Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
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Displaying 1-25 of 25 articles from this issue
Table of Contents
Amako Award
Review Article
Perspective of Aging Science
Clinical Practices of Geriatrics
Original Articles
  • Mayu Harayama, Koutatsu Nagai, Natsumi Okawa, Kyoko Sano, Hiroshi Kusu ...
    2022 Volume 59 Issue 4 Pages 483-490
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: To determine the association between physical activity and apathy in community-dwelling older adults.

    Methods: This was a cross-sectional study. Apathy was assessed using three sub-items from the Geriatric Depression Scale 15 (GDS-3A) on apathy syndrome. Physical activity was measured using a wrist-worn accelerometer. Exercise intensity was classified as sedentary behavior, light-intensity physical activity, or moderate-to-vigorous-intensity physical activity. A logistic regression analysis was used to examine the association between apathy and physical activity for each exercise intensity level.

    Results: Seven-hundred and eighty-four participants (age 72.7±5.9 years old) were included. Of those, 103 (13.1%) were in the apathy group. A multivariate analysis adjusted for demographic factors revealed that decreased total physical activity (odds ratio [OR] = 0.947, 95% confidence interval [CI] = 0.912-0.984, p = 0.005), light-intensity physical activity (OR = 0.941, 95% CI = 0.899-0.985, p = 0.009), and increased sedentary behavior (OR = 1.002, 95% CI = 1.001-1.003, p = 0.007) were associated with a greater OR of apathy, although moderate-to-vigorous-intensity physical activity was not significant (OR = 0.916, 95% CI = 1.826-1.017, p = 0.100). However, in the final model adjusted for depressive symptoms and functional factors, the association was not found to be significant, and a strong association was observed between depressive symptoms and apathy.

    Conclusion: Physical activity in older adults with apathy symptoms was decreased in this study. However, the associations seemed to be strongly affected by depressive symptoms, and physical activity was not independently associated with apathy.

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  • Kaori Teraoka, Taishi Tsuji, Takashi Jindo, Satoshi Tokunaga, Tomohiro ...
    2022 Volume 59 Issue 4 Pages 491-500
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Objective: This study aimed to ascertain the physical-fitness trends among community-dwelling older adults using performance testing. The results of the evaluation conducted during the COVID-19 pandemic were compared to data from the pre-pandemic period.

    Methods: A total of 240 community-dwelling older adults who participated in a health checkup program from 2016-2020 underwent the following tests: grip strength (upper limb muscle), single-leg balance with eyes open (static balance), sit-and-reach test (flexibility), timed up-and-go test (TUG, functional mobility), 5 meter habitual walk (walking ability), and hand working with pegboard (hand dexterity). Linear mixed effect models were applied to the hierarchical dataset: repeated data (Level 1), pre-pandemic (2016-2019), pandemic (2019-2020) (Level 2), and individuals (Level 3). Fixed effects and interactions were estimated for the survey year (Level 1), and between the survey year and pre- and post-pandemic (Level 2), with the range of decline set measured in terms of its standardized partial regression coefficient, "B," from 2019-2020.

    Results: The items for which significant cross-level interactions were identified. In males, the following items showed significant cross-level interactions: sit and reach test (B=−2.56, 95% CI: −4.45-−0.66 cm), TUG (+0.39, 0.21-0.56 sec) and 5 meter habitual walk (+0.15, 0.04-0.27 sec). In females items except single-leg balance with eyes open showed significant cross-level interactions: grip strength (−0.58, −1.11-−0.05 kg), sit-and-reach test (−3.53, −5.11-−1.95 cm), TUG (+0.15, 0.03-0.27 sec), for 5 meter habitual walk (+0.14, 0.04-0.24 sec), and hand working with pegboard (+0.89, 0.28-1.51 sec).

    Conclusion: In both males and females, a significant deterioration in flexibility and mobility movement ability was observed in 2019-2020. In addition, upper limb muscle strength and hand dexterity movement deteriorated in females.

