Aim: Awareness reform aims to enable survival in an aging society, and ultimately, improve healthcare. An ideal way to achieve this is by implementing Advance directive (Ad) and Advance Care Planning (ACP), which do not usually include postmortem events. This study aims to create opportunities for Ad and ACP to include the postmortem period as a trigger for this awareness reform.
Methods: We conducted an Ad/ACP enlightenment lecture, and a questionnaire survey pre- and post-lecture for the elderly in old New Town, which is known for its aging society. The questionnaire comprised 38 multiple-choice questions covering 6 themes assuming an advanced state of dementia.
Results: There were 35 participants (7 men and 22 women) aged 40-89 years. Several people left during the lecture, making it difficult to capture the precise transformation effect with regard to changing of mind. However, the effect of enlightenment was identified as a result of the consciousness survey. A statistically significant change in consciousness occurred in response to social contribution after death. Furthermore, notably more people wanted emergency transportation compared to those wanting resuscitation and extension of life.
Conclusions: The medical treatment desired might vary over time. Even the desire for life extension may differ significantly among individuals. This survey indicated a divergent view between the general public and medical staff, regarding a series of medical actions. We must persistently promote opportunities for enlightenment in cooperation with the general public (i.e., the communities and families we serve).
Aim: In Japan, the Kihon checklist, which a useful part of the Comprehensive Geriatric Assessment (CGA), is performed using questionnaire. On the other hand, specific health checkup screens are available for some basic diseases, such as diabetes and dyslipidemia, which can cause stroke, the largest cause of long-term care need. However, to date, no report has compared CGA and health checkups in older people for their ability to predict healthy life expectancy; therefore, this study was undertaken to do that.
Methods: Data from the Japan Gerontological Evaluation Study (JAGES) 2010, a self-administered mail survey of independent people aged 65 years or older, were used. A total of 9,756 participants in six cities responded to the questionnaire, underwent a health check, and were followed up for 3 years.
Cox proportional hazards models were used to estimate hazard ratios (HR) for the eventual need for long-term care level 2 or more or death, adjusting for sex, age, drinking or smoking habits, educational years, and equivalent income. Explanatory variables in the Kihon checklist included seven risks, namely, general frailty, functional disability, malnutrition, oral dysfunction, seclusion, cognitive impairment, and depression, and in specific health checkups, 15 required items including metabolic syndrome.
Results: The incident rate of long-term care level 2 or more or death was 19.4/1,000 person-years. All risks in the Kihon checklist, excluding oral dysfunction, were significant (range of HRs: 1.44-3.63). Six items in the specific health checkups (urine protein, low BMI, AST, HDL, FPG, and HbA1c) were significant (range of HRs: 1.37-2.07). Metabolic syndrome was not significant (HR: 1.05).
Conclusions: Therefore, CGA performed using questionnaire predicts healthy life expectancy better than a health checkup based on a blood test.
Aim: In Japan, because adult children are expected to perform a key role in decision-making on end-of-life care for older adults, conversing with parents on their wished-for end-of-life care can help these children to become prepared for this filial responsibility. Our aim in this study was to explore how likely Japanese adult children were to discuss end-of-life care with their parents as well as correlates of such discussions.
Methods: We conducted an online survey using a sample of 1,590 adult children with at least one living parent aged 65 or older. We analyzed data from 1,010 children who responded during three consecutive days in October, 2015.
Results: A small portion of our participants (22.8%) had discussed end-of-life care with their parents. Logistic regression analysis revealed that such discussions were likely in son-mother (Odds Ratio 〈OR〉 = 3.01) and daughter-mother (OR = 3.15) dyads compared with son-father ones as the reference. Occurrence of such discussions was also associated with having older parents (OR = 1.03), parental experience of severe diseases (OR = 1.47), parent-child coresiding (OR = 2.08), a higher level of perceived necessity for (OR = 1.36) and a lower level of emotional avoidance of (OR = 0.68) end-of-life communication.
Conclusion: Generally, adult children rarely discuss end-of-life care with their aging parents, suggesting the need to promote such familial communication while considering both children's and parents' circumstances.
Purpose: The purpose of this study was to develop the Life-trouble Scale for elderly people with dementia to concretely determine their life troubles in geriatric facilities.
Results: The subjects of this study were elderly people living in geriatric health services facilities whose degree of life independence was evaluated as ≥II, who had a diagnosis of dementia, and who agreed to participate in this study.
The study population included 191 subjects (male, n=144, 75.4%; female, n=47, 24.6%). The average age was 85.72 (±6.96) years, the mean degree of need for nursing care was 3.73 (±1.22), and the mean MMSE score was 9.11 (±8.80).
