Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 53 , Issue 4
Showing 1-21 articles out of 21 articles from the selected issue
Table of Contents
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Original Articles
  • Megumi Moriya, Miwa Matsuyama, Junko Inukai, Yukihiro Michiwaki, Hiros ...
    2016 Volume 53 Issue 4 Pages 347-353
    Published: October 25, 2016
    Released: November 24, 2016

    Aim: Although oral care is important in the prevention of aspiration pneumonia, the different institutions and practitioners employ various oral care methods, some of which are associated with the risk of aspiration. We have developed a new gel with the physical properties needed for waterless oral care. In the present study, we evaluated and investigated the properties and effectiveness of this gel.

    Methods: The physical properties of the trial gel and commercial moisturizing gels were compared using a VAS scale. The effects of plaque elimination were evaluated in healthy volunteers. Brushing was carried out by a dental hygienist using the gel and water. The number of throat suctions performed during brushing was also counted, and the difference was evaluated.

    Results: In the evaluation of physical characteristics, trial Gel B showed a significantly higher rating than the other gels. In plaque elimination, the rate of decrease in a modified PCR was significantly greater with the gel trial. Suctioning was also performed significantly fewer times with the trial gel.

    Conclusions: Good results were obtained with the newly developed trial Gel B with regard to the physical properties and the sensory evaluations. Its effectiveness was also confirmed in plaque elimination and in the evaluated risk of aspiration. The use of Gel B may have the potential to decrease the risk of aspiration during oral care and reduce the occurrence of aspiration pneumonia.

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  • Fumiko Miyamae, Chiaki Ura, Naoko Sakuma, Hirotoshi Niikawa, Hiroki In ...
    2016 Volume 53 Issue 4 Pages 354-362
    Published: October 25, 2016
    Released: November 24, 2016

    Purpose: The present study aims to develop a self-administered dementia checklist to enable community-residing older adults to realize their declining functions and start using necessary services. A previous study confirmed the factorial validity and internal reliability of the checklist. The present study examined its concurrent validity and discriminant validity.

    Methods: The authors conducted a 3-step study (a self-administered survey including the checklist, interviews by nurses, and interviews by doctors and psychologists) of 7,682 community-residing individuals who were over 65 years of age. The authors calculated Spearman's correlation coefficients between the scores of the checklist and the results of a psychological test to examine the concurrent validity. They also compared the average total scores of the checklist between groups with different Clinical Dementia Rating (CDR) scores to examine discriminant validity and conducted a receiver operating characteristic analysis to examine the discriminative power for dementia.

    Results: The authors analyzed the data of 131 respondents who completed all 3 steps. The checklist scores were significantly correlated with the respondents' Mini-Mental State Examination and Frontal Assessment Battery scores. The checklist also significantly discriminated the patients with dementia (CDR = 1+) from those without dementia (CDR = 0 or 0.5). The optimal cut-off point for the two groups was 17/18 (sensitivity, 72.0%; specificity, 69.2%; positive predictive value, 69.2%; negative predictive value, 72.0%).

    Conclusion: This study confirmed the concurrent validity and discriminant validity of the self-administered dementia checklist. However, due to its insufficient discriminative power as a screening tool for older people with declining cognitive functions, the checklist is only recommended as an educational and public awareness tool.

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  • Kazunori Kikuchi, Mutsuo Ijuin, Shuichi Awata, Takao Suzuki
    2016 Volume 53 Issue 4 Pages 363-373
    Published: October 25, 2016
    Released: November 24, 2016

    Aim: To clarify the mortality patterns derived from differences in the causes of death and to subsequently promote search activity and prevent the death of missing persons.

