evaluated using the Fall Efficacy Scale (FES), Functional Reach Test (FRT), Timed Up & Go Test (TUGT) and walking speed, before the program, at the end of the trial, and 10 weeks after the program. Results: There was no change in walking speed in either group, and difference in TUGT of the control group was observed. We found improvement in FRT and TUGT of the attention group. The FES decreased in the attention group. Conclusion: These findings indicate that balance exercise during an attention task can improve standing posture balance in frail elderly people who have fallen. These results also suggest that it is important to intervene in both motor function and attention function to decrease the fear of falling.
Aim: We studied the effect of an oral function improvement program based on the remote intervention by non-specialist assistant as coordinators, who played the role of intermediary between the participants and dental hygienists. Methods: Among senior citizens aged 65 or older living on pacific islands within the area of greater Tokyo (Tosyobu), 55 people participated in this study. Dental hygienists educated the coordinators beforehand. The participants were evaluated on mastication ability, swallowing ability and oral function-related quality of life (QOL) by dental hygienists before and after the program. The participants did the oral health improvement program every day at home, using materials provided by the dental hygienists. The coordinators reported compliance and questions about the oral function improvement program to the dental hygienists by fax once a week. The dental hygienists replied with technical advice on continuing the exercises, to coordinators by fax. Results: The summed time of 3 times of repetitive saliva swallowing test was significantly reduced (p<0.01). The oral diadochokinesis of articulation function was significantly improved (p<0.01). The color of the mastication function assessment gum significantly improved (p<0.01). Scores on the general oral health assessment index, an index of oral-related QOL, also significantly increased (p<0.05). The items about dental hygiene also improved on the same index. Conclusion: Oral function was improved in terms of swallowing, articulation, chewing, hygiene and QOL. This research suggests that the program, in which dental hygienists are involved in a remote way through coordinators, and offer services for oral function improvement, can be effective to improve the oral function of the elderly.
Aim: The aim of this study was to examine our new cognitive test which detects early decline in cognitive function. Methods: Our newly developed Simple Cognitive test (SC-test) takes 3 minutes, during which participants choose the figures in which both the shape and color are different from the figure on the left end of each line. The top score is 50 points. In a normal control study, the SC-test was given to 271 nursing home staff. We gave the Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and SC-test, to 114 participants in day-rehabilitation (Day group). Results: For the normal candidates, most young participants obtained nearly full marks. The average mark of those aged 18 to 29 was 48.1 (±3.40) points, while that for those 60 to 69 was 36.2 (±11.6) points. The average age of the Day group was 80.2 (±6.2), the MMSE average score was 23.8 (±4.3) points, the average FAB score was 11.2 (±3.5) points and the average on the SC-test was 13.1 (±11.5) points. The correlation coefficient between the SC-test and MMSE was r=0.569 (p=4.17×10-11), while that of the FAB was r=0.664 (p=6.661×10-16). In the 3-dimensional scatter chart of the three tests, despite near full marks on MMSE, people who obtained low scores on the FAB test also had low scores on the SC-test. Conclusions: The SC-test is very simple to use, and it has very high sensitivity and specificity regarding early decline in cognitive function, especially frontal lobe function.
Aim: Although anemia is common among the elderly, available data for anemia among them are limited in Japan. The aim of the present study was to compare the prevalence of anemia among elderly groups, and evaluate factors attributable to anemia. Methods: We enrolled 284 elderly residents in 2 long-term health care facilities, and 1,019 people aged 65 and over who visited outpatient clinics for medical checkups in 1 hospital all located in urban areas in Hiroshima. Hematological data from the 2004 National Nutrition Survey in Japan were cited for comparison. Results: Based on the WHO criteria for anemia, more than half of the residents in both health care facilities were anemic, regardless of gender. However, the prevalence of anemia among elderly people visiting outpatient clinics at hospital was only about 6% for both genders. Analysis of underlying diseases among residents of the health care facility did not reveal any association between a particular disease and anemia. Total serum protein values were significantly lower in the elderly in health care facilities than in those of the elderly of the outpatient clinics, and they showed weak statistical correlations with anemic state in the former group. Finally, the elderly in outpatient clinics showed significantly lower prevalence of anemia compared to the elderly in the National Nutrition Survey in Japan, partly due to selection bias. Conclusions: The prevalence of anemia in the elderly covered a broad spectrum depending on the group examined. Anemia in the elderly was an indicator of comorbidity.