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  • Jun Matsuura, Mitsuhiro Shirakawa, Natsuko Takahashi, Yukari Taki, Meg ...
    2022 Volume 59 Issue 4 Pages 501-506
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: The present study clarified the outbreak situation and background risk factors for drug-resistant bacteria infection in nursing homes.

    Methods: Subjects were 48 elderly individuals with urinary tract infections in 3 nursing homes during the 12-month period from January to December 2020. We analyzed the drug resistance of cultured bacteria using medical records.

    Results: Escherichia coli was the most frequently cultured bacteria (37.1%), and extended-spectrum β-lactamase (ESBL) -producing E. coli accounted for 26.1% of specimens. E. coli susceptibility to levofloxacin (LVFX) was seen in 47.8%, resistance in 47.8%, and intermediate response in 4.4%. E. coli susceptibility to ceftriaxone (CTRX) was seen in 73.9%, and resistance in 26.1%. E. coli susceptibility to sulfamethoxazole trimethoprim (ST) mixture was seen 81.8%, while resistance was seen in 18.2%. In addition, among ESBL-producing E. coli, susceptibility to LVFX was seen in 0% and resistance in 83.3%, and an intermediate response was seen in 16.7%, while susceptibility to ST mixture was seen in 83.3% and resistance in 16.7%. No marked differences in background risk factors were seen between the groups with LVFX-resistant and LVFX-susceptible E. coli. However, the body mass index was significantly lower (p=0.0389), and significantly more patients were treated with antimicrobial agents during the 1-year period preceding the sample acquisition and analysis (p=0.0418) in the group with CTRX-resistant E. coli than in the group with CTRX-susceptible E. coli.

    Conclusion: In the nursing homes examined, LVFX-resistant E. coli were highly prevalent, and ESBL-producing bacteria were also common. When we treat urinary tract infections, refraining from the use of LVFX is desirable, and antimicrobials should be chosen with care.

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  • Tao Yu, Yuko Oguma, Keiko Asakura, Michiyo Takayama, Yukiko Abe, Yasum ...
    2022 Volume 59 Issue 4 Pages 507-517
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: While the proportion of people of ≥85 years of age is expected to increase, there is limited research on the dietary patterns and physical performance of this population in Japan. The purpose of this study was to identify the dietary patterns of people of ≥85 years of age who live in Tokyo and to examine the relationship with their physical performance.

    Methods: Using data from the baseline survey (conducted in 2008-2009) of The Tokyo Oldest Old survey on Total Health study, the estimated 58 food intake items were aggregated into 33 items after energy adjustment, and a principal component analysis was performed. For physical performance, the results of grip strength, chair standing test, and 3 m timed up and go test conducted at normal walking speed were used. A multiple regression analysis was used to adjust for confounders and to examine the relationship between each dietary pattern and physical performance.

    Results: The subjects of the analysis were 87.3 (86.2-88.8) years of age (median [25-75th percentile] ). From the principal component analysis, three dietary patterns were identified: "various vegetable foods", "fish and mushrooms", and "cooked rice and miso soup". A higher propensity for the "fish and mushrooms" dietary pattern was significantly associated with grip strength (partial regression coefficient, B (95% confidence interval): 0.48 (0.13-0.83) ).

    Conclusions: In a population of people of ≥85 years of age in Tokyo, a positive association was observed between hand grip strength and a dietary pattern characterized by fish and mushroom intake.

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  • Masako Sato, Yumiko Uchiyama, Yatami Asai, Satoko Fujii, Mizue Suzuki
    2022 Volume 59 Issue 4 Pages 518-527
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: A geriatric health services facility had been working to improve end-of-life care since 2014. In 2017, the facility introduced the My Wishes notebook, which confirms individual's medical choices and distributed the Explaining Practices and Intentions of End-of-life Care book in 2018, in order to help their staff improve care for older adults. Care staff used their learning in caregiving for older adults. This study aimed to clarify the change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the My Wishes notebook.

    Methods: We requested cooperation from all care staff at a geriatric health services facility, and focus group interviews were conducted with 13 staff members over two days in June 2019. The responses in relation to two parameters, the staff members' thoughts and the change in end-of-life care, following the introduction of My Wishes were recorded and qualitatively analyzed.

