Aim: This study aimed to clarify whether serum magnesium (Mg) levels increased in elderly inpatients with impaired renal function receiving magnesium oxide (MgO) administration. Methods: We recruited a total of 1,282 inpatients (505 men, 777 women, mean age 79.6 years) in this study. Fasting blood samples were obtained early in the morning. Serum Mg was measured using xylidyl blue method. Estimated glomerular filtration rate (eGFR) levels were calculated according to the formula for ethnic Japanese, inserting sex, age and serum creatinine (cr) levels into the formula. Inpatients were divided into 5 groups according to eGFR levels (ml/min/1.73 m2): <30 eGFR (group 1), ≥30 but <60 (group 2), ≥60 but <90 (group 3), ≥90 but <130 (group 4), and ≥130 (group 5). Division into a further 4 groups was also carried out, into the same groups (1-3) as described above and ≥90 (group 4). In these subgroups we investigated how serum Mg levels changed according to different eGFR levels, or after being given MgO. Results: In 552 inpatients not given MgO and 372 given MgO, the percentages of subjects with ≥2.7 mg/dl of serum Mg were 38.5% in those not given MgO and 78.5% in those given MgO in group 1, 28.1% and 49%, respectively, in group 2, 0% and 23.1% to 29.6% in groups 3 to 5; the percentage of patients with <2.4 mg/dl of serum Mg was higher in groups 1 to 5 in those not given MgO than in those given MgO. These findings suggest an increase in serum Mg levels after initiation of MgO administration. At an average of 6.9 months in 22 men and 6.4 months in 39 women, both groups not receiving MgO serum Mg increased significantly, while eGFR reduced considerably. At an average of 6.4 months in 18 men and 10 months in 30 women who received MgO, serum Mg increased considerably, although eGFR did not show any significant change. In 4 cases spanning 4 to 14 months, seesawing alterrations between eGFR and serum Mg were often noted. We measured subjects from the 4 subgroups (divided according to eGFR), comprising 88 inpatients not given MgO, 116 who were given daily doses of 0.5 g to 1.5 g MgO, and 118 who were given daily doses of 2 g to 3 g MgO. In those without MgO serum Mg was markedly higher in group 1 than in groups 3 and 4. In all 4 groups, serum Mg was markedly higher in those given MgO than in those not given MgO. In group 1 only, serum Mg was markedly higher in those given daily doses of 2 g to 3 g than in those given 0.5 g to 1.5 g MgO. In 23 subjects with serum Mg levels of over 3.8 mg/dl (normal range: 1.7 mg/dl to 2.6 mg/dl), 7 not given MgO had markedly lower eGFR levels than 16 given MgO, and the mean levels of serum Mg were similar among these. The highest levels of serum Mg were 5.2 mg/dl in those not given MgO and 5.9 mg/dl in those given MgO. Conclusion: The important factors associated with elevated serum Mg levels noted in this study were: a reduction in eGFR to below 30 ml/min/1.73 m2, and MgO administration for treatment of chronic constipation and the simultaneous occurrence of the above two factors.
Aim: This study is to investigate whether the set point of HbA1c being 5.2% or more is too strict a line to be drawn by Tokutei-kensin (Health Examination for metabolic syndrome in Japan) on people 65 years old or more from the view point of glucose metabolism. Methods: Samples were out-patients of the community clinic and community residents from the jurisdiction of the community clinic. (1) Epidemiological data on those who were in their 50s, 60s and 70s with HbA1c level between 5.2% or more. (2) Second study was done on those who aged 40 years or more with their initial HbA1c measured after 1995 with a result of 6.1% or less, and had been followed for more than 5 years since. Results: First study covered 54.3% and 69.3% of age groups of 60s and 70s respectively and the percentages of HbA1c between 5.2% and 6.1% were 40.9%, 36.8% respectively. HbA1c level of 40 people who met the criteria of second study were followed for 5 to 13 years. Among 29 cases of those who aged between 40 and 75, 15 cases showed an increase from 5.2% to 6.1% over an average of 9.6 years of follow up and 7 of them increased to higher than 6.5%. When limited to the age of 65 to 75, 8 of them increased from 5.2% to 6.1% and 2 of them increased to higher than 6.5%. None of the 19 cases who were more than 40 years old and had an initial HbA1c below 5.2% showed a significant elevation of HbA1c. Conclusions: It is reported that diabetic cardiovascular complications exists in pre-dibetic stage and oral glucose tolerance test revealed high percentage of impaired glucose tolerance among HbA1c values between 5.2 and 6.1%. It has been investigated that among people aged between 65 and 74, those who had a HbA1c higher than 5.2% showed an increase of HbA1c over years when compared to those whose HbA1c below 5.2%. It was also reported that about 40% of the population of people in their 60s and 70s had a between HbA1c 5.2% and 6.1%. It is considered important that an assessment of state of arteriosclerosis and intervention of life style to people aged 65 to 74 when a value of HbA1c over 5.2% is found.