    Methods: The Ministry of Health, Labour and Welfare (MHLW) performed a mail survey using a self-administered questionnaire. The families of all 388 deceased dementia patients from among all of the missing persons reports involving dementia patients that were submitted to the police in 2013, and the 10,322 missing persons with dementia (or suspected cases) were the subjects of this survey. The survey was conducted from January 5 to February 2 in 2015. We analyzed the data provided by the MHLW on 61 cases in which the cause of death was recorded; the factors that were related to the differences in the causes of death were examined using a chi-squared test (Fisher's direct method) and a residual analysis. Based on previous studies, we classified the causes of death into three categories: "drowning," "hypothermia," and "others (e.g., traumatic injury, disease progression)."

    Results: When the cause of death was hypothermia, death often occurred between three to four days from the time that the deceased individual went missing. A significantly higher number of patients who died of other causes were found to have died on the day that they went missing. More than 40% of the drowning cases occurred on the day that the deceased individual went missing.

    Conclusion: We identified 3 patterns of mortality: (1) death on the day that the deceased individual went missing due to traumatic injury, disease progression, drowning, and other causes; (2) death due to hypothermia within a few days after the deceased individual went missing; and (3) patterns other than (1) and (2).

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  • Hiroaki Nishioka, Hidenori Arai
    2016 Volume 53 Issue 4 Pages 374-378
    Published: October 25, 2016
    Released: November 24, 2016

    Objective: To understand the attitude of Japanese individuals toward end-of-life care.

    Subjects and Methods: The present study was conducted among the individuals who participated in a public seminar and completed a questionnaire related to end-of-life care. We analyzed their responses. One hundred seventy-six participants (mean age: 64.7 years) answered the questionnaires, which asked whether they were familiar with the concept of a living will, who should decide their end-of-life care planning, what kind of nutritional support they would prefer to receive at the end-of-life, and what kind of medical treatments they were unwilling to receive. The answers were compared between the two age groups: those who were ≥75 years of age and those who were <75 years of age.

    Results: A total of 49% were aware of the concept of a living will and 8% had actually written a living will. The difference between the two groups was not statistically significant. Most of the respondents (76% of the respondents who were <75 years of age and 63% of the respondents who were ≥75 years of age) thought that they should be able to decide on their end-of-life care planning themselves; however, more of the respondents who were ≥75 years of age wanted to depend on their primary care physician for the decision. The proportion of respondents who wished to maintain only oral intake until the end of their life was 54%; there was no significant difference between the two groups. Among the subjects who were ≥75 years of age, a smaller number of respondents indicated a medical treatment that they were unwilling to receive.

    Conclusion: In the present study, most of the late-elderly respondents indicated that they preferred to decide on their own end-of-life care planning by themselves, as was seen in younger respondents.

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  • Mayumi Okuyama, Masumi Nishida
    2016 Volume 53 Issue 4 Pages 379-386
    Published: October 25, 2016
    Released: November 24, 2016

    Purpose: The aim of the present study was to examine the association between impending dehydration among elderly people in nursing homes and physical signs, including the axillary skin temperature, humidity, intraoral moisture content, and salivary components.

    Methods: The study included 78 elderly individuals who required long-term care in a nursing home (11 men and 67 women; average age, 86.6±7.3 years). The elderly subjects were classified in two groups according to their serum osmolality levels: those with levels between the upper limit reference value (292 mOsm/kg H2O) and the diagnostic reference value of dehydration (300 mOsm/kg H2O) were classified into the boundary zone group and those with levels of <292 mOsm/kg H2O were classified into the normal range group. The following parameters were measured: basic attributes (age, gender and level of care required), body mass index, diet, daily fluid intake per kilogram of body weight, physiological indicators (blood pressure, pulse rate, body temperature, axillary skin temperature, humidity, total body water, body water rate, internal liquid rate, external solution rate, blood components, intraoral water amount, and salivary components), and the indoor environment (room temperature and humidity). We then performed a statistical analysis to compare the boundary zone group with the normal range group. After adjusting for age and the daily fluid intake per kilogram of body weight (<25 ml/≥25 ml), we performed a logistic regression analysis (the boundary zone group was used as an independent variable) for variables that had significance levels of <0.05 (except for blood components).