    Results: Six categories of responses were extracted from the qualitative analysis: "Difficulty in using My Wishes", "Effects of the use of My Wishes ", "The practice of sought care", "Intentional involvement with patients' families", "Self-confidence in end-of-life care", and "End-of-life care becoming common practice".

    Conclusion: After the introduction of My Wishes, the care staff found that there were difficulties in using My Wishes, such as writing on paper and difficulties in them hearing. On the other hand, they felt the effects of using My Wishes, such as knowing a new side, feeling further possibilities of care, and activating communication among interdisciplinary healthcare providers. Then, while intentionally engaging with patients' families, they will seek and practice the care that the older adults want. Furthermore, while repeatedly searching for and practicing the care that older adults want, they will gain confidence in providing care and change to normalize these care practices.

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  • Toshiki Mizuno, Masaaki Isaka, Takao Kuramoto, Tomomi Inoue, Kei Kamid ...
    2022 Volume 59 Issue 4 Pages 528-535
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: We investigated the relationship between physical activity and sleep status among older adults requiring nursing care in the community.

    Method: We included 45 participants ≥65 years old (33 females; mean age, 83.2±4.4 years old) requiring nursing care. Physical activity was evaluated using the Life Space Assessment (LSA), and sleep status was measured by the Pittsburg Sleep Quality Index (PSQI) to determine the total sleep time, sleep efficiency, and PSQI total score. The physical function was measured by the timed up and go test (TUG) and grip strength. We performed a multiple regression analysis with the LSA as the dependent variable and sleep indicators (total sleep time, sleep efficiency, PSQI total score) and TUG as independent variables (demonstrating significant correlations with the LSA), and gender and age as adjusted variables. The analysis was divided into sleep time (Model 1), sleep efficiency (Model 2), and PSQI total score (Model 3). We used R commander, and < 0.05 was considered statistically significant.

    Results: TUG (β=-0.375) and sleep time (β=0.383) in Model 1, TUG (β=-0.368) and sleep efficiency (β=0.570) in Model 2, and TUG (β=-0.392) and PSQI total score (β=-0.590) in Model 3 were independently selected as significant variables.

    Conclusion: In addition to TUG, sleep status, such as the sleep duration and sleep quality, was shown to be related to physical activity in older adults who require nursing care. To improve physical activity, it is necessary to consider not only the physical function but also quantitative and qualitative assessments of sleep.

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  • Satoshi Ida, Ryutaro Kaneko, Kanako Imataka, Kaoru Okubo, Kentaro Azum ...
    2022 Volume 59 Issue 4 Pages 536-542
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Objective: The present study examined the relationship between loneliness and higher-level functions in elderly diabetic patients.

    Methods: The subjects were diabetic patients ≥65 years old who were outpatients at Ise Red Cross Hospital. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a self-administered questionnaire, was used to assess higher-level functions. To evaluate loneliness, we used a shortened version of the Japanese version of the loneliness scale, a self-administered questionnaire. A multiple regression analysis with TMIG-IC scores as the dependent variable, loneliness as the explanatory variable, and adjustment variables was used to calculate the adjusted partial regression coefficients of loneliness on higher-level functions.

    Results: One hundred and seventy patients were included in the present analysis. Ninety-one patients (53.5%) had loneliness, and the mean TMIG-IC score was 11.3. The unadjusted and adjusted partial regression coefficients of loneliness on higher-level functions were -1.61 (95% confidence interval [CI], -2.31 to -0.91; < 0.001) and -0.88 (95% CI, -1.52 to -0.23; P=0.008), respectively.

    Conclusion: Loneliness in elderly diabetic patients was found to be associated with lower higher-level functions. It is important to remind patients with diabetes mellitus who have loneliness about the risk of a decline in their higher-level functions.

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  • Tatsunori Shimizu, Ayuto Kodama, Kaoru Sugawara, Mariko Asano, Yuji Ok ...
    2022 Volume 59 Issue 4 Pages 543-550
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    Aim: To consider what is necessary to ensure the efficient performance of dementia community support coordinators.

