Aim: Few reports have described the characteristics of hyperglycemic hyperosmolar syndrome (HHS) in the elderly. We investigated the background characteristics and clinical features of 14 elderly patients with HHS.

Methods: HHS was diagnosed based on a blood glucose level of >600 mg/dL and an effective plasma osmolality [2 (Na) + glu/18] of >320 mOsm/kg. For 14 cases of HHS, we investigated the medical and social backgrounds of the patients, their clinical findings, and the outcomes.

Results: The mean patient age was 83 years, and the mean body mass index was 17.8 kg/m². Half had a history of either cerebral infarction or hip fracture. The mean duration of diabetes was 14 years, but 4 diabetes cases were newly diagnosed. There was a high prevalence of acute infection (79%) in HHS patients, especially urinary tract infection and pneumonia, with a seasonal peak in winter. Patients who had been treated with steroids, tube feeding, or both numbered 1, 2, and 1, respectively. Most HHS patients had a history of dementia. More than half of such patients were living alone or only with their spouse, and their activities of daily living showed marked deterioration. The mean blood glucose level, HbA1c, effective serum osmolality, and pH were 881 mg/dL, 10.3%, 353 mOsm/kg, and 7.39, respectively. One patient died during hospitalization, and 9 were discharged to nursing homes or other hospitals. The mean length of hospitalization was 55 days. In most cases, the insulin secretion capacity was preserved, and 9 patients were treatable with oral hypoglycemic agents alone.

Conclusions: Many cases of HHS in the elderly are associated with infection, a shortage of social support, cognitive impairment, or ADL decline. Although the survival rate in our series was high, the functional prognosis was impaired.

Aim: CONUT, a tool for "CONtrolling NUTritional status" assesses the nutritional status of a subject by taking into account their serum albumin level, total cholesterol level and total lymphocyte count. Elderly undernourished inpatients admitted to the internal medical department were divided into two groups, those who left the hospital and those who died in the hospital. The goal of this study was to analyze whether or not the CONUT score, serum albumin level, total cholesterol level and total lymphocyte count could predict the survival prognosis of elderly undernourished inpatients and to show the ratio of patients discharged with artificial hydration and nutrition (AHN).

Methods: We divided elderly undernourished inpatients into two groups, those who left the hospital (229 patients) and those who died in the hospital (363 patients), and examined the serum albumin level, total cholesterol level and total lymphocyte count within 10 days before discharge or death. Based on the degree of undernutrition as determined by CONUT, we further classified the patients 4-into four levels of nutrition status, normal, light undernutrition, moderate undernutrition and severe undernutrition. In addition, based on the serum albumin level, total cholesterol level and total lymphocyte count, the patients were also classified 4-into four levels of nutrition status, and we calculated the ratio of AHN patients in the discharged group.

Results: On comparing the discharge and death groups according to the degree of undernutrition, serum albumin level, total cholesterol level and total lymphocyte count, significant differences were found between the groups of all nutrition statuses except moderate undernutrition. Furthermore, the patients with moderate undernutrition status demonstrated no statistically significant difference in both groups, except the serum albumin level. Among the discharged patients, the ratio of AHN was 37.0% in those with a normal nutrition status and more than 50% in the patients with light to severe undernutrition.

Conclusion: We calculated and scored the serum albumin level, total cholesterol level, total lymphocyte count and the degree of undernutrition according to CONUT in elderly undernourished inpatients admitted to the internal medical department of an emergency hospital.

We then divided the patients into groups, based on death or discharge from the hospital as well as nutrition status, normal, light undernutrition, moderate undernutrition and severe undernutrition. Therefore, comparing the groups based on their death or discharge, their nutrition status was found to be helpful for predicting the prognosis.

Purpose: This study was performed to determine the effects of expiratory muscle strength training (EMST) on the oral and respiratory functions of community-dwelling older people.

Methods: Older people using a visiting-rehabilitation center were divided into an intervention group of 31 subjects and a control group of 15 subjects. Those in the intervention group were assigned home training for 8 weeks, which included 5 sets of 5 breaths per day with a 75% load of the maximum expiratory pressure using an EMST device. The outcome indices included (1) oral functions, evaluated by the cumulative time spent swallowing three times and the maximum phonation time (MPT) and (2) respiratory functions, evaluated by the maximum expiratory pressure and maximum inspiratory pressure (MEP/MIP). An independent t-test and paired t-test were used to analyze the data.

Results: The cumulative time spent swallowing three times was lower in the intervention group than in the control group. This difference remained significant even after adjusting for sex, age, and baseline values. The MPT was 2.1 seconds higher than baseline in the intervention group but 0.4 seconds lower than baseline in the control group. An average increase of 5.7 cmH₂O in the PEmax was observed in the intervention group compared with an average decrease of 4.6 cmH₂O in the control group, indicating a significant difference.

