Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.
The frequency of depression in patients with Parkinson's disease is approximately 30-40%. Depression has a significantly negative impact on the QOL in Parkinson's disease patients. It leads to the worsening of tremors and frozen gait without disease progression and decreases the patient's motivation to participate in rehabilitation. The distinguishing feature of depression in patients with Parkinson's disease is that guilt, self-blame and suicidal ideation are rarely seen compared to that observed in patients with major depression. Depression can occur in the pre-motor, diagnostic and advanced stages of Parkinson's disease. In particular, patients with wearing-off symptoms are apt to develop anxiety. As for treatment, it is very important to optimize dopamine replacement therapy. Antiparkinsonian drugs may have beneficial effects not only on the motor symptoms of the disease, but also the patient's mood. Cognitive behavioral therapy (CBT) and peer counseling may also be beneficial.
Aim: The purpose of anti-aging medical checkups is to evaluate the functional age of the patient, aiming to prevent functional aging and rejuvenate the functional age. In this study, a comparison of the medical checkup results was conducted in elderly groups with different levels of activities of daily living (ADL). Methods: There were three groups of subjects; and an independent group that included 43 independently-living subjects (68.9±6.3 years) in the Kyoto Yurin area, a support-requiring group that included 31 subjects (77.8±7.2 years) routinely visiting a day care center and a nursing-requiring group that included 19 subjects (83.7±6.8 years) who were living in a medical care facility for the elderly. We conducted anti-aging medical checkups, and the following five factors were evaluated: muscle mass by the bioelectric impedance method (Physion MD), bone strength by an ultrasonic wave method (A-1000: Yokogawa, AOS-100NW: Aloka), fingertip pulse wave analysis (SDP-100: Fukuda), cognitive function (Wisconsin card sorting test) and the serum insulin-like growth factor-I and dehydroepiandrosterone-sulfate (DHEA-s) level. To calculate the functional age of the subjects, we used the Age Management Check (Ginga Kobo, Nagoya), and the Δage (functional age-chronological age) was analyzed and compared between the groups. Results: The functional ages in the independent group were muscle age, 55.5±7.0; blood vascular age, 65.4±8.5; neural age, 63.6±14.8; hormone age, 70.4±7.6 and bone age, 60.2±14.6 years. As a result of an increase in 1,506 daily steps based on walking instruction with pedometer monitoring, the subjects significantly improved their body weight, BMI, waist size, fasting plasma glucose level and serum DHEA-s in six months. By showing them their functional age, their motivation to participate in the health promotion program was increased, and the compliance was high, with an omission rate of less than 20% in 2.5 years. The support- and nursing-requiring groups showed muscle ages of 58.8±3.3 and 61.9±4.0, blood vascular ages of 75.5±12.6 and 71.8±11.1, neural ages of 86.5±8.8 and 88.5±5.8 and bone ages of 81.0±12.0 and 75.7±12.3, respectively. The Δage analysis in the three groups revealed that the Δneural age increased as the ADL decreased. Conclusions: The Δage analysis indicated that the decreased ADL in the elderly may be mainly associated with their neural function in the factors examined. Anti-aging medical checkups are high in terms of their cost-performance ratio and are easily accepted by the elderly, and are thus recommended for elderly with all grades of ADL.
Aim: The objective of the present study was to evaluate the long-term effectiveness of an exercise program in modifying the exercise behavior of the community-dwelling elderly subjects. Methods: This study was a single-blinded randomized controlled trial. The subjects included 52 males and 65 females 65 years of age or over who were randomly assigned to an exercise-intervention group or a health-education group. The stages of change in exercise behavior were evaluated before and one-year after the intervention period. The subjects' physical function (muscle strength, balance, walking speed) and self-efficacy in each domain of the physical function were measured during the intervention period. Results: There were no significant differences in the stages of change before the intervention between the two groups. Significant differences in the stages of change were observed in "relapse" of stages at two points in time between the two groups (p<.01). A logistic regression analysis showed that "progression" of stages was associated with improvements in the timed up and go test (AOR 2.7; 95% CI 1.3-5.8) and sit and reach (AOR 1.14; 95%CI 1.0-1.3), while "relapse" of stages was associated with the group allocation (AOR 4.6; 95%CI 1.1-18.8), self-efficacy in "Walking" (AOR 1.54; 95%CI 1.0-2.3) and "Stair climbing" (AOR 0.68; 95%CI 0.5-0.9) with respect to physical activity during the intervention period. Conclusions: The results suggest that exercise intervention in community-dwelling elderly subjects is effective in preventing "relapse" of exercise behavior over long periods.