Aim: The goal of this study was to clarify how the post-discharge support by a full time psychiatric social worker (PSW) in a dementia ward affected the discharge status of dementia patients. Methods: Patients who were discharged from a dementia ward were examined for hospitalization, post-discharge status, nutrition methods, treatment drugs, and relationship with discharge support performed by the PSW. Results: A total of 192 cases met the requirements for this examination, and approximately half (94, 49.0%) of these patients had Alzheimer disease. Fifty-two patients (32.3%) moved to home care. Forty-five patients visited our hospital for treatment, while 17 visited other medical institutions for treatment. Thirty-four patients (17.7%) moved to other medical institutions, and the remaining 96 patients (50.0%) entered other institutions. About half of these patients entered insurance care facilities for the elderly, and the number of entered cases decreased in the order of special elderly nursing homes, paid homes for the elderly, and group homes. The highest mean support frequency per case was more than 50 occasions and 800 minutes for a paid home for the elderly. This support decreased in the order of special elderly nursing homes, insurance care facilities, and group homes. Cases treated at other medical institutions had the shortest hospitalization, but these cases had a greater mean support frequency than the cases treated at our hospital. The lowest mean support frequency was for oral meal intake while the highest mean support frequency was for nourishment by gastrostomy, with a significant difference between both (P<0.01). Only for cases that entered insurance care facilities for the elderly was there significantly more support frequency for cases that took donepezil hydrochloride than cases that took other drugs (P<0.03). Conclusions: After discharge from a dementia ward, the PSW spent a significant amount of time on discharge support, and this discharge support was indispensable. Hospitalization at a medical institution or admission to facilities was associated with a higher degree of discharge support than home care. Furthermore, patients who were hospitalized at a long-term medical treatment institution, or those who entered an insurance care facility for the elderly, needed frequent support for drug administration.
The salt intake of the Japanese is among the highest in the world, leading to a high prevalence of salt-sensitive hypertension. To prevent this, salt restriction, surpression of the rennin-angiotensin-aldosterone system, and natriuresis are important. Therefore, the use of a combination of an angiotensin II receptor blocker and thiazide diuretics is used for antihypertensive treatment. Some randomized controlled studies suggested that thiazide diuretics are useful not only to lower blood pressure, but also to prevent cardiovascular events and improve prognosis in the elderly, who are prone to being salt-sensitive. We encountered 2 elderly patients referred to our emergency room because of severe hyponatremia and consciousness disturbance, who had been treated with thiazide diuretics for 1 and 2 months, respectively. In both, hypernatriuria despite hyponatremia, slight dehydration, and refractory antidiuretic hormone (ADH) excess were obsereved, but activation of the rennin-angiotensin-aldosterone system was absent. Thyroid and adrenal functions were unremarkable. Theses phenomena have much in common with the condition called mineralcorticoid-responsive hyponatremia of the elderly (MRHE). Several weeks after discontinuation of diuretics, serum sodium values returned to normal levels, but transtubular potassium concentration gradient (TTKG) values were depleted despite slight hyperkalemia, and relative ADH excess was sustained, which suggested mineralocorticoid dysfunction and distal renal tubulointerstitial injury. Distal tubulointerstitial dysfunction is one of the most important causes of MRHE. On the basis of these 2 cases, we speculated whether distal tubulointerstitial injury may accelerate hyponatremia in the elderly. We need to check not only serum potassium, but also sodium levels, especially in elderly persons with suspected tubulointerstitial injury.