Conclusion: These results suggest that EMST improves the oral and respiratory functions of community elderly subjects. This may be explained by the fact that the pathway for swallowing is partially shared with that for phonation, which contributes to a shortened swallowing time by repeated suprahyoid muscle contractions.

Aim: Antiviral treatment for hepatitis C infection in elderly patients has been dramatically improved by direct-acting antivirals (DAAs). DAAs are easy to use as they are administered orally and the treatment periods are shorter. Furthermore, they are associated with fewer adverse effects. In this study, we sought to analyze the efficacy and safety of DAAs in HCV-infected elderly patients.

Method: We analyzed 223 HCV-infected patients who were treated with DAAs in Kanazawa University Hospital, Japan. As of August 31, 2016, all of the patients were observed to have achieved a sustained viral response by the 12th week of treatment (SVR12). We categorized patients into two groups. Group one included 79 patients (average age 75.5 years; range 70-85 years). Group two included 144 patients (average age, 58.1 years; range 27-69 years). Group one included more female patients.

Results: The platelet count of Group one was significantly lower than that of Group two. The FIB-4 index of Group one was significantly higher than that of Group two. Group one included a greater number of patients with a history of hepatocellular carcinoma (HCC) before the administration of DAAs. The SVR12 rate and rate of drop-out due to adverse effects did not differ between the two groups to a statistically significant extent. The rate of HCC occurrence after SVR in Group one was higher than that in Group two.

Conclusion: Our study shows that DAAs can be used for older patients and that the antiviral efficacy and safety are similar to the efficacy and safety in younger patients.

Aim: In the present study, we defined the state of pre-dehydration (PD) as the suspected loss of body fluids, not accompanied by subjective symptoms (serum osmotic pressure: 292-300 mOsm/kg・H₂O). The goal of this study was to develop a non-invasive PD check sheet for independent home care for the elderly.

Methods: We evaluated the serum osmotic pressure of 222 independent community dwelling elderly individuals who were >65 years of age. We then determined the association between the serum osmotic pressure and various dehydration-related diagnostic factors that we identified in a previous study. We performed a logistic regression analysis to determine the risk factors for dehydration and allotted scores based on the odds ratio. We developed a non-invasive PD check sheet consisting of items with high scores and categorized the risks based on the positive predictive value of the total score of the applied items.

Results: PD was confirmed in 46 subjects (20.7%) based on their serum osmotic pressure. We developed a PD assessment sheet which consisted of 6 items, (1) Dislike rehydrating before sleeping, as it induces the need to use the toilet (3 points), (2) Using diuretics (8 points), (3) Casual blood sugar ≥126 mg/dl (9 points), (4) Age ≥85 years (3 points), (5) Male sex (4 points), (6) Body weight ≥60 kg (3 points). Patients with a score of >13 points on this sheet were considered to have a high risk of PD (maximum score: 30 points) (positive predictive value, 72%; negative predictive value, 85.6%; P<0.0001).

Conclusion: In the present study, we found that 20.7% of elderly subjects had PD. Based on these data, we developed an effective noninvasive tool for detecting PD among independent community dwelling elderly.

Purpose: The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly).

Methods: Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores.

Results: The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD.

Conclusion: When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

Aim: The objective of this study was to assess the burdens of anticholinergic and sedative drugs in community-living individuals of 85 years of age or older.

Methods: The Tokyo Oldest Old survey on Total Health (TOOTH) is a cohort study designed to assess the physical, mental, and oral health of the community-living oldest old. We investigated the relationships between the anticholinergic/sedative burden and physical/cognitive outcomes. The drug burden was assessed by the Drug Burden Index (DBI). Relationships between the DBI score and the physical/cognitive outcomes were evaluated by multivariate regression. The age-related changes (baseline to 3-year follow-up) of these outcomes were also investigated.

Results: At baseline, the data of 306 subjects were subjected to a cross-sectional analysis. The Instrumental Activities of Daily Living and Mini Mental State Examination scores were found to be significantly associated with the DBI score. After 3 years, the Activities of Daily Living score was significantly associated with the DBI score in 176 subjects. Changes in these outcome measures were small during the 3-year follow-up period and were not associated with the DBI scores at baseline.

Discussion: DBI in the community-living oldest old were evaluated. Our findings suggest that anticholinergic and sedative drugs may influence the physical and cognitive function in the oldest old. Additional studies should be performed to investigate the relationships between the change of the physical/cognitive functions and the DBI score over a long-term observation period.