Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
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Amako Award
Review Articles
  • [in Japanese], [in Japanese], [in Japanese]
    2019 Volume 56 Issue 4 Pages 417-426
    Published: October 25, 2019
    Released: November 22, 2019
  • Hajime M. Koyano
    2019 Volume 56 Issue 4 Pages 427-433
    Published: October 25, 2019
    Released: November 22, 2019

    As a result of the rapid aging of society, the number of elderly diabetic patients with a decreased self-management ability in Japan is increasing. At present, family members primarily perform injection at home and measure the blood glucose levels for patients who require these procedures. However, as aging progresses and the birthrate further declines, it is expected that it will become difficult for such patients to receive assistance from their family members. Therefore, a discussion at the national level and development of urgent measures are required. In the future, the expanded involvement of those with medical qualifications and augmented multi-occupational collaboration-specifically, increasing the frequency of visiting nursing services, facilitating injections at home by pharmacists and making the most of "community-based integrated care systems", without major changes in the current legislation, will be foremost in reinforcing or taking the place of family members performing injections at home and measuring blood glucose levels. If cost is given the highest priority, injection at home and measurement of blood glucose levels by non-medical and non-nursing care workers seems to be the best option. However, careful deliberation is required.

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Perspective of Aging Science
Clinical Practices of Geriatrics
Original Articles
  • Yoko Higami, Mai Kabayama, Eriko Kojiya, Ga Ko, Mariko Yamamoto, Masak ...
    2019 Volume 56 Issue 4 Pages 468-477
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: The present study investigated the behavioral and psychological symptoms of dementia (BPSD) and pharmacological therapy among elderly people with dementia who received home medical treatment.

    Methods: This study was part of the Osaka Home Care Registry study (OHCARE-study). Participants were >65 years old with dementia. Demographic and medical data, BPSD, and the LTCI [long-term care insurance] care-need level were collected. A multiple logistic regression analysis was performed in order to clarify the factors associated with BPSD.

    Results: Among 110 subjects (82.0±11.3 years old), 64.6% had a diagnosis of dementia, most commonly Alzheimer's dementia. Aside from home medical treatment, 58.1% had a nurse visit, 48.1% received home care, and 40.0% used a day service. The prevalence of BPSD was 53.0%. Those with BPSD most frequently had an LTCI care-need level of 3, and the prevalence of BPSD declined as the level increased after 3. Psychotropic drugs were prescribed in 61.5% of those with BPSD. Antipsychotic drugs were used significantly more frequently in those with nursing care resistance, assault and delusions than in others (all, p <0.005). A multivariate analysis showed that the positive predictor of BPSD was antipsychotic drug use, while negative predictors were an LTCI care-need level and the use of visiting rehabilitation.

    Conclusion: The BPSD in elderly dementia patients receiving home medical treatment were clarified. The LTCI care-need level is an independent predictor of BPSD after adjusting for the activities of daily life. Further longitudinal investigations including the BPSD severity and frequency are needed.

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  • Rumiko Okamoto, Kazutaka Adachi, Katsuyoshi Mizukami
    2019 Volume 56 Issue 4 Pages 478-486
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: Facial expressions are often impaired in patients with Parkinson's disease (PD). Few studies have examined the effects of head and neck rehabilitation in patients with PD using a facial expression analysis. In the present study, to further elucidate the effects of facial rehabilitation exercise in patients with PD, a three-dimensional facial expression analysis with FaceReader™ and surface electromyography (EMG) were performed in order to assess the facial expressions and muscle activities, respectively. The effects of such exercises on the mood and mental health were also evaluated.

    Method: Twenty-one patients with PD (63.3±12.1 years) participated in the present study and were randomly assigned to an intervention group and non-intervention group. Facial rehabilitation exercise was performed for 60 minutes once a week for 12 weeks in the intervention group. GHQ-12, the facial expression analysis with FaceReader™, surface EMG, and the VAS scale for mood changes were used to evaluate the effects of the program. The results from both groups were compared.

    Results: The results from eight patients in the intervention group and five in the non-intervention group were analyzed. FaceReader™ revealed a higher "Happy" index and lower "Sad" index in the intervention group than in the non-intervention group, and a significant interaction "Happy" index by an analysis of variance was noted between the two groups. EMG also showed increases in the activity of facial muscles in the intervention group. The subjects' mood improved after each facial rehabilitation exercise session.

