Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
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Review Article
Perspective of Aging Science
Clinical Practices of Geriatrics
Original Articles
  • Takahiro Shiba, Yohei Sawaya, Tamaki Hirose, Masahiro Ishizaka, Akira ...
    2020 Volume 57 Issue 2 Pages 149-154
    Published: April 25, 2020
    Released: May 29, 2020

    Purpose: To clarify the prevalence and risk factors of sarcopenia in commuting rehabilitation service users.

    Target: The 104 participants of the plant [Sorry, the English is unclear: please clarify the meaning of the highlighted text] (56 men, 48 women; average age 78.6±7.7 years).

    Methods: The diagnosis of sarcopenia was classified based on the AWGS diagnostic algorithm. The following 10 items were investigated for their causal relationship with sarcopenia as risk factors: risk factor survey (1) cerebrovascular disease, (2) hypertension, (3) respiratory disease, (4) cardiovascular disease, (5) orthopedic disease, (6) fracture, (7) cancer, (8) intractable diseases, (9) diabetes mellitus, and (10) fall history in the past year.

    Results: The prevalence of sarcopenia was 51.9%. Significant differences were observed in the items of "cancer" and "fall history in the past year" as risk factors for sarcopenia.

    Conclusion: Elderly people needing support or care (especially those with cancer and a history of falling) have a very high risk of sarcopenia and are expected to require early intervention.

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  • Masae Tsutsumi, Hiromi Suenaga, Chizuru Nagata, Hiroshi Nogaki
    2020 Volume 57 Issue 2 Pages 155-162
    Published: April 25, 2020
    Released: May 29, 2020

    Aim: In recent years in Japan, forest therapies have been implemented in various places. While the effects of such therapies have been reported in previous research papers, those of artificial gardens have not been clarified. At the 2018 Yamaguchi Yume Flower Expo, the Yamaguchi University Faculty of Medicine had the opportunity to provide a "Well-being Garden" in collaboration with the Japan Landscape Contractors Association Yamaguchi Prefecture Branch. We examined the physical and mental responses of older people who strolled in the Well-being Garden.

    Methods: Participants were 158 people ≥ 65 years old. Pre-and post-stroll interviews were conducted, and the heart rate, blood pressure, and autonomic nervous activities were measured.

    Results: After strolling in the garden, the heart rate significantly decreased from 76.1±12.9 to 73.9±11.8/min (p<0.01), and both the systolic and diastolic blood pressure significantly decreased from 142.5±24.4 to 139.4±24.1 mmHg and from 83.7±12.0 to 81.5±11.9 mmHg, respectively (p<0.01). The ralue of low frequency/high frequency (LF/HF) after strolling in the garden came closer to the standard one than before, both in the participants with much tension and with less tension. In the post-stroll interview, 74 reported feeling very good, and 84 felt good.

    Conclusions: These results suggested that strolling in the Well-being Garden positively influenced the physical and mental condition of the participants.

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  • Kazuhiro Nakazato, Tomoko Wakui, Hiroko Kodama, Chiho Shimada
    2020 Volume 57 Issue 2 Pages 163-172
    Published: April 25, 2020
    Released: May 29, 2020

    Families are involved in decision-making regarding end-of-life (EOL) care in Japan. However, how support from medical professionals toward families' decision-making affects families' satisfaction with EOL care has not been adequately studied. We aimed to examine the impact of support from medical professionals considering the care recipients' preferences on families' overall satisfaction with EOL care and the mediating effect of fulfilling care recipients' preferences.

    We administered self-report questionnaires through home-nursing providers to bereaved families (n=753), who lost loved ones between April 2015 and March 2016. Analyses were conducted with 237 of these bereaved families whose loved ones had been ≥65 years old, and had no missing values in key variables. We asked whether the families had received any support from medical professionals in determining the care recipients' EOL preferences, in discussing how to honor the care recipients' own interests, and in supporting the families' decision-making. We also collected data measuring the overall satisfaction with EOL care, families' perceptions that the care recipients' preferences were honored during EOL care, and demographic characteristics of care recipients and caregivers.

    Data from 58 male and 179 female family members were analyzed. The average age was 65.8 (standard deviation [SD]=11.9) years. Care recipients were 113 men and 124 women, and their average age was 83.0 (SD=9.1) years old at the time of death. A path analysis revealed that support for families from medical professionals was related to families' satisfaction with EOL care through the mediating factor of fulfilling care recipients' preferences.

    Support from medical professionals considering care recipients' preferences will help families' involvement in EOL decision-making.