Based on the factor analysis of the Life-trouble Scale, the first factor was named, "Basic Life Behavior and Life Trouble with Communication." The second factor was named, "Life Trouble Associated with Irritation and Confusion". The third factor was named, "Trouble with Human Relations Associated with Feelings and Changes in Consciousness". The fourth factor was named, "Life Trouble Associated with Changes in Consciousness and Repeated Behavior". The Cronbach's α of the 4 factors was 0.884, and the NPI and Crichton rating scales were significantly correlated with the 4 factors.
Conclusion: The results showed that the Life-trouble Scale had reliability and validity, and that it was useful for solving problems in geriatric health services facilities.
Aim: In this study, we performed intraoral examinations and dental treatment before umbilical cord blood transplantation for elderly people and investigated the development of oral mucositis after transplantation. The results of this study are reported herein.
Methods: Study period: January 2009 to December 2016. Subjects: 106 patients who requested oral examinations at our department prior to cord blood transplantation. Methods: We examined the following information from charts and nursing records: (1) blood disease; (2) history of dental treatment and the details thereof; (3) the relationship between the average number of days from the initial dental visit until transplantation and the history of dental treatment and the details thereof; (4) the relationship between the occurrence of oral mucositis after transplantation and the details of treatment; and (5) the dates of the occurrence and disappearance of oral mucositis after transplantation, along with a comparison of the levels of granulocytes and platelets between the occurrence date and the disappearance date.
Results: For patients who had undergone "periodontal therapy" and "tooth extraction," the average number of days from the initial dental visit to transplantation was longer than in patients not undergoing "periodontal therapy" and "tooth extraction." The levels of granulocytes and platelets at the onset of oral mucositis after transplant were lower than those at the disappearance of oral mucositis. In particular, the level of granulocytes was significantly decreased.
Conclusion: For transplant patients, a rapid intraoral examination is necessary, and it is important to start and end dental treatment at an early stage.
Aim: Atrial fibrillation (AF), which can lead to cardioembolic stroke, is often not properly diagnosed in hospital outpatient departments or medical clinics. We therefore used a pulse analysis to screen patients for AF, and examined the benefits of using this method in screening.
Methods: We performed screening of the hospital's first-visit and ambulatory patients during the afternoon in 2014 (total number, 50,875; true number, 16,356), mainly targeting patients older than 65 years of age. Among the true number of outpatients, the device was used on 5,013 patients, 8,656 times. We independently developed a pulse analysis software application which analyzed the pulse interval variation. We assessed the accuracy of this analytical method in the detection of AF.
Results: AF was detected in 56 patients, who were considered for or introduced to anticoagulation treatment. In their cases, the method was considered useful for detecting undiagnosed or untreated AF. This figure amounts to 0.34% of all outpatients and 1.1% of the patients who were screened in 2014. The average age was 76.9±7.7 years, 67.9% of the patients had a CHADS2 score of more than 2, half had a history of arrhythmia in the past, and 37.5% were first-visit patients. The sensitivity of the device used was 89.7%.
Conclusions: Using the method described in this study, we detected asymptomatic AF in numerous patients, and demonstrated that this method is potentially useful in screening outpatients for asymptomatic AF.
For elderly people who are difficult to operate, percutaneous transhepatic gallbladder drainage (PTGBD) is conducted instead. In PTGBD, the bile is drained externally and impaired absorption of fat is a concern. Egg yolk lecithin, which is a fat emulsifier, is not easily broken in emulsion even under a low-pH condition, and the emulsified state is stable. Even in bile duct ligation rats, the emulsifier in egg yolk lecithin emulsion is reported to be superior to lipid absorption using other emulsifiers. Emulsification with egg yolk lecithin may possibly contribute to improvement of nutrition during biliary excretion disorders such as external drainage. We report a case of good progress with enteral nutrition with egg yolk lecithin-mixed liquid diet after PTGBD for acute cholecystitis. The patient was an 80-year-old man with a history of myocardial infarction and dementia. He was diagnosed with calculous cholecystitis, and conservative treatment was started. His cholecystitis was exacerbated, and PTGBD was performed on day 12 of the disease. On imaging, the lower extremities of the duodenum were edematous because of the spread of inflammation. Glutamine preparation alone was administered after resuming fasting. A liquid diet containing egg yolk lecithin, 200 ml of K-LEC (1 kcal/ml), was started from day 23, and was administered three times daily. Liquid diet dose was increased to 1,200 kcal/day with added dietary fiber on day 29. The patient's overall condition improved, and transthyretin level and body weight increased. Thereafter, after swallowing training, the patient was switched to oral meal intake from day 37.