    Results: The univariate analysis revealed significant differences in the following parameters: the serum sodium, chloride, and creatinine levels; the blood sugar level; the urea nitrogen/creatinine ratio; the axillary skin temperature; and room humidity. Only the axillary skin temperature showed a significant association in the final model of the logistic regression analysis (odds ratio, 3.664; 95% confidence interval, 1.101-12.197; p = 0.034).

    Conclusion: As the axillary skin temperature increased by 1°C, there was a 3.67-fold risk of being classified into the boundary zone group instead of the normal range group. Thus, the axillary skin temperature was associated with impending dehydration.

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  • Satsuki Komai, Yutaka Watanabe, Yoshinori Fujiwara, Hunkyung Kim, Ayak ...
    2016 Volume 53 Issue 4 Pages 387-395
    Published: October 25, 2016
    Released: November 24, 2016

    Aim: To investigate the association between nutritional evaluation indices (body mass index, albumin, and weight loss) and sarcopenia severity among community-dwelling elderly people in Japan.

    Methods: The subjects consisted of 758 community-dwelling elderly people ≥65 years of age, categorized into two groups by based on Operation of long life medical care system (medical care system for elderly in the latter stage of life), the cut-off value for age used was 75. The outcome measures were basic characteristics, anthropometric measures, physical function, and blood biochemistry (five assessments). The appendicular skeletal muscle mass was calculated via a bioelectrical impedance analysis. The subjects were categorized into three groups by the body mass index (BMI) [BMI 3 group]. The cut-off value for albumin used was 3.8 g/dL [A1b 2 group]. Weight loss was assessed using item 11 on the Kihon check list: "Have you experienced more than 2-3 kg weight loss over the past 6 months? Yes=1, No=0." [weight loss 2 group]. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People definition, using the Asian Working Group for Sarcopenia cut-off values. All subjects were then categorized into four groups based on their sarcopenia status: non-sarcopenic (non-), pre-sarcopenic (pre-), sarcopenic (sarco-), or severely sarcopenic (severe-) [sarco4 group].

    Results: The prevalence of sarcopenia and severe sarcopenia in men was 5.6% (n=18) and 1.2% (n=4), respectively, and in women was 7.8% (n=34) and 1.6% (n=7), respectively. The analysis showed that, among the people (>75 years of age) with normal BMI (18.5-25.0), 10.4%-15.6% were in the Sarco group. Further, among women over 75 years of age with BMI >25.0, 5.7% (n=2) were in the Sarco group. There was a significant association between weight loss and sarcopenia severity in older men. No significant association between albumin levels and sarcopenia severity was observed. 80.0% of weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL.

    Conclusion: Sarcopenia and severe sarcopenia were prevalent among those with normal BMI, and particularly among obese women over 75 years of age. Weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL. Our findings indicate that the nutritional evaluation indices, including BMI, albumin, and weight loss, were insufficient in screening for malnutrition and sarcopenia among the elderly.

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  • Kosuke Okada, Yumiko Yamaguch, Nanao Kamada, Masahiro Okada, Shigeko K ...
    2016 Volume 53 Issue 4 Pages 396-403
    Published: October 25, 2016
    Released: November 24, 2016

    Aim: As part of a broader study on polypharmacy among elderly nursing home residents, we examined the impact of reducing or discontinuing the prescription of proton pump inhibitors and other anti-ulcer drugs.

    Methods: We employed a strategy of reducing and discontinuing the prescription of drugs to 160 elderly residents of the Hiroshima Atomic Bomb survivors nursing home, Kandayama Yasuragien. The residents had entered the home between April 2012 and November 2015. As part of this study into anti-ulcer drugs, we also measured the concentrations of Helicobacter pylori antigen in stool specimens, and the serum concentrations of H pylori antibodies and pepsinogen I and II.

