The incidence of type 2 diabetes and metabolic diseases increases with age. Clarification of the underlying mechanisms in age-dependent worsening of such metabolic disorders is crucial for developing more effective strategies for prevention and treatment. However, due to limitations in studying aging-related changes, especially at the tissue level in humans, investigations with adequate animal models are important. Therefore, we investigated 2 inbred lines of mouse, the Nagoya-Shibata-Yasuda (NSY) mouse and the Fatty Liver Shionogi (FLS) mouse. By analyzing NSY mice, which spontaneously develop type 2 diabetes mellitus through impaired insulin secretion and insulin resistance in an age dependent manner, we demonstrated that environmental factors, including infant nutritional condition, modified aging-related metabolic changes, and the effect of genetic components on glucose metabolism, vary according to age. In FLS mice which developed non-alcoholic steatohepatitis with normal feed, accumulation of hepatic lipids caused by reduced VLDL secretion progressed to hepatic inflammation and fibrosis, which was ameliorated by vector-induced hepatic expression of microsomal triglyceride transfer protein, a key molecule for VLDL secretion. In addition, the glucose intolerance of this mouse exhibited 2 different phases: age-related deterioration due to worsening of insulin sensitivity up to 6 months, followed by time-dependent amelioration owing to increased capacity of insulin secretion and β-cell mass thereafter, suggesting slow adaptive β-cell expansion in this model. These results indicate that age-related metabolic changes are an integral part of multiple organ dysfunctions, each of which has a different period of worsening, and which collectively leads to disease.
Aim: To investigate the reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which is used worldwide as a screening tool for social isolation in elderly individuals. Methods: An interview-format questionnaire survey was given to 232 elderly community residents undergoing general health checkups. In addition to the Japanese version of the LSNS-6, other questionnaire items regarding social support, the Japanese version of the Zung Self-Rating Depression Scale (SDS), base attributes, and self-ratings of health, physical function and suicidal ideation were obtained. The internal consistency, test-retest, and interrater reliability of the Japanese version of the LSNS-6 were determined using the Cronbach α correlation, Spearman correlation, and intraclass correlation coefficients, respectively. Construct validity was investigated by comparison with the results of a previous study, while concurrent validity was determined in relation to SDS scores as well as questionnaire items on social support. Results: The Cronbach α coefficient was 0.82, the correlation coefficient for the test-retest was 0.92 (P<0.001), and the intraclass correlation coefficient for interrater reliability was 0.96 (95% confidence interval [CI] 0.90-0.99). Mean scores on the Japanese version of the LSNS-6 increased as the number of household members increased (P=0.033), but decreased among elderly individuals at risk of suicide (P=0.026), and tended to decrease among those with a poor self-rated health score (P=0.081). Scores on the Japanese version of the LSNS-6 had a significant negative correlation with SDS scores (P<0.001) On 4 of the 5 questionnaire items on social support, and those without social support had significantly lower mean scores on the Japanese version of the LSNS-6 (P<0.05) than those with social support. Conclusions: We confirmed the reliability and validity of the Japanese version of the abbreviated LSNS-6.
Aim: The morbidity of hypertension increases with aging although the exact relationship between hypertension and menopause has not been clearly elucidated. Therefore we set out to clarify the effects of aging and menopause upon women's vascular systems. Methods: We divided 151 elderly and middle-aged women into 3 groups (premenopause group, menopause group and post-menopause group). We measured height, weight, blood pressure (BP), total cholesterol (T-chol), HDL-cholesterol (HDL-chol), LDL-cholesterol (LDL-chol), high sensitivity C-reactive protein (hsCRP), creatinine (Cr), triglyceride (TG), fasting blood glucose (FPG), IRI, HOMA-R, brachial-ankle pulse wave velocity (baPWV), augmentation index (AI), percentage of flow-mediated dilatation (%FMD), and echocardiography. Results: In the post-menopause and menopause groups systolic BP and AI were significantly higher than those in the pre-menopause group. There was a significant difference in systolic BP between the post-menopause group and menopause group. In the post-menopause group, baPWV, Cr, and hsCRP were significantly higher than those in the pre-menopause group. There was significant difference in baPWV between the post-menopause group and menopause group. In the post-menopause group, %FMD and eGFR were significantly lower than those in other 2 groups. In the post-menopause group and the menopause group, E/A was significantly lower than in the pre-menopause group. There was also a significant difference in E/A between the post-menopause group and the menopause group. Conclusions: Elevated blood pressure, atherosclerosis and endothelial dysfunction were associated with aging and menopause in their present study. These results suggest that understanding women's cardiovascular changes which accompany aging are important for women's health care and prevention of cardiovascular events.
Aim: In our aging society, the number of community-dwelling dependent elderly people is increasing. Many studies have shown that depression influences the health of older persons. In the present study, we examined whether depressive status is associated with mortality and hospitalization in community-dwelling dependent older people during a 3-year follow-up period. Methods: This study was a prospective cohort analysis of 1,409 community-dwelling disabled elderly (489 men, 920 women; average age 80.1, the Nagoya Longitudinal Study for Frail Elderly). Data included demographic characteristics, basic activities of daily living (ADL) scores, comorbidity, and depressive status as assessed by the short version of the Geriatric Depression Scale (GDS-15) at baseline. The participants were considered to have depression or severe depression if their GDS-15 score was 6-10 or above 10, respectively. The Cox proportional hazard model and the Kaplan-Meier method were used to assess any association with depressive status at baseline with mortality or hospitalization during a 3-year period. Results: During a 3-year observation, 284 participants died (53 at home, 231 at hospital), and 576 were admitted to hospitals. Univariate analysis revealed that the depressive status of participants was associated with mortality and hospitalization during a 3-year follow up. However, multivariate models used to adjust for potential confounders including gender, age, ADL status, and comorbidity, did not show any association between depressive status and mortality and hospitalization. Conclusions: Depressive status among community-dwelling disabled elderly was not associated with mortality or hospitalization in the present series.