    Methods: In Akita Prefecture, we conducted a simple questionnaire survey of dementia community support coordinators in 25 municipalities to clarify the current status of their activities and examine what needs to be done to develop their projects more efficiently.

    Results: It became clear that residents were not aware of the existence of these coordinators, underscoring the need to publicize their existence and activities. The lack of tools to improve the public's understanding of social resources for sharing information on building a support system was also demonstrated. In terms of cooperation, it was found that, despite the establishment of cooperation with IPIST and the medical center for dementia, cooperation with dementia support coordinators was insufficient. Furthermore, we confirmed that support coordinators were not very involved in the creation and activities of dementia care paths.

    Conclusions: Based on the above findings, we propose five points to support further efficient development. 1. Disseminate information to inform local residents about dementia community support coordinators, 2. Collaborate with dementia support coordinators and the welfare commissioner, 3. Create social resource maps and facilitate their understanding and establish dementia care path activities, 4. Create a work environment where dementia community support coordinators do not have to work concurrently, and 5. Create learning opportunities to improve understanding of the overall dementia policy.

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Case Reports
  • Hironobu Nakamura
    2022 Volume 59 Issue 4 Pages 551-558
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    An 86-year-old woman who had received a V-P shunt for subarachnoid hemorrhage 23 years previously presented to the emergency room with a chief complaint of fever. The diagnosis on admission was urinary tract infection, and treatment with CMZ was started. Abdominal CT scan on admission revealed that the V-P shunt had penetrated the ascending colon; however, because there were no clinical symptoms or imaging findings suggestive of peritonitis or meningitis, the V-P shunt was not initially considered to be related to the fever. However, since the fever in the 39°C range persisted for a week despite a urine culture showing susceptible Escherichia coli, a spinal fluid examination was performed on the assumption of meningitis caused by the V-P shunt. We found elevated cell counts in the CSF and diagnosed the patient with bacterial meningitis. After shunt removal surgery was performed, the patient quickly recovered from fever. Later, Pseudomonas aeruginosa was detected at the shunt tube and in the CSF, and CFPM was administered continuously. The patient was discharged with good progress.

    A review of the relevant literature revealed that half of the patients with a V-P shunt penetrating the intestinal tract will pass asymptomatically and are unlikely to develop peritonitis, while half of the patients may develop meningitis. In addition, if there is an artifact in the body, it is always necessary to consider the possibility that it may be the source of infection.

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  • Masashi Miyawaki, Ayumi Toba, Joji Ishikawa, Kazumasa Harada
    2022 Volume 59 Issue 4 Pages 559-564
    Published: October 25, 2022
    Released on J-STAGE: December 06, 2022

    An 80-year-old woman with a history of hypertrophic obstructive cardiomyopathy and Lewy body dementia was admitted to our hospital with a first episode of syncope while walking. The pressure gradient of left ventricular outflow tract (LVOT) had been stable at nearly 10 mmHg for 3 years before the admission. We evaluated the cause of syncope. Echocardiography showed that the pressure gradient of LVOT was unchanged, even in the supine position ergometer exercise test. Although the head-up tilt test revealed a drop in blood pressure of 44 mmHg systolic and 23 mmHg diastolic, she was asymptomatic during the test. The orthostatic hypotension was considered to be a manifestation of autonomic failure due to Lewy body dementia; however, it was insufficient to explain the syncope on exertion. Echocardiography in a sitting-up position showed that the pressure gradient of LVOT was exacerbated to 41 mmHg, which might be the cause of syncope while walking. Orthostatic hypotension, especially in patients with Lewy body dementia, is a common cause of syncope in the elderly. However, we should keep in mind that the exacerbation of LVOT obstruction due to posture-dependent fluid shift can be a cause of syncope in patients with hypertrophic cardiomyopathy or sigmoid-shaped interventricular septum. In such patients, echocardiography in a sitting-up position can be an effective tool to diagnose the cause of syncope.

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Short Report
Care Facility for Elderly
Proceedings of Regional Meeting of the Japan Geriatrics Society