    Conclusion: The results of the present study suggest that the facial rehabilitation exercise affected the mood, facial expression, and facial muscle activities in patients with PD and indicate that the expression analysis with the FaceReader™ and surface EMG are useful for evaluating the effects of facial rehabilitation exercise.

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  • Mizue Suzuki, Youko Matsui, Etuko Ootaka, Chieko Ichikawa, Kunihiko Ab ...
    2019 Volume 56 Issue 4 Pages 487-497
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: This study aimed to clarify the effects of a fall prevention intervention that focused on the characteristics of falls among elderly patients with dementia and was based on person-centered care in geriatric facilities on care staff.

    Methods: This study was conducted between May 2016 and January 2017, and the subjects were classified into two groups: the intervention group, consisting of members who had participated in a three-month education training program, and the control group, consisting of members who provided the usual care. The study period was nine months divided as follows: training period (three months), fall prevention practice (three months), and follow-up period (three months). The quality of care was measured using the Nursing Quality Indicator for Preventing Falls (NQIPFD), and the assessment scale of health care professionals' recognition of the successful Interdisciplinary Team Approach in Health Care Facilities for the Elderly was also used. In total, the care staff members were evaluated four times: once to obtain baseline values before training, and again after the training period, after the fall prevention practice, and after the follow-up period. The results were analyzed using an analysis of variance (fixed factors = group and time, random factor = subjects, and covariance = years of experience working at the geriatric facility and type of job).

    Results: There were 50 care staff subjects in the intervention group and 69 people in the control group. The results of the analysis of variance indicated that there was a significant difference in the NQIPFD between baseline 68.60 (±9.09) and follow-up 70.02 (±9.88) in the intervention group. With regard to the differences by intervention, the effect size of the dementia knowledge scale scores was 0.243 higher than the others, which was significant (p<0.01).

    Conclusions: The results showed that the participation of care staff in a fall intervention program to support elderly patients with dementia based on person-centered care significantly improved the NQIPFD and other measured factors. These findings suggest that the program fostered positive effects among the care staff.

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  • Kazuya Ooi
    2019 Volume 56 Issue 4 Pages 498-503
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: In order to ensure that patients use medicines and dressings properly, the pharmacist must understand a patient's medication history, symptoms, and test results. This information helps pharmacists to apply their technical knowledge to the prescription of drugs. In Japan, more than a quarter of the population is over 65 years of age; the country is heading toward a "super-aged" society. It is common for older patients to have more than one disease. Improved healthcare has resulted in easier access to medications. Consequently, the problem of polypharmacy has emerged. In this study, we examined the effect of a pharmacist-led intervention on polypharmacy.

    Methods: The study subjects were patients of 65 years of age or older who had visited a pharmacist for a consultation between September 2019 and November 2019. The pharmaceutical consultation content and number of proposals were recorded, and the percentage of prescriptions modified and the percentage of patients who experienced changes in symptoms at 4 weeks after the consultation were calculated.

    Results: Three hundred sixty-one patients underwent pharmaceutical consultation. Most patients were 80 years of age or older. For 349 patients (96.7%), the consultation resulted in a prescription change. Before the consultation, the average number of drugs was 7.2. After intervention, this decreased by 1.2 to an average of 6.0 drugs. In addition, polypharmacy with≥6 drugs dropped sharply from 67.3% of patients before the consultation to 53.7% of patients after the consultation. The full pharmacotherapy guidelines in 2015 suggested that 33.7% of drugs require particularly careful dosing. Changes in symptoms at 4 weeks after the pharmacist's consultation occurred in 84.5% of patients.

    Conclusion: The results of this study suggest that pharmacists should review the prescriptions of elderly patients. We conducted an active intervention for cases of polypharmacy and observed a decrease in the number of drugs following prescription consultation. Furthermore, a reduction in medicines was suggested on the basis of physical checks and test values. Blood test results allow pharmacists to improve the quality of their advice.

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  • Asahi Tanaka, Yasumichi Arai, Takumi Hirata, Yukiko Abe, Yuko Oguma, H ...
    2019 Volume 56 Issue 4 Pages 504-515
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: To assess the burdens of polypharmacy and the drug burden index in community-dwelling elder people.

