Twenty-eight cases of the aged over 70 years had 31 operations at the Tokyo National Chest Hospital during last 5 years, and the complications of pre-, intra- and postoperation were studied. The series contains 17 operations of thoracic surgery including 11 pulmonary resections and 14 of abdominal surgery including 10 of upper abdomen, and among them 20 operations were for cancer.
As the preoperative complications five severe cases were found in hepatic, renal, circulatory and/or respiratory lesions, and 15 cases of moderate or slight complications.
No patient died during operation or anesthesia. In many cases of anesthesia duration of more than 2 hours, systolic and diastolic blood pressure and pulse rate were remarkably changeable, and in 75% of cases of more than 4 hours the systolic pressure changed more than 51mm Hg during anesthesia and one of them was complicated with postoperative acute renal failure due to circulatory shock during anesthesia.
The operation death within 30 days were 5 cases. In 7 emergency cases 4 patients died while in 24 usual cases only one died. The mortality of emergency operations was very high. The causes of death were two renal failures, one hyponutrition with hypopotassemia, one rupture of esophageal varicocity and one haemorrhage of metastatic cerebral cancer.
As the postoperative complications in survival cases, renal failure, hypopotassemia and hepatic failure were important as same as continuation or increasing of preoperative complications. While some literatures report the high rate of pulmonary complications after thoracic or upper abdominal surgery or in the cases of chronic lung disease, authors experienced only two cases of pulmonary complications. It seems to be very effective that for the purpose of prevention of pulmonary complication respiratory physiotherapeutic exercise and assistance were routinely carried out pre-and postoperatively in our hospital.
As to other complications authors explained several considerations for preventive care.

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Our present studies were concerned with sleep EEG pattern and sleep rhythm of senile or presenile psychosis. We studied 2 cases of Alzheimer's disease and a case of Pick's disease whose symptoms became all fixed within 3 years, followed by total aphasia, panagnosia and panapraxia, and a case of Pick's disease who was wandering about and couldn't control his own behavior. The polygraphic recordings of all night sleep were carried out for consecutive five or seven nights.
The following results were obtained:
1) In two cases of Alzheimer's disease, alpha waves were not observed in arousal EEG, and there observed no spindle waves, but low amount and amplitude of delta-band waves in deep sleep stage, so that sleep EEG pattern was simplified. To the contrary sleep EEG pattern in REM stage was so variable that there observed high amplitude slow waves.
2) In respect to the amount of all night sleep through consecutive five or seven nights, two cases of Alzheimer's disease were differentiated from one another. The mean time of all night sleep was 394 minutes in one case with symptoms of total aphasia, panagnosia and panapraxia and was 231 minutes in another whose symptoms were less stationary than those of the former. The mean time of awakening in the midst of all night sleep was 101 minutes in the former and was 250 minutes in the latter.
3) In two cases of Pick's disease whose symptoms were differentiated from one another, 9-10 Hz alpha waves were observed in arousal EEG, and moreover sleep EEG patterns were similar to the normal pattern except REM stage. Spindle waves with somewhat low amplitude and delta-band waves in deep sleep stage were observed, but sleep EEG patterns in REM stage were so changeable that low amplitude fast waves were intermingled with theta-band waves.
4) The amount of all night sleep of Pick's disease was low through consecutive five or seven nights. The mean time of all night sleep was 258 minutes in one case with symptoms of total aphasia, panagnosia and panapraxia apd was 219 minutes in another who was wandering about and couldn't control his own behavior, while the mean time of awakening in the midst of all night sleep was 242 minutes in the former, but it was only 15 minutes in the latter. The average rate of deep sleep stage of the former (3.48%) was lower than that of the latter (12.28%).
5) The average rates of REM stage in all night sleep of all four cases were low from 6.98%, to 9.38%, and moreover the duration of REM stage was reduced in all cases, especially it was about 20 seconds in the case of Pick's disease whose symptoms were total aphasia, panagnosia and panapraxia.
6) No sleep EEG pattern suggesting impairment of consciousness in all four cases was observed there.

