Background & aims: Endoscopic resection, including endoscopic mucosal dissection (ESD), has gained acceptance widely for early gastric cancer (EGC). However, after therapy, some elderly patients with non-curative resection do not undergo radical surgery, because elderly patients may have limited life expectancy or comorbid disease. The aim of this study is to verify if radical surgery after non-curative resection should be performed in the elderly patients as in young patients. Methods: This is a retrospective review of 432 elderly patients (over 75 years) who had undergone enodscopic resection for EGC at the National Cancer Center Hospital between January 1999 and December 2005. We compared the overall and disease-free survival rate between the curative resection group, non-curative resection with surgery group, and non-curative resection without surgery group. Results: A significant difference in overall and disease-free survival was evident between the patients with curative resection and non-curative resection without surgery. Conclusions: In the patients with non-curative resection for ECG endoscopically, additional surgery is still necessary even in elderly patients.
Aim: This study describes the acceptance of patients with feeding tubes in nursing homes for the elderly. Methods: We sent questionnaires to 1,438 nursing homes in 2006-7 asking how many patients with feeding tubes the nursing homes had and how many new patients with feeding tubes they would accept in the future. Results: The response rate was 63.6%. We analyzed the data of 735 nursing homes. The median range (25-75%) of the number of patients, patients accepted, and total number of patients currently resident was determined. The percentage of tube feedings to total beds in those categories was 8.0% (range 4.0-13.3), 5.0% (0-10.0), and 13.3% (8.0-23.8), respectively. Whereas 6% of the nursing homes had no limits on acceptance of patients with feeding tubes, 27.2% of the nursing homes replied that they would no longer accept such patients. Factors associated with restricted acceptance included nurse responses (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.30-0.95), a facility with over 100 beds (OR 2.14, 95% CI 1.10-4.17), and no current patients with feeding tubes (OR 4.19, 95% CI 2.36-7.43). Conclusion: One quarter of nursing homes for the elderly in Japan replied that they would no longer accept patients with feeding tubes. More nurses than other professionals replied that they would accept patients with feeding tubes. Larger nursing homes were less likely to accept tube-feeing patients. Furthermore, nursing homes with no tube-feeding patients were unwilling to accept such patients.
Aim: Chronic illnesses are common among elderly people, and may considerably affect to their quality of life (QOL). We investigated the impact of chronic conditions on QOL among community-dwelling elderly people, and the stability of QOL over time. Methods: A total of 2,762 community-dwelling elderly persons (men: 47.0%, age 76.7±5.8 [mean±SD]) completed postal QOL questionnaires twice over 4 years. Chronic illnesses were selected from the following 9 conditions: cerebrovascular disease, hypertension, heart disease, cancer, diabetes mellitus, bone fracture, chronic digestive disease, chronic respiratory disease, and the diseases of joints or muscles. The QOL questionnaire was developed based on the QOL components proposed by Lawton, and consisted of 6 subscales: daily activity, health satisfaction, human support satisfaction, economic state satisfaction, symptoms of depression, and positive mental attitude. The subjects were divided into 3 groups regardless of the presence of chronic illnesses. QOL subscale scores were compared among the 3 groups, and fluctuations over 4 years were also evaluated. Results: The baseline QOL scores showed significant differences among the 3 groups, especially regarding health satisfaction, but not in satisfaction with human support. There were significant differences among the 3 groups in fluctuations over 4 years in health satisfaction, daily activity, and positive mental attitude. Conclusions: Chronic illnesses have a negative impact on the QOL of elderly people, and also influence fluctuations in QOL over time. Degrees of impacts differed according to each QOL subscale. Therefore, evaluation of QOL in community-dwelling elderly needs multi-dimensional assessment.
Aim: To develop a scale for attitudes towards family caregiving of people with dementia among the general public in Japan. Methods: We conducted a postal self-administered questionnaire survey in a sample of the general population aged 20 and over: there were 2,161 (86%) valid responses. Question items in the survey included sociodemographic characteristics, attitude towards family caregiving for people with dementia, and the following three variables associated with dementia and caregiving: respondents' personal anxiety about developing dementia, their knowledge about the Long-Term Care insurance service, and their experiences of caregiving. Results: Factor analysis revealed the following four subscales within this scale: feelings of obligation towards family caregiving (F1), expected feelings of caregiving burden (F2), expectation of personal growth through family caregiving (F3), and negative attitudes towards family caregiving (F4). The Cronbach alpha coefficients for these four subscales ranged from 0.73 to 0.82. In addition, analysis of covariance (ANCOVA), with sociodemographic characteristics as covariates, showed significant relationships (1) between personal anxiety about developing dementia and both F1 and F2, (2) between personal experience of caregiving and F3, and (3) between each of the three variables associated with dementia and caregiving and F4. Conclusions: The present study confirmed the reliability and validity for the scale of attitudes towards family caregiving of people with dementia among the general public in Japan.
Aim: Falling is one of the most common health hazards for the elderly. Tinetti et al. (1990) proposed the concept of falls self-efficacy, which explored fear of falling from the perspective of self-efficacy. Falls self-efficacy and its associated factors have not been extensively studied in Japan. This study examined the impact of various factors associated with daily life on falls self-efficacy. Methods: We conducted individual interviews with 180 elderly participants (men=93; women=87) on topics such as falls self-efficacy, perceived health status, and time spent on physical activities. Results: Multiple linear regression analysis revealed that the main factors influencing falls self-efficacy were perceived health status, past experience of falling, age, chronic pain, average time spent sitting during a weekday, and moderate or vigorous physical activity time per week. Falls self-efficacy was not significantly associated with gender, human environment, recent falling of acquaintances, or walking time per week. Conclusions: The results indicated that moderate or vigorous physical activity could enhance falls self-efficacy. Moreover, past falling experiences were negatively associated with falls self-efficacy, whereas perceived health status and chronic pain had a significant impact. Future fall prevention programs should adopt a multifactorial approach that focuses on enhancing falls self-efficacy.
Acquired hemophilia A is a rare bleeding diathesis caused by autoantibodies against clotting factor VIII. The incidence of acquired hemophilia A increases with age. We report two cases of acquired hemophilia A in elderly patients and their clinical characteristics. Case 1: A 66-year-old man was referred to our hospital with massive subcutaneous and intramuscular hemorrhage. Prolonged APTT, low factor VIII activity and factor VIII inhibitor with high titer (42 BU/ml ) were observed, confirming the diagnosis of acquired hemophilia A. His hemorrhages disappeared soon after 50 mg/day oral prednisolone was administered. Although early steroid withdrawal lead to repeated prolongation of APTT, the addition of 20 mg/day oral prednisolone successfully decreased the inhibitor titer. The underlying disease was not identified. Case 2: An 85-year-old man with advanced gastric cancer was referred to our division because of severe bleeding. His factor VIII inhibitor titer was 64 BU/ml . Activated prothrombin complex concentrates were used to control the bleeding. Initially, he did not seem to respond to 20 mg/day oral prednisolone, but a further 12 weeks of 20 mg/day prednisolone finally achieved normalization of his hemostatic parameters. Subsequently, he successfully underwent surgery for cancer. The responses to immunosuppressive therapy were very different in the two cases, probably because of the difference in the underlying diseases. The immunosuppressive therapy of acquired hemophilia A should be strictly tailored to the patient's characteristics to minimize treatment-related adverse effects.