Aim: Despite the significant advances in chemotherapy, the prognosis of unresectable or recurrent gastric cancer is still very poor. Given that older adults are likely to have a number of concomitant diseases and an impaired major organ function, cancer chemotherapy in elderly patients requires particular caution. We examined what factors are associated with the overall survival of gastric cancer patients undergoing chemotherapy.
Methods: A retrospective chart review of gastric cancer patients receiving oral fluoropyrimidines (N=130) was performed at Nagoya Memorial Hospital over 9 years. The overall survival was calculated from the beginning of chemotherapy until death or the most recent date of follow-up. The Kaplan-Meier method was used to plot survival curves, which were compared using the log-rank test. A multivariate analysis was performed using stepwise Cox proportional hazards models. A comprehensive geriatric assessment was conducted for the elderly patients. The chart review was approved by the ethics committee of Nagoya Memorial Hospital.
Results: The objective response rate and overall survival did not differ markedly between the patients < 75 years (N=64) and those ≥ 75 years of age (N=28). The addition of lentinan significantly prolonged the survival of the stage 4 gastric cancer patients. In a multivariate analysis of those ≥ 75 years of age, the only independent prognostic factor for the survival was the functional capacity, as measured by the TMIG Index of Competence.
Conclusions: This comprehensive geriatric assessment was useful for predicting the longevity of patients with stage 4 gastric cancer ≥ 75 years of age.
Aim: To investigate the clinical course of patients with elderly-onset rheumatoid arthritis (RA).
Methods: We compared the characteristics, and clinical course of 55 patients who developed RA at over 80 years of age (elderly-onset [EO] group) with 119 patients who developed RA at 40-59 years of age (non-elderly onset [non-EO] group). We also investigated the characteristics and clinical course of 19 patients who developed RA at over 80 and who received biological disease-modifying anti-rheumatic drugs (bDMARDs).
Results: The mean DAS28-ESR (DAS) and HAQ-DI (HAQ) of the EO were significantly higher in comparison to the non-EO group (4.91±1.31 vs 4.41±1.47, p=0.043, 1.2±0.9 vs 0.5±0.6, p<0.01). For the first treatment, 87.3% in the EO group received conventional synthetic DMARDs (csDMARDs), none received MTX. The rate of prednisolone (PSL) administration in the EO group was significantly higher than the non-EO group (56.4% vs 30.3%, p<0.01). The DAS and HAQ were significantly decreased in both groups, while the HAQ of the EO group was higher than the non-EO group. The decrease in DAS and HAQ of the PSL users was significantly greater than the non-PSL users (ΔDAS: 2.55±1.83 vs 1.83±1.23, p<0.01, ΔHAQ: 0.9±1.0 vs 0.3±0.6, p=0.027). Among the 19 patients with bDMARDs, the mean DAS and HAQ at baseline were significantly decreased 6 months later.
Conclusion: Early use of csDMARDs and PSL was effective for functional disability of elderly-onset RA; however, some of them required bDMARDs. Further study should be performed to investigate the effectiveness of the early induction of MTX and bDMARDs.
Aim: To investigate the clinical conditions of convalescent rehabilitation for stroke patients.
Methods: We classified 147 stroke patients into 4 groups according to their discharge destination as follows: A, home; B, institution; C, geriatric health services facility; D, nursing home-type unit. A comparative examination was carried out for the following items: age, period from the onset to hospitalization (POH), NIHSS scores (NS), length of stay (LS), quantity of rehabilitation (QR), stroke types, FIM scores at admission and discharge (FS), and motor FIM gains (MFG) and efficiency scores (MFE). In addition, we performed a sub-analysis of 107 elderly patients (≥65) among the 147 total subjects.
Results: Group A was the youngest on average. The mean values of POH, NS, and LS increased in order from group A to group D. The average QR was the smallest in group A and the largest in group C. There was no marked difference in stroke types among the four groups. The FS revealed a gradual decline from group A to group D. The MFG in groups B and C was higher than in groups A and D. In the elderly patients, the MFG decreased in groups B and C, and a reduction of the MFE was demonstrated in group C.
Conclusion: A relationship was noted between the ADL levels at admission and discharge. It was suggested that MFG and MFE were not predictive factors for the outcome and that elderly patients with a low ADL level tended to have a reduced effect of rehabilitation.
Aim: The Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee reported 'Glycemic Targets for Elderly Patients with Diabetes' in 2016. Based on this recommendation, we aimed to clarify 1) the achievement status of glycemic targets in the elderly and 2) the presence of hypoglycemia in real life among elderly individuals with an HbA1c below the lower limit.
Subjects and Methods: [Analysis I] In 326 elderly with diabetes ≥65 years of age visiting the outpatient department specializing in diabetes, the proportions of patients with HbA1c values below the lower limit and the use of drugs potentially associated with severe hypoglycemia (e.g. insulin formulations, sulfonylureas, glinides) were investigated. [Analysis II] Of the patients with HbA1c values below the lower limit, seven were tested for hypoglycemia in real life using a continuous glucose monitoring system (CGM).
Results: [Analysis I] Among the 326 subjects, 235 (72.1%) were using drugs potentially associated with severe hypoglycemia, and 63 (19.3%) had an HbA1c value below the lower limit. [Analysis II] In the seven patients examined using CGM, hypoglycemia was detected in five, all of whom were unaware.
Conclusions: A considerable number of elderly patients were taking drugs associated with hypoglycemic risks and had an HbA1c value below the lower limit, some of whom actually had hypoglycemia as detected by CGM. Using tools such as CGM, preventive measures against hypoglycemia should be taken.
Aim: We aimed to investigate subjective quality of life (QOL) and related factors in elderly people with a high functional capacity using daycare centers who require support and mild long-term care.
Methods: We collected data on the basic attributes, social background (hobbies, JST-Index of Competence), and subjective QOL (Revision PGC Morale Scale) through interviews with 238 people ≥65 years of age using daycare centers who required support and long-term care (level 1, 2). We conducted a t-test and χ2 test to compare male and female participants and a multiple regression analysis using sex, age, hobbies, eating together, and the JST-Index of Competence (using new devices, collecting information, living management, social participation) as independent variables to predict the subjective QOL (dependent variable).
Results: We observed no marked differences in the subjective QOL between men and women, but a significant difference was noted between sexes in the number of people who ate with others. We conducted a multiple regression analysis using the above independent variables with the body mass index and level of care as explanatory variables and subjective QOL as a dependent variable to predict the value of the dependent variable. The subjective QOL tended to be higher in participants with high scores for social participation (standard partial regression coefficient 0.26, 95% confidence interval 0.14-0.38), living management (0.23, 0.09-0.37), and hobbies (0.20, 0.09-0.32).
Conclusions: In elderly subjects with a high functional capacity, living management, social participation, and presence of hobbies were found to be associated with a decreased QOL.