Aim: The purpose of the present investigation was to explore the process towards functional disability and predicting factors in Japanese diabetic elderly. Methods: We recruited 317 older patients aged 65 or over among participants in the large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial (J-EDIT). We analyzed the changes of daily life function prospectively for 6 years. Information about diabetes, blood examinations and complications was obtained, and basic activity of daily living (ADL) and instrumental ADL (IADL) were assessed by total Barthel index score and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index), respectively. Results: During 6 years of follow-up, 13.6% of subjects had developed a new ADL disability (bADL) and 38.3% had developed a new functional impairment assessed by TMIG index. In the 65-74 years age group, basic ADL decreased only in males, while females became functionally impaired. In 75-84 years age group, basic and IADL decreased in both men and women. Older age and metabolic syndrome negatively affected ADL, while baseline IADL impairment, cognitive dysfunction, physical inactivity, and insulin therapy were significant predictors of a future decline in the IADL. Conclusion: This study identified the disability process and prognostic factors, including the future decline of basic ADL and IADL in diabetic elderly patients. There are modifiable factors for ADL impairment, comprehensive treatment and care are required to keep Japanese diabetic elderly patients healthy in daily life functioning.
One year has passed since the Great East Japan Earthquake and the Fukushima No. 1 nuclear power plant accident. Even currently, more than 150,000 evacuees in Fukushima Prefecture are forced to leave their home and to move throughout Japan. Because of the limited space of temporary housing and the weakening of personal ties in local communities, many families need to move and have separate lives. As a consequence, Fukushima has a serious shortage of caregivers for the elderly. There have been more than 1,300 disaster-related deaths due to shock and stress after long-distance drifts from town to town. Most of the victims were the elderly, who collapsed, caught pneumonia, suffered stroke and heart attack. Concerns about the safety of low-dose radiation exposure deprived the elderly of important contact with playing outside with their grandchildren in Fukushima. Fear of invisible radioactive contamination inactivated outdoor activities such as farming, dairy, fishing, gardening, hiking and wild-vegetable/mushroom hunting, although most of these activities have been traditionally supported by the wisdom of the elderly. Several recent questionnaire investigations revealed that older evacuees wish to go home even if the environment has significant contamination. In contrast, more than half of younger generation with small children have a different attitude. Nuclear accident brought serious social pains although it did not acutely hurt our bodies.
Aim: The purpose of this study was to construct a scale that measures multidimensional attitudes regarding death in the middle-aged and elderly, using scale items for adolescents, and to examine its reliability and validity. Methods: Twenty-nine items which were selected from the scale of Attitudes toward Death (Tange, 1999) were administered to subjects, consisting of 2,223 community-living Japanese men and women aged 40-79 years. Both exploratory factor analysis and confirmatory factor analysis were performed to examine the factor structures. The reliability and validity of the scale were examined. Results: Exploratory factor analysis was performed to examine the factor structures of death attitudes, using the data from half of the subjects, indicated 5 factors. Confirmatory factor analysis, using the data from the remaining half, supported the goodness of fit of that model. Using this structure, the attitude toward death scale for the middle-aged and elderly (ATDS-A; five subscales) was constructed; "fear of death", "belief in existence of afterlife", "intention to live out own life", "meaning of death for life", "approval of death with dignity". For these subscales, the alpha coefficients ranged from 0.59-0.87. The validity of the subscales was suggested through the relation with the ego integration score. Conclusions: This study suggested that the ATDS-A was reliable and valid, and was useful for the measurement of death attitudes in the middle-aged and elderly.
Objective: Percutaneous endoscopic gastrostomy (PEG) serves as a major artificial hydration/feeding method in the terminal care of elderly patients. We surveyed the state of patients who underwent PEG at our hospital and investigated the clinical characteristics of patients in the long-term survival group, and the short-term survival group. Methods: The subjects were 125 patients who underwent PEG at our hospital between January 2007 and June 2011. Two kinds of examination were performed. In the first examination, subjects were divided into a short-term group of 37 patients who survived <181 days and a long-term group of 88 patients who survived ≥181 days. In the second examination, subjects were divided into 2 purpose-oriented groups: a prolongation of life group of 76 patients and a being able to eat group of 49 patients. We analyzed the clinical records of these patients and conducted a telephone-based survey. Results: In the short-term group, there were many cases of PEG after hospitalization due to medical diseases such as pneumonia. In the long-term group, many subjects were young, female, suffered from recurrence of cranial nerve disease, or slowly developed dysphagia. The involvement of rehabilitation doctors, the rate of undergoing rehabilitation for dysphagia, and cases who were able to achieve oral ingestion were significantly high. Of 49 patients who underwent PEG with the aim of being able to eat, 24 achieved oral ingestion. Conclusion: Our findings suggest that involving rehabilitation doctors and undergoing rehabilitation for swallowing effectively promote long-term survival after PEG.
Aim: The purpose of this study is to consider the influence which the form of tube feeding nutrition products has on meal delivery operating man-hours, personnel expense, and the quality of nursing. In addition, it is also considers operational efficiency improvement. Methods: We used liquid nutrition material packaged in a paper container before we changed the nutrition product. After the change of the nutrition product, semi-solid nutrition with ready to hang (RTH) moderately viscous nutrition was used. We investigated the tube feeding administrative task and the contents of nursing using the Industry Engineering technique. Results: We were able to reduce by half the man-hours required for 1 morning tube feeding in 238.1 minutes to 106.1 minutes by changing to RTH semi-solid nutrition. Thereby, we were able to reduce personnel expenses by 514,290 yen per month. The total man-hours which could be spent on nursing increased to 170 from 139. Conclusions: By using the RTH semi-solid nutrition with moderate viscosity, the operating efficiency of tube feeding management has improved greatly. As a result, the time which can be spent on nursing increased.
Aim: The purpose of the present study was to examine the relationship between comprehensive quality of life (QOL) and some factors regarding chewing and swallowing function among community-dwelling elderly individuals. Methods: The subjects were 675 independent elderly persons residing in the northern area of Miyazaki Prefecture, and we obtained the self-administered questionnaires from 545 elderly people. We used "active scale for the elderly (ASE)" and "dysphagia risk assessment for the community-dwelling elderly (DRACE)" to evaluate their comprehensive QOL and function of chewing and swallowing, respectively. Furthermore, we examined some factors such as age, gender, subjective satisfaction with diet and verbal communication. Results: The score of ASE showed a significant decline with age (p<0.01) while the DRACE score increased significantly with age (p<0.01). Pearson's correlation coefficients revealed that the ASE score was significantly related to all of the factors regarding regulation of food intake. Partial correlation coefficients adjusted for age also revealed the same tendency. From the multiple regression analysis, subjective satisfaction with verbal communication, DRACE score, age and appetite were extracted as factors influencing ASE score (adjusted R2=0.43, p<0.01). Conclusion: Among independent elderly persons residing in the community, the comprehensive QOL was significantly related to factors such as subjective satisfaction with verbal communication, dysphagia risk, age, and appetite.