Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
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Volume 52, Issue 3
Displaying 1-15 of 15 articles from this issue
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Original Articles
  • Relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons
    Naoko Morisaki, Hiroko Miura, Shuichi Hara
    2015 Volume 52 Issue 3 Pages 233-242
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.233
    JOURNAL FREE ACCESS
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    Aim: We herein examined the relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons. Methods: The subjects included 218 community-dwelling dependent elderly persons. The data were collected via questionnaires, including information regarding age, sex, the level of care required, nutritional status and swallowing function. We used the Mini Nutritional Assessment-Short Form (MNA-SF) to measure the nutritional status and the Dysphagia Risk Assessment for the Community-dwelling Elderly (DRACE) to evaluate the swallowing function. The tongue pressure and the labial closure force were measured using a tongue pressure measurement system (JMS Co. Ltd., Hiroshima, Japan) and the Lip de Cum (Cosmo-Instruments Co, Ltd, Tokyo, Japan). Results: The mean MNA-SF score was 10.07±2.58. The mean DRACE score was 4.39±3.80. The mean tongue pressure was 23.89±10.61 kPa. The mean labial closure force was 10.17±6.04 N. The results of bivariate regression analyses showed that there was a poor correlation between the MNA-SF and the DRACE, tongue pressure and labial closure force. Furthermore, the multiple regression analysis with the MNA-SF as the dependent variable revealed a correlation between the DRACE and labial closure force (p<0.01, R2=0.02). Conclusions: Our results suggest that the nutritional status is significantly related to the swallowing function and labial closure force among community-dwelling dependent elderly persons.
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  • Development of a self-administered dementia checklist (SDC) (1): Examination of factorial validity and internal reliability
    Chiaki Ura, Fumiko Miyamae, Naoko Sakuma, Hirotoshi Niikawa, Hiroki In ...
    2015 Volume 52 Issue 3 Pages 243-253
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.243
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    Aim: The aim of this study was to develop a self-administered dementia checklist (SDC), in order to help community-residing older adults realize their declining functions and encourage them to begin using necessary services, and to examine its factorial validity and internal reliability. Methods: A panel of dementia clinical experts developed a questionnaire according to pre-selected items and conducted a self-administered survey with community-residing people aged 65 + (n=2,483). The team developed a scale through an exploratory factor analysis and item response theory (IRT) analysis (Study 1). Using this scale, they conducted a self-administered survey with community-residing people aged 65 + (n=5,199), conducted another exploratory factor analysis, and developed a 10-item scale. A confirmatory factor analysis was subsequently conducted and reliability coefficients were computed. Results: The exploratory factor analysis of the proposed 37 items extracted 5 factors: Factor 1 was named "subjective decline in daily living functioning," and Factor 2 was "subjective cognitive decline" in the early stage of dementia. The team developed a 20-item scale by selecting 10 items from each factor which had high factor loadings and high slope values in the IRT analysis (Study 1). After the exploratory factor analysis of the 20-item scale, they developed a 10-item scale by selecting 5 items from each factor which had strong associations. The confirmatory factor analysis verified the 2-factor model. The Cronbach α coefficients for the subscales of Factors 1 and 2 were 0.935 and 0.834, respectively, and 0.908 for the overall 10-item scale. Conclusion: The authors developed a 10-item SDC with 2 factors and confirmed its factorial validity and internal reliability.