Aim: To examine the place and cause of death in community-dwelling disabled elderly people. Methods: The baseline data of 1,875 participants and their caregivers in the Nagoya Longitudinal Study for Frail Elderly were used for the analysis. Cox proportional hazard models were used to assess the associations between the variables and the place of death during the 3-year follow-up period. Results: During the observation period of three years, 454 died (hospital death: 347, home death: 107). In total, the rates of pneumonia-, cancer- and heart failure-related death were 22.7%, 14.5%, and 13.2%, respectively. Among the home deaths, 22.4% were age-related deaths and 18.7% were heart failure-related deaths. Females, older, and participants with dementia were more likely to die at home, while those with cancer or a spouse caregiver were more likely to die in the hospital. There were no differences in the levels of caregiver burden or formal service use between the cases of home and hospital death. Multivariate Cox hazard models revealed that home death was associated with an older age and the absence of diabetes mellitus and cancer at baseline. Conclusions: We demonstrated that death at home among community-dwelling disabled elderly is associated with an older age, and the absence of diabetes mellitus and cancer. Due to the lack of important factors that should be addressed, a further study is required in the future.
Aim: To examine the intervention effects of a physical function improvement program for community-dwelling frail elderly subjects. Methods: The subjects included 309 participants (108 males, 224 females) who took part in "Iki Iki Health Classes," an exercise training program for frail elderly individuals conducted over three years from April 2008 to March 2011. The average participant age was 75.4±5.8 years in the males and 74.6±5.6 years in the females. Results: Many participants had bone and joint disease with hypertension. The proportion of those with a history of falls (49.0%) was high. Significant improvements from the program were seen in the motor function and in the total scores for the Kihon checklist, grip strength, standing on one leg, timed up-and-go test (TUG), 5-m walking time and 5-m walking maximum time, fear of falling (77.5→70.1%) and subjective health ("good/well good/usually," increased from 73.6% to 89.1%). A new care-needs certification was issued in 21.6% of the subjects during the period spanning to March 31, 2013. A logistic regression analysis revealed that the deterioration of subjective health was significantly related to the presence of risk factors for new care-needs certification (odds ratio and 95% confidence interval: 4.99 (1.04-23.9), p=0.04). Conclusions: These results suggest that the interventions used in the program to improve the physical function contributed to improving the subjects' mental and physical functions. We speculate that whether improvements in subjective health are linked to roles in normal life and/or social activity participation is important for care prevention.
Aim: We investigated circadian changes and seasonal variation in the salivary cortisol levels in elderly persons in nursing homes. Methods: Circadian changes in the salivary cortisol levels were measured in the elderly subjects ten times every three hours from two hours at 21:00 from 6:00, three times at 6:00. The seasonal variation in salivary cortisol was determined according to a fixed method applied on one day between December and October (autumn), March and January (winter), June and April (spring) and September and July (summer). The samples were preserved in frozen storage in an exclusive freezer (at less than -20) and measured for the cortisol concentrations using EIA. Results: Analyses using a general linear model of the salivary cortisol levels as the dependent variable and sex, age, season and time as independent variables showed that the primary factors affecting the salivary cortisol levels were time (morning>night), sex (male>female), age (B=0.1151) and season (autumn>summer). In addition, a meaningful interaction was observed between time and sex. Females exhibited higher levels at 6:00 than males, while males demonstrated a small decline from 6:00 to 11:00, which gradually continued thereafter. Conclusions: The analysis of circadian changes showed high cortisol concentrations in females. It is necessary to consider daily changes, seasonal variation and sex differences when using the salivary cortisol level as an index of stress.
The patient was a 76-year-old, male who was diagnosed with high blood glucose at 30 years of age. He suffered a stroke at 52 years of age. and was diagnosed with type 2 diabetes at a nearby hospital. Oral hypoglycemic medicines were administered along with diet and exercise therapy, which resulted in good glycemic control. The patient required an emergency hospital admission in December 2010 for weight loss. In addition, he suffered from frequent urination. He was diagnosed with diabetic ketoacidosis based on the following findings: blood glucose, 1,003 mg/dL; glycated hemoglobin, 7.7%; positive urine ketone bodies; and blood gas pH, 7.293. Although he had previously received medical treatment, the patient was transferred to our hospital, as he was unable to achieve stable glycemic control. At the time of admission, level of blood glucose and fasting serum C peptide were 1.002 mg/dL and 0.1 ng/mL, respectively. A glucagon loading test performed at our hospital revealed a serum C peptide level of <0.5 ng/ml. Tests for islet-cell autoantibodies were negative, and the patient's pathological conditions met the diagnostic criteria for fulminant type 1 diabetes. His human leukocyte antigen genotype was DRB1*0405 DQB1*0401, which is a disease susceptibility haplotype. In our experience, acute exacerbation of fulminant type 1 diabetes is observed in elderly patients who receive treatment following a diagnosis of type 2 diabetes. The differential diagnosis of ketoacidosis in elderly patients with type 2 diabetes should also include fulminant type 1 diabetes. Furthermore, providing an appropriate diagnosis and rapid treatment intervention is required.