[in Japanese]

View full abstract

Aim: This paper aims to describe and discuss strategies for the advancement of "gerontechnology," a concept that is useful for solving problems in a super-aged society.
Methods: The term "gerontechnology" is a combination of "gerontology" and "technology" that refers to the fusion of the science of aging and engineering. In this paper, a survey of market size, information technology for persons with cognitive disabilities, personal mobility technology and universal design was conducted. In addition, strategies for advancing gerontechnology are discussed.
Results: The market for assistive products is approximately 1.2 trillion yen, while that for universal design products is approximately 3.6 trillion yen.
Information technology improves the capacity for independent living among individuals with dementia. There is a project underway to develop a communication robot to provide important information to patients. Pill reminders and locators are also useful tools based on field tests of Japanese patients.
Robot technology improves the development of personal mobility devices, which are useful for the elderly.
The number of universal design products is increasing. Assessing the function of the elderly using ergonomics and standardized protocols improves these products.
Conclusions: Technology to assist the elderly is improving. In order to advance the concept of gerontechnology, the promotion of field-based innovation, that is user- and usage field-centered concepts, is important.

View full abstract

Aim: The purpose of this study was to investigate changes over one year in the prevalence of kyphosis, the ability to perform activities of daily living and self-efficacy among elderly residents of mountainous areas.
Methods: The subjects included 155 elderly residents of mountainous areas (68 males, 87 females) aged 65 or older who participated in both our initial and follow-up investigations. The investigations were conducted via interviews using questionnaires and the index of kyphosis (I/K). The subjects were divided into three groups (non-kyphosis, kyphosis without changes, kyphosis with worsening) according to the change in I/K.
Results: The average patient age was 74.9±6.2 years. The average I/K on the initial investigation was 10.0±3.7 (2.4-20.0). On the follow-up investigation, the average I/K increased slightly to 10.2±3.6 (3.0-22.9). A particularly large number of females 65 to 69 years of age exhibited an increase in the I/K. The percentage of subjects with an I/K of 13.0 or above was 20.6%. The male kyphosis sufferers demonstrated a significant decrease in the health-related QOL categories of "able to fulfill everyday life roles (physical)" and "able to fulfill everyday life roles (mental)."
There were no significant differences between the females with and without kyphosis. One year later, there were significant differences between the three groups in terms of the health-related QOL categories of "vitality" and "ability to live in society."
Conclusions: Female kyphosis sufferers are affected by psychological factors. Kyphosis should be detected early and carefully followed up in elderly patients in order to prevent the need for nursing care, and appropriately estimating the patient's physical condition is required to prevent a decline in the lower limb function.

View full abstract

Aim: The aim of this study was to identify factors associated with the level of disability in elderly adults based on the Japanese long-term care insurance system.
Methods: The participants included 3,198 frail elderly subjects (mean age: 82.0±6.45). The slightly disabled group, with a support level in the long-term care insurance system, comprised 1,129 elderly adults, and the moderately disabled group, with a care level of 1 or 2 in the long-term care insurance system, comprised 2,208 elderly adults who received day-care services. The following parameters were evaluated: grip strength, chair stand test 5-times (CST), one-leg standing with eyes open (OLS), timed "up & go" (TUG), walking speed, the mental status questionnaire (MSQ) score and functional independence measures (FIM). The participants were categorized into two groups based on the 13 motor subscales of the FIM (FIM-M): the activity of daily living (ADL) independent group, who scored 6 points or higher on all ADL measurements, and the ADL care need group, who scored 5 points or under on at least one item in all ADL measurements. A multiple logistic regression analysis was used to examine the relationships between the long-term care insurance level and the potential correlates.
Results: The multiple logistic regression model indicated that gender, grip strength and the MSQ and FIM-M scores were significantly associated with the long-term care insurance level (p<0.05). The FIM-M score exhibited a particularly strong correlation with the type of long-term care required (odds ratio: 2.47, 95% confidence interval: 1.89-3.24).
Conclusions: The Japanese long-term care insurance level is associated with physical performance, the cognitive function and the ability to perform ADL's. These results suggest that comprehensive assessments are useful for understanding the impact of the long-term care insurance level in elderly adults.

View full abstract

Aim: Memantine hydrochloride (Memary^®), launched in June 2011 in Japan, is used in patients with moderate to severe Alzheimer's disease. We performed an integrated analysis of data obtained from different clinical studies of memantine hydrochloride conducted between 2002 and 2011 in Japan in order to examine the long-term tolerability and efficacy of this drug at a dose of 20 mg/day.
Methods: Using clinical studies of memantine hydrochloride performed in Japan between 2002 and 2011, the therapeutic safety and the time course of MMSE scores in 702 subjects who had received memantine hydrochloride were examined.
Results: The mean duration of memantine treatment was 798.1 days, with the longest duration of 3,373 days (approximately nine years and two months). The incidence of adverse events every 52 weeks of treatment ranged from 71.0% to 88.9%, and the incidence of adverse drug reactions ranged from 5.6% to 32.1%, with no associations between the incidence of adverse events and the treatment duration. There were no adverse drug reactions specific to the long-term administration of this drug. The occurrence of "adverse events" was the primary reason for drug discontinuation. During the long-term study observation period, there were many cases of adverse events and treatment discontinuation due to the background factors of the subjects, including adverse events associated with aging and progression of the underlying conditions. In addition, treatment discontinuation was also associated with admission to a nursing home or facility due to changes in home nursing care. The degree of MMSE score reduction over time was lower in the patients treated with memantine than the expected MMSE score reduction observed in the untreated patients.
Conclusions: Based on these findings, there are no issues regarding the tolerability of memantine hydrochloride administered at a dose of 20 mg/day over the long term. Considering changes in the MMSE score, the results indicated that memantine hydrochloride may inhibit worsening of the cognitive function for long periods of time in patients with Alzheimer's disease.

View full abstract

Older adults often complain of nocturia as one of the most bothersome symptoms of lower urinary tract incontinence. Nocturia places such patients at risk of falling down and insomnia and increases the care burden. The causes of nocturia include various factors, such as neuropathic bladder, prostate hyperplasia and pelvic floor muscle weakness. It has also been reported that nocturia is caused by an increased renal blood flow while lying down and the loss of diurnal variation in vasopressin. The intranasal administration of desmopressin at night may improve nocturia. We experienced a case of severe nocturia that could not be controlled with fluid restriction, urethral catheterization before sleep or anticholinergic drugs. Due to frequent urination during the night, the patient was unable to sleep well and required frequent nursing care. Following the administration of nasal desmopressin before sleep, the number of episodes of nocturia considerably improved. In addition, no adverse events, such as hyponatremia, were observed with desmopressin use. Physicians should therefore consider using desmopressin in cases with treatment-resistant nocturia.

View full abstract