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  • A study of endoscopic therapy for bile duct stones in elderly patients
    Mitsuru Sugimoto, Tadayuki Takagi, Hiromasa Ohira
    2015 Volume 52 Issue 3 Pages 254-259
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.254
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    Aim: To evaluate the safety and efficacy of endoscopic therapy for bile duct stones in elderly patients aged over 80 years. Methods: We enrolled 20 elderly patients aged over 80 years and 50 patients who were younger than 79 years of age who had received their first endoscopic therapy for bile duct stones at our hospital from February 2012 to December 2013. A retrospective analysis was performed which included the following clinical parameters: the use of antithrombotic drugs; a past history of abdominal surgery; performance status (PS); the shortest diameter of the largest stone; and the total number of stones. The treatment outcomes of operations with endoscopic sphincterotomy, endoscopic papillary balloon dilation, or endoscopic papillary large balloon dilation were compared. The operative time, complete stone clearance rate, operative success rate (complete stone clearance or bile duct stent insertion), and adverse events were compared as treatment outcomes. Results: There was no significant difference in the use of antithrombotic drugs, past history of abdominal surgery, number of stones, or treatment received between the age groups, while PS was significantly lower, and the diameter of the largest stone was significantly greater in the patients over 80 years of age. The operative time, complete stone clearance rate, operative success rate, and the number of adverse events did not differ significantly between the age groups. Conclusion: Endoscopic therapy for bile duct stones was found to be safe and effective in elderly patients over 80 years of age.
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  • Long-term care level as a predictor of a poor outcome in elderly patients with pneumonia
    Kei Miyagishima, Toshifumi Matsui, Toshimasa Obara, Sayuri Mitsuma, Ma ...
    2015 Volume 52 Issue 3 Pages 260-268
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.260
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    Aim: To determine factors associated with physical decline and a poor prognosis after hospitalization in physically dependent elderly patients with acute pneumonia. Methods: The subjects included 112 geriatric patients (86.8±5.5 years old) with acute pneumonia consecutively admitted to an inpatient unit of Geriatric Medicine, Kyorin University Hospital in the period from April 2012 to March 2013. All patients were generally treated with broad-spectrum antibiotics according to nursing- and healthcare-associated pneumonia (NHCAP) guidelines. The patients' baseline severity of pneumonia was evaluated according to the A-Drop score and their physical dependency was assessed according to the JABC score before and after admission. Results: The patients were categorized into the community acquired pneumonia group (CAP) (n=29) and NHCAP group (n=83). The patients in the NHCAP group had a longer hospital stay (NHCAP vs. CAP: 33 vs. 21 days, p=0.02), higher A-Drop scores (2.88±0.80 vs. 2.45±0.87 points, p=0.02) and were more frequently diagnosed with aspiration pneumonia (89.2% vs. 42.9%, p<0.0001) than those in the CAP group. Three patients in the CAP group (10.3%) and 13 patients in the NHCAP group (15.7%) died during their hospital stay (p=0.69). Although the rest of the patients were successfully treated for pneumonia, their physical dependency progressed after admission in both groups (p<0.0001). After adjusting for age, gender and the JABC score before admission, NHCAP (risk ratio against CAP: 6.2, 95% CI 1.2-32.2, p=0.03) and a serum albumin lower than 2.5 g/dl (RR: 7.8, 95%CI 1.7-35.7, p<0.01) were significantly associated with the progression of physical dependency after admission. Conclusions: The diagnosis of NHCAP is a risk factor for the progression of physical dependency. Therefore, palliative care may be an optional approach for frail patients.
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  • Cross-sectional and longitudinal associations of physical performance and skeletal muscle mass with cognition and cognitive decline among community-dwelling older Japanese
    Yu Taniguchi, Satoshi Seino, Yoshinori Fujiwara, Yu Nofuji, Mariko Nis ...
    2015 Volume 52 Issue 3 Pages 269-277
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.269
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    Aim: This study had two objectives: to confirm the cross-sectional associations between the physical performance scale (PPS), skeletal muscle mass (SMM) and sarcopenia and cognition, and to examine whether PPS, SMM and sarcopenia are independent risk markers of cognitive decline (CD). Methods: Among 805 adults 65 years of age or older who participated in a baseline survey (2008-2011), 649 were reevaluated for their level of cognition at least once until 2012, and PPS, SMM, sarcopenia and cognition were assessed. CD was defined as a decrease of at least 0.5 points per year on the MMSE. Results: After controlling for sex, age and years of education, PPS, SMM and sarcopenia were associated with cognition, respectively. During a median follow-up of 3.0 years, 201 adults (31.0%) had CD. After controlling for important confounders, PPS showed a significant association with CD [OR=0.75 (95%CI: 0.65-0.87)], whereas SMM showed no significant association with CD. As compared with the people who had normal PPS and SMM, people who had low PPS and normal SMM had 2.10 times higher risk for CD. Conclusions: We confirmed the cross-sectional associations between physical performance, SMM and sarcopenia and cognition in a general population of older adults. Although people had normal SMM, low physical performance was found to be a risk marker for subsequent CD.