Background & Aim: Elderly patients often suffer comorbidity, which leads to polypharmacy (≥6 concurrent medications). The extent of polypharmacy in very elderly patients in university hospitals has been reported, but not in community hospital outpatient units. We investigated polypharmacy in late-stage elderly patients at an outpatient unit of a community hospital. Methods: The study group comprised 159 patients who visited a community hospital during 6 consecutive days. We analyzed the number of consultations and the changeless prescriptions for the past three months or more in the medical records of these patients. Results: Patients took up to 15 types of medication (average 6.5 ± 3.5) and up to 36 tablets (average 12.4 ± 7.8 tablets/day) at the time of survey. Over 9 months, 76.1% of patients had multiple consultations. A total of 57.9% of patients received polypharmacy. Antihypertensive drugs were prescribed to 20.3% of patients. Inappropriate prescription accounted for 4.8% of a total of 1,031 prescriptions. Conclusion: A larger number of very elderly patients was receiving polypharmacy and multiple consultations in outpatient units of a community hospital than has been previously reported in university hospitals. It is important to prescribe appropriately for very elderly patients in teams which include pharmacists and nurses as well as doctors.
Aim: Pneumonia-associated deaths are the 4th leading cause of death in elderly people, and fatality tends to increase with age, especially after the age of 65. We aimed to further define convalescence in this patient population by examining the clinical characteristics of elderly pneumonia patients. Methods: We retrospectively examined the data of 292 patients aged 65 years or older who had died of pneumonia. Analysis was performed according to the guidelines for the management of pneumonia of the Japanese Respiratory Society (JRSGMP), which retrospectively classifies pneumonia into a community-acquired type (c type) and hospital-acquired type (h type). In the present study, there were 110 cases of c type and 182 cases of h type. Results: Among the factors that accurately predicted disease severity in the c type group, age was associated with the highest frequency (104; 94.5%). Furthermore, age was most frequently associated with a convalescence prediction factor in the h type group (150; 82.4%). The remaining factors collectively comprised approximately 50%. Except in mild cases in the c type group, deaths occurred in each of the disease severity groups for both pneumonia types. Dysphagia occurred in many cases in both groups, and in both pneumonia types the most common complication was dementia. In the h type group, cerebrovascular diseases were the second most common complication. Conclusion: When assessing disease severity in elderly pneumonia patients, the JRSGMP may not allow accurate judgment of convalescence. It is very likely that dementia and cerebrovascular diseases cause dysphagia. Furthermore, very elderly patients are frequently at risk of developing aspiration pneumonia during treatment. For these reasons, it may be necessary to add the condition of a patient with these complications to the disease severity rating or convalescence prediction factor when considering the outcome of pneumonia in very elderly patients. It is necessary to consider all these factors when treating such episodes.
An 82-year-old woman with severe dementia, living in a nursing home, had severe chronic constipation, possibly due to the presence of multiple risk factors for constipation such as a past history of abdominal open surgery, diabetes, hypothyroidism, and bedridden status. She visited our department accompanied by nursing staff with complaints of nausea and vomiting. Abdominal X-ray films and computed tomography (CT) images showed ileus. We diagnosed strangulation ileus, and performed an emergency laparotomy. There was a mobile cystic lesion located 180 cm from the ileocecal junction which was causing the intestinal obstruction. The cystic lesion was surgically removed via an enterotomy. The greatest dimensions of the cystic lesion were 5×3 cm, and it was histologically diagnosed as a fecalith. We report a rare case of ileus caused by a fecalith in an elderly patient.