Aim: The aim of this study was to objectively assess the risk parameters associated with walking in housebound elderly. Methods: The subjects were 622 community-dwelling elderly (210 men and 375 women: age 65-85) with independence in activities of daily living (ADL). We administered questionnaires pertaining to housebound factors and measured walking parameters, twice, in May 2008 and May 2009. Housebound status was defined as leaving the house no more than once a week, and non-housebound status as more than once every 2-3 days. We measured the following walking parameters: usual and maximum walking speed, timed up and go, obstacle-negotiating gait, stair-climbing, and number of daily steps. Results: The overall prevalence of housebound status was 10.0% in men and 8.5% in women. No statistically significant differences were seen in the prevalence of housebound status between genders or age groups. In men, maximum walking speed, timed up and go, and daily steps were slower or less in housebound than in non-housebound subjects. In women, all walking parameters, except usual walking speed, were slower or less in housebound than in non-housebound subjects. Logistic regression analysis showed that obstacle-negotiating gait was a risk factor for men (odds ratio 2.49), and for women, all walking parameters, except walking at usual speed, were risk factors, with the highest odds ratio of 4.77 for obstacle-negotiating gait. A slower obstacle-negotiating gait was a risk factor for housebound status for both men and women. Conclusion: Compared with non-housebound subjects, housebound elderly with the ability to go out alone had a similar usual walking speed but a slower obstacle-negotiating gait.
We report a case of a patient with incarcerated obturator hernia who presented with right thigh pain. An 88-year-old woman who had experienced right thigh pain for the previous 3 years was given a diagnosis of sciatica at the orthopedic department. In July 2009, she was hospitalized with the chief complaint of appetite loss. The day after admission she experienced increased right thigh pain and lower abdominal pain. Abdominal ultrasonography revealed a keyboard sign. Based on this finding, we diagnosed an ileus, which was alleviated by the insertion of an ileus tube. However, after the removal of the ileus tube, her right thigh pain recurred. Therefore, a diagnosis of hernia was considered. Contrast-enhanced computed tomography revealed an incarcerated bowel in the region between the pectineus muscle and muscle obturator. Laparotomy showed that the ileal part located about 15 cm from the terminal ileum was incarcerated in the right foramen obturatum; therefore, ileal resection and end-to-end anastomosis were performed. After the operation, her intestinal obstruction symptoms and right pain disappeared. If right pain and ileus symptoms of unknown cause occur in elderly persons, obturator hernia should be considered.
A 78-year-old man was receiving regular treatment for diabetes and dementia at our hospital. Diabetes was diagnosed about 10 years previously, at which time the patient's HbA1c level had been maintained at 6% by diet therapy and an oral hypoglycemic agent. In July, 2008, he was admitted with fever and hospitalized for pneumonia, which improved with antibiotic treatment and chest drainage. However, pyothorax developed, and in October, 2008 he was admitted again with fever and inflammation. A chest computed tomography (CT) scan revealed a right subphrenic abscess, which improved with antibiotic treatment. He was readmitted for fever and lumbago in November, 2008, and an abdominal CT scan showed a left iliopsoas abscess that did not improve with antibiotic treatment, and had increased in size. Due to infection from the central vein catheter in the left femoral vein inserted at the end of October, the catheter was withdrawn at the end of November. There was a rapid reduction of the left iliopsoas abscess, his inflammation and lumbago symptoms reduced, and he was discharged in January 2009. In cases of dementia in elderly with diabetes, a catheter from a femoral vein is frequently used to prevent complications. However, this method has been known to result in infection at the site of the catheter, and to cause fever. The circumstances of this case strongly support the removal of such a catheter in elderly patients at the first indication of persistent infection.
We report a case of an 82-year-old woman with senile dementia who was hospitalized at a specialist dementia hospital for 10 months. She had swelling of the left shoulder joint, subcutaneous hematoma in the left upper arm, and anemia was noted on blood examination. Her serum hemoglobin level was lower than normal at 4.6 g/dL, but there was no sign of gastrointestinal disease or gastrointestinal bleeding, and her stool specimens were negative for occult blood. Hematoma subsequently appeared on her chest and back. She had a low activation level of factor VIII (<1%), a high concentration of acquired inhibitors of factor VIII (18.5 BU/mL), and prolonged activated partial thromboplastin time (83.1 seconds). The possibility of drug-induced anemia or hematoma were ruled out. We diagnosed acquired hemophilia A (AHA), and suspected that this was the cause of her hematomas. We began treatment of her AHA with oral prednisolone and intravenous infusion of factor VIII. The bleeding improved, but she later died due to bacterial pneumonia. AHA is very rare, with a reported annual incidence of 0.1/100,000 in Japan. However, it is necessary to consider such a rare disease when we encounter bleeding in elderly patients.