Background and objectives: After the Great East Japan Earthquake, elderly individuals, who are particularly vulnerable during natural disasters, experienced difficulty while evacuating the area. This report discusses the Kampo treatments provided to elderly individuals in the disaster areas, and the role of integrative medicine and Kampo treatment. Methods: The changes in symptoms and Kampo treatment contents were summarized using the medical records of treatments provided in the evacuation centers until 10 weeks after the earthquake. Results: Infectious diseases, the common cold and hypothermia were frequently observed in most patients for first two weeks after the disaster. Allergies increased two weeks later, and mental distress was commonly observed six weeks later. We prescribed several Kampo formulas to treat the individual symptoms. Discussion: Many elderly individuals were treated using Western medications, but the symptoms persisted; however, after Kampo formulas were included in the treatment, the symptoms of many patients improved. Unlike Western medications, Kampo formulas warmed the bodies of elderly individuals who often had a reduced basal metabolism and low body temperatures due to exposure to the cold tsunami waters. Therefore, the Kampo formulas may have improved the immunity of those who were under psychological and physical stress because they had spent several days in the evacuation centers. Conclusion: Many studies have reported the effectiveness of Kampo formulas. Therefore, the combined usage of both Western and Kampo medicine may be used in a mutually complementary manner, and these combination treatments may play an important role in preserving the victims overall health after natural disasters.
Aim: When considering the health of elderly individuals, extending a healthy lifespan as well as the average life expectancy has been discussed. In general, life expectancy is determined by biological health, socioeconomic factor, and social disparities. However, the effects of fatal diseases, such as cancer, socioeconomic factor, and self-rated health on the average life expectancy and healthy life expectancy have not been fully elucidated. Methods: In the present study, a multiple regression analysis was used to clarify the relationships between the lifespan and socio-economic conditions, such as the GDP, GiNi index, age-adjusted mortality from cancer, suicide rate and self-rated health in 27 European countries. Results: According to the multiple regression analysis, the average life expectancy was significantly correlated with mortality from cancer (β=-0.816, P=0.001), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.759, p=0.001) in males. In females, the average life expectancy was significantly correlated with mortality from cancer (β=-0.470, p=0.004), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.605, p=0.001). Conclusions: These findings indicate that there is a significant correlation between cancer and life expectancy. Meanwhile, self-rated health is an important factor for increasing the longevity of a healthy life expectancy.
Purpose: This study aimed to develop a questionnaire to evaluate indoor life-space mobility and assess its validity in community-dwelling older adults certified as needing support or care. Methods: The participants included 37 community-dwelling older adults undergoing home-visit rehabilitation (mean age: 78.5±7.0 years). We developed a questionnaire to assess the degree of indoor life-space mobility (home-based life-space assessment (Hb-LSA)), evaluating the functional status (life-space assessment (LSA), time spent away from bed, functional independence measure (FIM), bedside mobility scale (BMS)), physical function (hand grip power (HGP), 30-second chair stand (CS-30), one-leg standing (OLS)) and cognitive status (mental status questionnaire (MSQ)). Results: The average Hb-LSA score was 56.3±24.3 (minimum 4 to maximum 102.5). The test-retest reliability was high (intraclass correlation coefficients: (1, 1)=0.986, (1, 2)=0.993). The Hb-LSA scores were significantly associated with the LSA (r=0.897), time spent away from bed (r=0.497), FIM (r=0.786), BMS (r=0.720), HGP (r=0.388), CS-30 (r=0.541) and OLS (r=0.455). There were no significant associations between the Hb-LSA scores and the FIM cognitive subscores (r=0.180) or MSQ scores (r=-0.240). The Hb-LSA scores were significantly higher among the participants able to move independently indoors (75.8±18.8 points) than in those who required help to move (45.7±20.2 points). Conclusions: The Hb-LSA is a useful, reliable and valid tool for assessing the degree of indoor physical mobility in the life-space. The Hb-LSA score is related to the degree of independence of indoor mobility.
Aim: To assess the validity and reliability of a pre-visit questionnaire newly developed to identify geriatric conditions in older adults in an outpatient clinical setting. Methods: A new self-administered questionnaire consisting of 17 items was distributed to 277 patients or their caregivers visiting a memory clinic. The questionnaire was designed to address common symptoms associated with an increasing age based on yes/no responses with symptom-oriented questions avoiding the use of 'jargon'. The patients also underwent comprehensive geriatric assessments (CGAs), as well as tests of the Barthel index, Lawton instrumental activities of daily living, mini-mental state examination (MMSE), geriatric depression scale and vitality index to assess construct validity in a factor analysis. The differences in the prevalence of symptoms between the patients and their caregivers were also assessed. Results: The factor analysis detected eight components that included symptoms referring to gait disturbance, numbness, urinary incontinence, insomnia or body weight loss and were significantly correlated with the measurements of the CGA. Cronbach's alpha coefficient for the internal consistency of the questionnaire was 0.729. The caregivers tended to respond to the questionnaire for older patients (81.6±5.5 vs. 76±9.7 years of age for patients with caregivers as responders versus patients as responders respectively, p<0.001) and those with lower MMSE scores (19.4±5.8 vs. 24.8±4.2 points, p<0.001). A higher prevalence of falls and episodes of delusions was observed among the patients with caregivers as responders. Conclusions: These results demonstrate that the current questionnaire is a valid and reliable instrument for use in clinical practice and that obtaining collateral source information is essential for assessing significant geriatric symptoms. Such information also provides clinicians with a guide to conducting more detailed evaluations of geriatric conditions and aids in the diagnostic process in older patients with multidisciplinary complications.