    Methods: The survey was conducted on 396 participants who participated in The Kawasaki Wellbeing Project from March to December 2017. We investigated the associations between the drug burden and the physical/cognitive/mental outcomes. The drug burden was determined by calculating the number of medications and the drug burden index (DBI) based on the use of anticholinergic and sedative drugs. A multivariate regression analysis was conducted for the outcome measures ADL, IADL, MMSE, J-CHS, and EQ5D5L after adjusting for the sex, age, number of diseases, education level, smoking history, and alcohol history.

    Results: A total of 389 subjects were analyzed, the mean age of the population was 86 years old, and 187 people (48%) were male. Polypharmacy was reported in 243 people (62%), and DBI exposure was reported for 142 people (36.5%). We found that this population was physically healthy, with a median ADL of 100, and had high quality of life, with a median EQ5D5L of 0.895. Polypharmacy was found to be related to the J-CHS (β: 0.04) and EQ5D5L (−0.01). The DBI was also related to the EQ5D5L (−0.04).

    Conclusion: These results showed that even though this population was healthier than the general Japanese elderly population, the drug burden of polypharmacy and high dosages of anticholinergic/sedative drugs exerted significant negative effects on frailty and the quality of life. Additional research should be conducted to investigate the long-term effects of polypharmacy and anticholinergic/sedative drugs on elderly people.

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  • Hitomi Yamamoto, Kuniko Makigami, Naoki Fukumura, Masao Ushiyama
    2019 Volume 56 Issue 4 Pages 516-524
    Published: October 25, 2019
    Released: November 22, 2019

    Aim: To evaluate the effect of intensive and comprehensive dysphagia rehabilitation on the prevention of hospital-acquired pneumonia.

    Patients and Methods: In this non-randomized retrospective observational study, we compared two patient groups in a convalescent rehabilitation ward. One included patients after the introduction of an intensive and comprehensive rehabilitative program including various measures, such as nutritional support and respiratory physical therapy (intensive program group); the other included patients who had been admitted before the introduction of the above measures (control group). The primary endpoint was the onset of pneumonia during the hospital stay. A multivariate logistic regression analysis was used to determine the adjusted odds ratio for the relationship between dysphagia rehabilitation and pneumonia onset.

    Results: In the intensive program group, 5 of 291 patients were diagnosed with pneumonia, while in the control group, 13 of 460 were diagnosed with pneumonia. The adjusted odds ratio for intensive and comprehensive dysphagia rehabilitation with respect to hospital-acquired pneumonia was 0.326 (95% confidence interval: 0.112-0.949, p=0.040).

    Conclusion: This intensive and comprehensive dysphagia rehabilitation program was thought to be effective in preventing hospital-acquired pneumonia in a convalescent rehabilitation ward.

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Case Report
  • Shoya Matsumoto, Keiji Nishihara, Masaki Hasegawa, Shosuke Satake, Hid ...
    2019 Volume 56 Issue 4 Pages 525-531
    Published: October 25, 2019
    Released: November 22, 2019

    An 84-year-old woman who had diabetes mellitus and atrial fibrillation presented to our hospital with appetite loss and difficulty in standing up. Her cervical, axillary, and mediastinal lymph nodes were swollen. At first, malignant lymphoma was suspected, but positron emission tomography-computed tomography and cervical lymph node biopsy did not support this diagnosis. She was admitted to our hospital 41 days after the first consultation because of appetite loss and fever. We suspected a disorder related to Epstein-Barr virus infection because Epstein-Barr virus-encoded small RNAs were found in the lymph node. She was diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) based on the diagnostic criteria of the Japanese Society for Pediatric Infectious Diseases. Her symptoms, including appetite loss and fever, were alleviated after the administration of prednisolone (20 mg per day). She was discharged 90 days after admission. At two weeks after discharge, she was readmitted for respiratory failure, and died five days after readmission.

    To the best of our knowledge there are no previous reports of EBV-HLH in patients over 80 years of age, and the optimal treatment strategy is unknown. This case suggested that prednisolone may alleviate the symptoms of EBV-HLH. When a patient presents with swollen lymph nodes, clinicians should keep the possibility of EBV-HLH in mind.

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