    Results: The proportions of residents who were taking more than six drugs on April 2012, August 2014 and November 2015 were 55.2%, 49.0% and 43.0%, respectively. At the same times, the proportions of residents who were taking anti-ulcer drugs were 50.0%, 49.0% and 6.0%, respectively. The presence of H pylori antigen and antibodies, and serum pepsinogen concentrations, did not influence the decisions to continue or discontinue anti-ulcer drugs.

    Conclusions: We have already reported that reduction of diuretics reduces the incidence of falls and fall-related fractures in our residents, and have demonstrated the benefits of discontinuing folic acid and drugs that are given to control hyperkalemia. In the present study, we found that many anti-ulcer drugs were also of low necessity to elderly care home residents. It is essential to examine the clinical benefits of addressing polypharmacy in elderly individuals. In the future, we intend to focus on reducing hypnotics, laxatives and other drugs.

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  • Keizo Sakai, Yasuhiko Masuda, Kunio Miyanishi
    2016 Volume 53 Issue 4 Pages 404-411
    Published: October 25, 2016
    Released: November 24, 2016

    Aim: The aim of the present study is to identify the factors associated with the prognosis of advanced dementia patients who are newly admitted to a geriatric health services facility.

    Methods: This retrospective cohort study used data that were obtained on admission in the care-assessment of long-term care facility patients. The 177 participants with advanced dementia were admitted to our facility between 2006 and 2013. The association between the factors in the care-assessment and the three-month-mortality rates were examined throughout the year.

    Results: At each of the 3-month time points, the mortarity rates of the patients who had total dependence on oral eating or hypoalbuminemia (<3.5 g/dl by BCG method) were significantly higher in comparison to the patients who had neither of these factors. The mortality rates in the patients with a past history of pneumonia (within 3 months) were significantly associated with both factors. At each time point, the three-month-mortality rates showed a significant decrease in the following patients groups (in order): patients with both total dependence on oral eating and hypoalbuminemia, patients with dependence on oral eating or hypoalbuminemia, patients without these two factors.

    Conclusion: Our results indicate that the factors in the care-assessment. That were associated with the prognosis of patients with advanced dementia on admission may be total dependence on oral eating and hypoalbuminemia. Evaluating the combination of these two factors can be a simple and useful measure to identify advanced dementia patients with a high risk of death who receive palliative care in a geriatric health services facility.

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  • Yuta Hayashi, Shinnosuke Hato, Tatsuyuki Imada, Osamu Kobayashi, Tsuto ...
    2016 Volume 53 Issue 4 Pages 412-418
    Published: October 25, 2016
    Released: November 24, 2016

    Objective: The present study aimed to investigate the effects of the presence or absence of physical therapists (PTs) and occupational therapists (OTs) in an adult day service on the users' gait function, and to generalize the format of an effective service aimed at the preventing the exacerbation of the gait function and at promoting self-reliance in activities and participation.

    Methods: The study population included 830 elderly day service users (mean age, 83.7±6.8 years; male, n=252; female, n=578) in Japan. Their normal gait speed was measured at the baseline and at 1 year. The sex, age, level of nursing care, and number of adult day service users were assessed at the baseline. The subjects were divided into 2 groups: (1) those who used services that employed PTs or OTs (the PTOT group) and (2) those who used services that did not employ PTs or OTs (the control group). We performed a univariate analysis to confirm the absence of differences between the groups in terms of all their baseline variables. Next, we performed a repeated measures analysis of variance using the presence or absence of PT or OT and time as factors. We subsequently performed a univariate analysis to examine the difference in the gait speed of the groups, as well as the differences in the gait speed between the groups at the baseline and at 1 year.

    Results: Although the repeated measures analysis of variance did not show that time had a significant effect on the gait speed, it showed the significant effects of the presence or absence of PTs or OTs as well as the interaction between time and group. Intragroup comparisons showed a significant difference between the gait speed at baseline and that at 1 year in the PTOT group. However, there was also a significant difference in the baseline and 1-year gait speeds of the control group. The intergroup comparisons did not show a significant difference in the gait speed at baseline, but did show a significant difference in the gait speed at 1 year.