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Case Reports
  • A case of acute respiratory failure in an elderly patient with elderly asthma-COPD overlap syndrome (ACOS) is differentiated from acute eosinophilic pneumonia
    Hirosumi Suzuki, Kazufumi Yoshida, Shinji Teramoto
    2015 Volume 52 Issue 3 Pages 278-284
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.278
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    We report a case of acute respiratory failure in a 77-year-old male with chronic obstructive pulmonary disease (COPD) who showed marked eosinophilia (61.5% of the peripheral total white blood cells [WBCs]; 13,200/mm3). The patient was an ex-smoker, but he had started smoking again one month previously, His forced expiratory volume in one second (FEV1) was low and dyspnea symptom was observed. Although rhonchi were detected, wheezing chest sounds were not detected. Chest X-radiography and computed tomography of the lung revealed diffuse bilateral pulmonary infiltrates and emphysematous changes. He was given intravenous methyl prednisolone (1,000 mg) for 3 consecutive days. The abnormal shadows on the chest X-ray film improved remarkably and the eosinophils in his peripheral blood were reduced. Furthermore, it was no longer necessary to administer oxygen to treat his hypoxemia. The symptomatic and clinical course mimicked to a case of acute eosinophilic pneumonia (AEP). However, transbronchial lung biopsy specimens did not reveal eosinophilic infiltration in the alveolar septa. The fraction of eosinophils in the patient's bronchoalveolar lavage was 4.4% and not greater than 25%. After hospitalization, 5-15 mg of prednisolone administered orally in combination with bronchodilators to better manage his clinical symptoms. This case was thus determined to correspond to elderly asthma-COPD overlap syndrome (ACOS).
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  • Elderly patient with acquired hemophilia A with IX・XI and XII factor decline
    Naofumi Hanyu, Yasuo Aota, Akihiko Gotoh, Michio Sakurai
    2015 Volume 52 Issue 3 Pages 285-290
    Published: July 25, 2015
    Released on J-STAGE: August 13, 2015
    DOIhttps://doi.org/10.3143/geriatrics.52.285
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    Acquired hemophilia is a rare bleeding diathesis caused by autoantibodies against clotting factor VIII. Many cases are associated with autoimmune disease, malignancy and an elderly status. Acquired hemophilia is very rare, with a reported annual incidence of 1.48/million/y. However, it is necessary to consider this rare disease when encountering bleeding of unknown cause in elderly patients. An 84-year-old woman was referred to our hospital with subcutaneous bleeding and anemia. The patient had severe anemia and a prolonged activated partial prothrombin time (APTT). Despite the administration of red blood cell transfusions, the decline in hemoglobin continued. Since the activity of coagulation factor VIII was <1%, and the level of inhibitor against coagulation factor VIII (509 BU/ml) was >5 BU/ml, the patient was diagnosed with acquired hemophilia. No underlying diseases were found, and we concluded that this case was idiopathic. Although she was treated with prednisolone at a dose of 40 mg per day, the bleeding tendency did not improve. Therefore, she was given activated prothrombin complex concentrates (APCC) for four days. The subcutaneous bleeding and Hb decline stopped, and the dose of prednisolone was gradually reduced. The patient's clotting function and clinical course were satisfactory, and she was discharged on the 64th day. An early diagnosis and optimal treatment are critical for treating acquired hemophilia. The development of a bleeding tendency related to the appearance of coagulation factor VIII inhibitor is serious in many patients. Therefore, recognizing this disease and providing prompt management are necessary.
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