Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
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Clinical Practices of Geriatrics
Original Articles
  • Kensei Nakamura
    2020 Volume 57 Issue 1 Pages 45-52
    Published: January 25, 2020
    Released: February 18, 2020

    Aim: To clarify risk factors for aspiration pneumonia and the effects of aspiration pneumonia on the recovery after stroke in elderly stroke patients in a convalescent rehabilitation ward.

    Methods: We conducted a retrospective study of 463 stroke patients with dysphagia who were ≥65 years of age (mean age, 80.2±8.1 years) who were admitted to our convalescent rehabilitation ward. Information was obtained from medical charts. A multivariate analysis was performed to clarify risk factors for aspiration pneumonia and the association between aspiration pneumonia and increased functional oral intake scale and functional independence measure motor scores. For the increase in functional independence measure motor score, values of ≥16 points and ≤15 points were coded as 1 and 0, respectively.

    Results: Aspiration pneumonia developed in 52 patients. The multivariate analysis revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.59-5.95, p<0.001), geriatric nutritional risk index (OR for one unit increase 0.94, 95% CI 0.90-0.97, p<0.001) and tube feeding (OR 3.89, 95% CI 1.71-8.83, p=0.001) on admission were significant predictors of aspiration pneumonia. Aspiration pneumonia was associated with increased functional oral intake scale scores (OR 0.29, 95% CI 0.12-0.66, P=0.003) and increased functional independence measure motor scores (OR 0.23, 95% CI 0.09-0.55, P=0.001).

    Conclusions: Male sex, undernutrition and tube feeding on admission are risk factors for aspiration pneumonia. Aspiration pneumonia is suggested to be associated with recovery of the oral intake of food and activities of daily living.

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  • Setsuko Ueno, Momoko Nakamura, Saori Miyata, Keiko Ueda, Yoshiki Takao ...
    2020 Volume 57 Issue 1 Pages 53-59
    Published: January 25, 2020
    Released: February 18, 2020

    Following the passage of a new traffic law in March 2017, an inquiry survey was performed for 202 patients (men 60.9%, women 39.1%) in a medical center for neurocognitive disorders in Japan. Half of the 108 patients who currently had a driver's license had experienced traffic problems, including nearly crashing accidentally, in the past, but only a few of the men were willing to return their driver's license to the government, regardless of age (<75 and ≥75 years old). They mainly worried about how they would manage daily activities without a car, such as shopping for necessities, visiting the clinic, having the chance to get outside. They also worried about increasing the burden of other family members. In contrast, the other 94 patients who either did not have a driver's license or had already returned them to the government expected only slight issues due to the law, or even felt positive about losing their license. However, roughly half of those 94 patients did not get exchanging benefits (traffic discount card and license record card) on losing licenses probably due to less knowledge about such benefits. The present study revealed various aspects of elderly patients' thoughts concerning their driver's licenses in a local city of Japan.

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  • Tomoko Yano, Mai Kabayama, Kei Kamide
    2020 Volume 57 Issue 1 Pages 60-71
    Published: January 25, 2020
    Released: February 18, 2020

    Objectives: We examined the associations of weight loss and low serum albumin level with death in community-dwelling elderly, as well as related factors by a systematic review with a meta-analysis.

    Methods: We searched MEDLINE, Cochrane Library (CENTRAL), Web of Science, and CHINAL for articles on cohort studies investigating the association of weight loss and low serum albumin with death in community-dwelling elderly and extracted a total of 3,812 published articles. We also investigated the factors associated with this relationship. Relative risk ratios and 95% confidence intervals were cultivated.

    Results: Based on our search for articles related to weight loss, we extracted 1,180 cases and finally analyzed 11 cases. The meta-analysis revealed that the risk ratio (RR) for mortality was 1.69 times higher than that in the weight loss group. Based on our search for articles related to low serum albumin, we extracted 2,632 cases and finally analyzed 10 cases. The mortality RR was 1.92 times higher than that in the maintenance group albumin low level group. Overall, the degree of heterogeneity in the analyzed studies was high. There were some influencing factors influencing the associations; however, the feeding behaviors, swallowing function and food eating patterns were not fully investigated.