    Conclusion: The employment of PTs and OTs in adult day service controlled the exacerbation of the gait function. The gait speed in elderly individuals who require long-term care is associated with the activities of daily living and mortality rates; thus, the results of the present study indicate the need for the employment of rehabilitation specialists in adult day services.

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Case Reports
  • Yasuhisa Iriki, Naoya Oketani, Mitsuru Ohishi
    2016 Volume 53 Issue 4 Pages 419-423
    Published: October 25, 2016
    Released: November 24, 2016

    The patient was an-85-year-old man with hypertension and hyperlipidemia. The patient had a history of faintness on standing. He visited our hospital after experiencing chest oppression and pre-syncope in 2015. Brain magnetic resonance imaging and echocardiography did not detect any structural brain or heart disease. Ischemic heart disease was suspected based on the myocardial scintigraphy findings, but coronary angiography revealed no unusual findings. Holter electrocardiography did not reveal the reason for his symptoms. Because he had experienced 2-second sinus arrest rather than faintness or pre-syncope during the Holter monitoring (not an indication for the implantation of a pacemaker), we implanted a loop recorder to detect the cause of pre-syncope.

    The loop recorder required that he or his family to manually send the telemetry monitoring data, but he and his wife did not understand how to do it. After the loop recorder failed to reveal the cause of his symptoms, he was hospitalized for its extraction. When we manually checked the loop recorder data on the day of hospitalization, sinus arrest of >3 seconds was detected 271 times; the maximum sinus arrest was 4 seconds. Sinus arrest was confirmed to be cause of his symptoms. His symptoms completely disappeared after the implantation of a permanent pacemaker.

    Although faintness is not rare in elderly people, it can be difficult to diagnose. An implantable loop recorder was useful for diagnosing pre-syncope; however, in the present case, it was difficult for the elderly patient and his wife to perform telemetry monitoring.

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  • Makoto Saito, Masanobu Morioka
    2016 Volume 53 Issue 4 Pages 424-430
    Published: October 25, 2016
    Released: November 24, 2016

    We herein report the cases of two elderly patients with acquired hemophilia A (AHA) for whom treatment was difficult.

    An 89-year-old woman (Case 1) was admitted to our department with subcutaneous hemorrhage and melena. Her activated partial thromboplastin time (APTT), factor VIII activity, and factor VIII inhibitor level were 127.7 seconds, 1.0%, and 48 BU/mL, respectively, which was suggestive of AHA. The administration of prednisolone (PSL 0.5 mg/kg) was initiated. After 3 weeks, PSL was combined with cyclophosphamide (CPA 50 mg). Two months after the start of treatment, her factor VIII inhibitor level decreased to 3.4 BU/mL. However, hemorrhagic signs were repeatedly observed during the discontinuation of recombinant activated factor VII (rFVIIa) preparation; bleeding control became insufficient, and pneumonia developed, thus leading to a fatal outcome.

    An 81-year-old woman (Case 2) was admitted to our department with subcutaneous hemorrhage, anemia (Hb: 9.2 g/dL), and a prolonged APTT (78.7 seconds). Her factor VIII activity was reduced to 0.9%, and her factor VIII inhibitor level was markedly increased to 1,364.9 BU/mL, suggesting AHA. Treatment with PSL (0.5 mg/kg) was initiated. After one month, it was combined with CPA (50 mg); however, her hemorrhagic signs were protracted, and her Hb level decreased to 8.0 g/dL. Subsequently, pneumonia occurred. However, weekly rituximab therapy (375 mg/m2) for 4 weeks decreased her factor VIII inhibitor level, leading to the disappearance of the inhibitor at 1 year and 5 months. During this period, there were no episodes requiring the administration of bypassing agents, such as rFVIIa.

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