Aim: The aim of this study was to examine risk factors for the certification of long-term care insurance (hereafter reffered to as "certification") in the community-dwelling elderly individuals. Methods: At baseline, 4,503 community-dwelling elderly responded to a self-completed questionnaires including items for "certification". Among the respondents, we analyzed 4,213 individuals with a non-support status who provided data regarding sex. The endpoint was the onset of "certification". At the end of the four-year follow-up period, 313 subjects had received "certification" (support-transition group), while the remaining 3,639 subjects continued to exhibit a non-support status (non-support group). Results: The support-transition group contained a higher proposion of subjects with chronic disease than the non-support group. The presence of chronic disease, a poor condition of the eyes or teeth, infrequent medical checkups, a high BMI, changes in body weight within one year, sleep disturbances, poor appetite, impaired ambulation, a slow speed while walking and a history of fall(s) within the previous one year were found to be significantly related to an increased risk of "certification". These items differed between men and women. Conclusion: This longitudinal study demonstrated that risk factors related to "certification" among community-dwelling elderly are multimodal and differ between men and women. The presence of chronic disease, the level of health management and the ability to engage in physical activity at baseline exhibited significant correlations with the need for "certification" over the four-year study period.
Aim: Although many neuropsychological tests have been developed to evaluate higher brain dysfunction, conducting several tests in daily medical care is very difficult for both the patient and the examiner. We herein reviewed the correlation between the results of 11 neuropsychological tests in order to create a new compact and easily administered combination of screening tests to detect dementia. Methods: We performed 11 neuropsychological tests in 1,674 outpatients suspected of having cognitive dysfunction and 46 normal control subjects. The 11 tests included the following examinations: the mini mental state examination (MMSE) and Hasegawa dementia rating scale-revised (HDS-R) for the total intelligence function, the frontal assessment battery (FAB) and Montreal cognitive assessment (MoCA) for the frontal lobe function, the neuropsychiatric inventory (NPI) and Abe's behavioral and psychological symptoms of dementia score (ABS) for emotional changes, the geriatric depression scale (GDS) for depressive conditions, the vitality index (VI) and apathy score (AS) for reduced motivation and the clinical dementia rating (CDR) and Alzheimer's disease cooperative study-activities of daily living (ADCS-ADL) scale for ADL's. In order to determine the most compact test series, we compared all test features, correlations between the scores and the time required to complete each test. Results: Correlations were found between tests of the cognitive function, tests of the cognitive function vs NPI, tests of the cognitive function vs ADL, NPI vs ABS, NPI vs GDS, GDS vs AS, VI vs AS and CDR vs ADCS-ADL. The duration of testing was shorter for the FAB than for the MoCA and for the ABS than for the NPI. Conclusions: A combination of six tests (MMSE or HDS-R, FAB, ABS, GDS, AS and ADCS-ADL) was found to be useful for screening dementia and reducing the test burden on the patient in daily medical practice.
Aim: The purpose of this study was to examine the effects of bright light exposure on behavioral and psychological symptoms of dementia (BPSD), including sleep disturbances and the burden on caregivers in institutionalized elderly with cognitive decline. Methods: The subjects included eight people with cognitive decline (mean [SD] age, 79.9 [9.1] years) living in geriatric healthcare facilities for the elderly. BPSD and the burden on caregivers were measured over three weeks using the CMAI (Cohen-Mansfield Agitation Inventory), NPI-NH (Neuropsychiatric Inventory-Nursing Home Version) and J-ZBI (Modified Japanese Version of the Zarit Caregiver Burden Interview) at the end of each week. During the second week, the subjects received either 12,000 K (white) or 2,400 K (orange) of light corresponding to approximately 2,000 lux from a light-emitting diode (LED) device, measured before the eyes in the gaze direction, from 9 : 00 to 9 : 30 during occupational tasks, such as origami and coloring. Differences in the variables obtained at the different weeks were assessed using ANOVA with multiple comparisons. Results: The scores for the severity of BPSD, including sleep disturbances and the burden on caregivers, on the NPI-NH significantly (P<0.05) improved following the treatment with white light exposure, while the scores for the MMSE and J-ZBI did not change over the three-week study period. Conclusions: These results suggest that exposure to white bright light during occupational tasks in the morning may have a benefit in improving BPSD, including sleep disturbances and the burden on caregivers.