Percutaneous coronary intervention (PCI) with a transradial approach can be performed in very elderly patients with ischemic heart disease. In our hospital, 20% of elderly patients, who did not undergo emergency PCI for acute coronary syndrome (ACS), died. In contrast, only 7.3% of the elderly patients with ACS (80-98 yrs old, mean age 85 ± 4 years) died, and 4.6% of those (66-79 yrs old, mean age 73 ± 4 years) died after successful emergency PCI. In-hospital major adverse cardiovascular events were associated with anemia, CRP levels at admission, max CK-MB, and the number of involved vessels. The long-term prognosis of the elderly patients after emergency PCI was good with optimum medication, and it was associated with max CK-MB and renal function. Therefore, the indications for emergency PCI for elderly patients with ACS should be identical to that for young patients. However, elderly patients with ACS often show ambiguous symptoms, which make it difficult for them to undergo emergency PCI. Dementia and renal dysfunction are also problematic. On the other hand, improvement in the long-term prognosis of chronic ischemic heart disease by PCI has been shown in elderly patients, but not in younger patients. Observational monitoring showed a better mid-term prognosis after PCI with drug-eluting stent, but bare metal stents are preferable in cases of elderly patients with ACS.
Sarcopenia disturbs the daily life of elderly people, and hinders healthy aging. We studied the association of daily physical performance with muscle volume and muscle strength in a randomly selected community-living population. Results: Grip power and leg muscle strength decreased about 1% per year after age 40 in both men and women. Muscle strength was greater in men than in women at every age by decade, and muscle strength in men in their 80s was similar to that in women in their 40s. Therefore, the effect of a decrease in muscle strength on daily physical performance was greater in women than men. On the other hand, the muscle volume of all limbs decreased with age in men, but there was almost no decrease in muscle volume in women. These results indicate that qualitative change in muscle was more significant than quantitative change in muscle in women. Daily physical performance was influenced by muscle performance and could be assessed based on grip power and walking speed. To prevent frailty, it may be important to determine the high-risk group for frailty using these assessments.
Aim: The purpose of this study was to determine the predictors of interruption to living at home as a result of death, hospitalization, or admission to a long-term care facility in frail elderly people enrolled in a home visit rehabilitation service. Methods: A total of 311 patients entered a home visit rehabilitation service within a study period of 1 September, 2005 to 31 March, 2010, 146 of whom met the criteria to be enrolled in this study and gave consent. Of these, 73 received a continuous home visit rehabilitation service (continuous group) of over 2 years and 73 experienced interruption to this service due to death, hospitalization, or admission to a long-term care facility (interruption group). The following physical, social, and medical factors were recorded and analyzed: age, sex, care level, disease diagnoses, gait disability, cognitive impairment, living with another person and cause of the interruption to the home-visit rehabilitation service. We compared each item between the interruption and continuous groups. Logistic regression analysis was used to identify the significant predictors of interruptions to living at home. Results: Patients in the interruption group demonstrated significantly lower functioning in activities of daily living (ADL), gait ability and lower cognitive status, and higher rates of respiratory diseases and cancer compared with the continuous group. On logistic regression analysis, ADL score (odds ratio [OR]=0.97, p<0.01), and the presence of respiratory diseases (OR=4.35, p=0.04) and cancer (OR=13.46, p<0.01) were significantly associated with interruptions to living at home. Conclusions: Lower ADL functioning, respiratory diseases and cancer were significant predictors of interruption to living at home in frail elderly adults.
Aim: The number of hearing-impaired elderly people in Japan remains to be clarified. In the present study, we analyzed the data from the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) to ascertain the prevalence and 10-year incidence of hearing loss in Japanese elderly people. Methods: Hearing loss prevalence was calculated based on 2,194 subjects who had been included in the 6th survey of the NILS-LSA (2008-2010) and was represented as crude rates (calculation A) and as rates after the exclusion of occupational noise-exposure and ear disease history (calculation B). Estimates of hearing loss incidence were performed at a national level based on demographic statistics. Subsequently, we analyzed the 10-year incidence in 465 subjects showing no hearing loss at baseline (1997-2000 survey) all of whom also participated in the 6th survey of the NILS-LSA (2008-2010). Results: The prevalence of hearing loss greatly increased after the age of 65 years. The prevalence observed in calculation A was 43.7%, 51.1%, 71.4%, and 84.3% in men aged 65-69, 70-74, 75-79, and over 80 years old, respectively. In women, the prevalence for the same age groups was 27.7%, 41.8%, 67.3%, and 73.3%, respectively. The size of the hearing-impaired population older than 65 years old was estimated to be 16,553,000. The 10-year incidence rates of hearing impairment in the 60-64- and 70-74-year-old age groups were 32.5% and 62.5% (age at baseline), respectively. These rates rapidly increased with age, although a number of elderly people with good hearing were also observed. Conclusions: Age-related hearing loss is an issue of national importance. These results also indicated that it is possible to preserve good hearing into later in life, and that hearing loss in the elderly may be preventable.