    Conclusions: Our meta-analysis of the relevant literature revealed that the RR for mortality was significantly high in community dwelling elderly with weight loss or low serum albumin. Based on these results, the maintenance of body weight and serum albumin would be important for preventing death and serious diseases in the community dwelling elderly.

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  • Takashi Shii, Minpei Kuroda, Noriko Shamoto, Yoshihiro Mimaki
    2020 Volume 57 Issue 1 Pages 72-80
    Published: January 25, 2020
    Released: February 18, 2020

    Aim: Kampo medicines containing Scutellariae Radix (the root of Scutellaria baicalensis Georgi; SR) sometimes cause serious adverse effects, including interstitial pneumonia and liver dysfunction. Baicalin (BL) is the major active component of SR and is presumed to be responsible for the adverse effects. We analyzed the amounts of BL in Kampo medicines to better understand how they can be used safely.

    Methods: We determined the amounts of BL in 28 Kampo decoctions containing SR (recommended daily dose: 1.5-4 g/day) and corresponding Kampo extract products by high-performance liquid chromatography.

    Results: The amounts of BL in the Kampo decoctions were 1.7-4.0-fold higher than those of the corresponding Kampo extract products. Inter-product variations in the amounts of BL in Shosaikoto, Otsujito, Daisaikoto, Saibokuto, Orengedokuto, and Saireito Kampo extracts from various companies were also examined. Significant differences in the amounts of BL were observed for Shosaikoto, Otsujito, Daisaikoto, and Saibokuto extract products (up to 2.6, 1.6, 1.5, and 1.3-fold differences, respectively), whereas no significant differences were observed for Orengedokuto and Saireito extract products.

    Conclusions: Because the Kampo decoctions containing SR that we examined contained 1.7-4.0 times as much BL as the corresponding Kampo extract products, medical doctors and pharmacists should be aware that Kampo decoctions containing SR might cause more severe side effects than corresponding Kampo extract products. Furthermore, we recommend that the amounts of BL and its aglycone, baicalein (BA), in Kampo extract products be made known to practitioners and patients.

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  • Shunji Imanaka, Yasunobu Shibasaki
    2020 Volume 57 Issue 1 Pages 81-88
    Published: January 25, 2020
    Released: February 18, 2020

    Aim: To investigate whether a combination of readily available osteoporosis screening systems, instead of dual energy X-ray absorptiometry (DXA), can aid in the identification of characteristic features of hip fracture in post-menopausal patients undergoing hemodialysis.

    Methods: Forty patients (58-90 years old) who had undergone quantitative ultrasound (QUS) on more than one occasion were included. Heel QUS (conducted yearly for 3 years), digital image processing (DIP), and the fracture risk assessment tool (FRAXR) were used to evaluate bone fragility. The latter two assessments (DIP and FRAXR) were conducted on 25 and 26 of the 40 patients mentioned above respectively, for this study.

    Results: Hip fractures were identified in five patients. The mean values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) in patients with hip fractures were 80±7 dB/MHz and 1,491±14 m/s, respectively, while the recorded values in patients without fractures were 88±9 dB/MHz and 1,506±22 m/s, respectively. The maximum value of BUA and SOS in patients with hip fractures were 91 dB/MHz and 1,510 m/s, respectively. These values were similar to the mean values in patients without fractures. The DIP (YAM) was 55-67% in four patients with fractures, compared to 44 - 91% in 25 examined patients without fractures. Moreover, in four patients with fractures, the FRAXR score was 12 - 55% for major osteoporotic fracture (MOF) and 3.3 - 9.3% for hip fracture (HF), compared to 4.4 - 33% for MOF and 0.3 -18% for HF in 26 examined patients without fractures. The results of these three methods were not statistically significant between patients with and without fractures.

    Conclusions: The combination of the three screening systems was not superior diagnostic method for hip fractures in post-menopausal patients, compared to DXA. Heel QUS and FRAXR (MOF, HF), both of which do not include bone mineral content (BMC) and DIP (peripheral cortical bone), which accounts for BMC, were used to evaluate bone fragility. In patients undergoing hemodialysis, the clinical importance of measuring DXA is growing, but it is necessary to estimate not only bone mass, but also bone quality. New modalities for the evaluation of bone quality are required in the future.

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