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  • Naoko Ishiyama, Eiichi Sudo
    2020 Volume 57 Issue 2 Pages 173-181
    Published: April 25, 2020
    Released: May 29, 2020

    Aim: In our hospital, the number of cases in which peripherally inserted central catheters (PICCs) are used has increased; these patients include elderly people who cannot take medications orally, patients with low levels of awareness, and patients with dysphagia. We report the situation at this time mainly with regard to the number of days on which PICCs were used.

    Methods: Fifteen elderly patients (male, n=7; female, n=8; average age, 89.3±5.3 years) underwent PICC insertion at our hospital from August 2016 to October 2018. Among these patients, 6 had cerebrovascular disorders, 5 had aspiration pneumonia, 2 had Parkinson's syndrome, 1 had consciousness disorder resulting from asphyxia caused by foreign body aspiration, and 1 had interstitial pneumonia. Seven patients received home management. In each patient, we measured the length of time that the PICC was in place.

    Results: The average duration for which a PICC was in place was 92.9±25.4 days (in cases of home care management, 159.5±48.3 days). The longest duration was 342 days, in a patient with aspiration pneumonia. The endpoints were death and discharge from hospital. Complications/accidents occurred as a result of catheter infection in 2 cases (both patients recovered after catheter removal) and as a result of self-extraction in 1 case.

    Conclusions: These results suggest that PICC is useful and does not cause serious adverse effects, even in elderly patients who require central parenteral nutrition management.

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  • Hiroshi Akasaka, Hisashi Yonezawa, Jyunko Takahashi, Satoko Obara, Tos ...
    2020 Volume 57 Issue 2 Pages 182-194
    Published: April 25, 2020
    Released: May 29, 2020

    Aim: To verify the clinical utility of instrumental activities of daily life evaluated using the Tokyo Metropolitan Institute of Gerontology index of competence (TMIG-IC) as a screening tool for patients with early-phase cognitive impairment, including mild cognitive impairment (MCI) and early Alzheimer's disease (AD).

    Methods: We recruited healthy subjects from our community-based cohort and consecutive subjects with MCI and AD from our clinic. The TMIG-IC was investigated in all participants and their family members. The total and subscale scores were compared among all groups. We then statistically determined the accuracy of the differentiation of MCI and AD.

    Results: We registered 187 normal controls (NC), 39 participants with MCI, 50 AD patients with functional assessment staging (FAST) 4, and 19 AD patients with ≥5 FAST. The family-report score was significantly lower in MCI patients than in others, followed by AD patients. The total score was able to differentiate MCI and AD with a sensitivity of 85.7% and a specificity of 90.9% (area under the curve [AUC]=0.913). Differentiation of MCI alone had a low accuracy (AUC=0.787). However, the AUC was 0.847 when only the items with inconsistent responses between self and family reports were used as indices.

    Conclusions: The TMIG-IC is a useful tool for evaluating the severity of AD, including early AD. These findings suggest that family-report scores can differentiate MCI and AD from cognitive normal aging with a sufficient degree of accuracy. It was also suggested that inconsistencies between self and family reports were higher when differentiating MCI than the self- and family-reports.

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Case Report
  • Motoo Kikuchi, Shouko Fujita, Kyouji Senoo
    2020 Volume 57 Issue 2 Pages 195-199
    Published: April 25, 2020
    Released: May 29, 2020

    Influenza (flu) is a prominent infectious disease that worsens the general prognosis of older adults. We herein report a case of a clinically odd and rare reaction on an instant diagnostic kit for influenza. An 81-year-old man with a fever and rhinorrhea consulted our hospital. He had a history of dementia of Alzheimer's type and rheumatoid arthritis and had been treated with oral prednisolone (10 mg/day). Instant diagnostic test kit A using exudation from the upper pharynx showed positivity for antigen of flu A virus, and computed tomography indicated acute pneumonia. Immediately after the diagnosis, 150 mg/day of oseltamivir was started for 5 days. However, a high fever over 38.0°C persisted, and flu A antigen from the upper pharynx was repeatedly detected using test kit A. Despite subsequent oral treatment with 100 mg/day of amantadine and single venous infusion of 300 mg/day of peramivir, the high fever continued, and the detection of C-reactive protein in the serum as well as flu A antigen in the upper pharynx persisted. We suspected test failure, and the results of another test kit (kit B) were indeed negative. Furthermore, polymerase chain reaction performed by two independent laboratories failed to detect flu gene fragments. We concluded that the patient did not have the flu, and results of test kit A had been a false positive. The patient was successfully treated with ABPC/SBT infusions. We should consider the implications of diagnosing flu using instant test kits.

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