Aim: Systemic edema is often observed at the terminal stages of cardiac or renal failure, with some cases showing a large amount of exudate excretion from the whole body. We investigated 3 such cases by comparison with those excreting less exudate. Methods: We examined the data of 3 male inpatients (age, 81, 89 and 97 years) with cardiac or renal failure who had systemic edema, with excretions of a large amount of exudate (more than 3,000 ml/day) and who subsequently died of malnutrition, oliguria or anuria. We used a control group (20 inpatients, 10 men and 10 women, mean age, 82) with excretions of less than 1,000 ml/day of exudate for comparison. Blood test values and the number of remaining days of life after the onset of oliguria/anuria were compared between the 2 groups. Moreover, the laboratory test findings of exudade and serum were compared within the subject group. Results: The subject group had a higher mean serum BUN level than the control group (138 mg/dl vs. 81 mg/dl). There were no significant differences in any other blood test values between the 2 groups. Remarkably, the number of remaining days of life after the onset of oliguria or anuria in the subject group was greater than that in the control group (mean, 14 days vs. 7 days). The laboratory data of the subject group showed that total protein, lipids, AST, ALT, γ-GTP, Ca and CRP levels were lower in the exudate than in the serum, whereas BUN, creatinine, UA, K and Cl levels showed no significant differences. Conclusions: It is suggested that a production of large amount of exudate is caused by a complex of various factors which increase vascular permeability. However, in the present study, BUN, UA and K levels in the exudate of patients were similar to those in the serum of the subject group. The longer survival observed after oliguria or anuria in the subject group may be explained by an increased excretion of K which occurs with a large amount of exudate. Further investigation is necessary for elucidation of the etiology of large amounts of exudate.
Aim: To examine the associations among the presence, level, and the duration of pain, the number of painful areas and physical function in elderly patients. Methods: The participants in this study were 351 men and women aged 75 years orolder who were living in the community. Participants were interviewed about the presence, level, number of painful areas and duration of pain. Physical function was self-assessed using a questionnaire. Results: The presence of pain was higher in women than men. No significant differences in the level, number of affected areas and duration of pain were observed between men and women. Physical function was significantly associated with the presence of pain (odds ratio[OR]: 1.75), presence of pain in the upper and lower extremities (OR: 5.15), pain in more than 3 areas of the body (OR: 11.56), presence of strong pain (OR: 4.65), and pain with a duration of over 5 years (OR: 3.35). Conclusion: It is insufficient to assess the association between physical function and pain solely by the presence of pain. These findings suggest that it is necessary to assess the association between physical function and pain by the presence and level of pain, number of painful areas and duration of pain.
Aim: The assessment of cognitive function is important in comprehensive geriatric assessment (CGA), and several standardized screening tests for dementia such as the Mini-Mental State Examination (MMSE) are available. However, it takes 5 to 20 minutes to perform the MMSE. We have developed a CGA initiative named 'Dr. Superman' which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for cognitive decline preceding the MMSE. Methods: The MMSE and a question on episodic memory, ("What kind of food did you have last night?") were administered to 90 elderly outpatients with various diseases. They were divided into 2 groups according to their MMSE scores: a normal group (MMSE score≥24) and an abnormal group (MMSE score≤23). Within these groups, each domain (D) (D1: time orientation, D2: place orientation, D3: immediate memory, D4: calculation, D5: recall, D6: language, and D7: spatial cognition) and episodic memory was separately scored and the sensitivity, specificity, and positive predicative value of each were calculated. Based on these data, the best combination of the domains was evaluated for practical use as an assessment tool. Results: The MMSE scores ranged from 10 to 30, and 42 cases were classified into the normal group. High sensitivity, specificity, or positive predicative value was observed in D1, D2, D4, D5 and episodic memory categories. On the basis of the characteristics of each item in these domains in order to make a short-form assessment, a combination of "What is this year" in D1, "Serial 7's twice" in D4, and a question on episodic memory was found to be superior to other combinations (sensitivity: 93.8%; specificity: 71.4%; positive predicative value: 78.9%). Using this combination for 50 outpatients with 2 raters, it took 32 to 55 seconds to accomplish the assessment with good inter-rater reliability (κ=0.861). Conclusions: The combination of "What is this year?", "Serial 7's twice", and "What kind of food did you have last night?" was the best and most valuable short-form screening test for cognitive decline.