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In order to clarify the characteristics of myocardial infarction in aged people, 121 cases were selected from the series of patients examined their electrocardiography during the years of 1965 to 1972. The diagnosis on each case was confirmed not only abnormal Q waves with ST-T changes of electrocardiogram, but also clinical symptoms, course and other laboratory findings. Their average age was 61.7 ranging from 36 to 85, and 84 were males and 37 were females.
They were further classified into three age groups: 48 cases of under 59 (Middle age group), 45 cases of over 65 (Advanced age group) and the remaining intermediate age group. Various comparisons were made between the first two groups.
Following points of difference were observed in the clinical characteristics of the advanced age group compared with the middle age group.
1. The ratio of female cases increases with age, although males are always predominant in any age groups.
2. Attacks of the infarction are more often atypical or not recognizable in the advanced age.
3. Congestive heart failure and central nervous system sympotoms, such as strokes, are more frequent in the advanced aged, especially in those with atypical or unrecognized attack, whose infarction are often found just because of these symptoms.
4. The ratio of incidence of posteior or diaphragmatic infarction to anterior wall infarction is higher in the advanced age group. The tendency is especially apparent in female.
5. “Coronary risk factors”, such as hypercholesteremia, obesity, smoking and so on are less frequent in the advanced aged.
6. While, cases associated with hypertension are more frequent in them.
These results seem to correspond with the differences of the developmental process of the coronary atherosclerosis which is the main cause of the infarction;that is, coronary sclerosis in the advanced age has usually made a gradual development during a longer period with less accelerated factors, and thus distributes more or less all over the coronary arteries, while the most cases of myocardial infarction in middle age people are the result of occlusion of coronary artery by thrombosis or atheroma per se, which follow more rapidly developed and more localized coronary sclerosis.

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Because of the popularization and improvement of diagnostic study to the aged, a large number of operation recently was performed. But hypofunction that must be strongly influence to the prognosis was often noticed in clinical study. Preoperative status and complication were discussed for the upper abdomonal surgery, especially the gastric and bile duct surgery of the aged, and the results were as follows:
1) The majority of the aged had the wrong in body weight, EKG and vital capacity on clinical examination. Jaundice was noticed in 50% patients of the bile duct disease. 87% cases of gastrectomy were applied to II or III stage, on the other hand 70% of bile duct diseases were conformed to III or IV stage of the physical status.
2) Pulmonary complication was found most many times, while the infection and bleeding from the gastrointestinal tract in obstructive jaundice was most.
3) Postoperative complication was increased together with the physical status, extension of operation time and extended resection in gastrectomy.
4) Shock, hepatorenal syndrome and hemorrhage to digestive tract were most serious complication in the aged.

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This study was planned to decide whether or not the effect of chemotherapy on pulmonary tuberculosis of the aged is inferior to that in young adults and to elucidate the cause in case there is such a difference.
Among patients admitted to this hospital for initial treatment from January 1962 to February 1971, 75 aged patients with pulmonary tuberculosis over the age of 60 and 389 young adults patients below the age of 39 with the same disease were compared as to the results of 12 months treatment with combination of SM, INH and PAS.
Results:
1) Two groups were compared as to the chest x-ray findings, positive or negative tubercle bacilli in the sputa, and amount of bacilli in the sputa at the time of detection or beginning of initial treatment. While no difference was found in the positive or negative bacilli in the sputa and amount of bacilli in the sputa, chest x-ray findings definitely showed the predominance of old lesions resistant to chemotherapy in the aged.
2) Comparison of the effect of 12 months treatment with SM, INH and PAS revealed no difference in the rate of change of bacilli in the sputa to negativity. Rate of improvement of fundamental disease type and closure of cavity, however, was definitely inferior in the aged. This is apparently related to the predominance of cases resistant to chemotherapy among the aged subjects before treatment.
3) Cases with as much resemblance as possible as to the conditions before treatment were therefore selected from each group in a so-called matched pair system, to compare the result of chemotherapy. No difference was then detected between the two groups and aged patients responded as the young adults.
4) The true onset was presumed based on the past history on respiratory system and others. In the aged, true onset was frequently old and a delay of detection was rather conspicuous.
These results would suggest that pulmonary tuberculosis of the aged appears to be resistant to chemotherapy because many patients in this age group are already in the stage with poor response to chemotherapy, due to the delay in the detection and treatment as one of the main causes.

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Bacteria in 179 urinary specimens were isolated from 48 aged patients mostly with cerebral apoplectic sequelae, and the following findings were obtained:
1. Out of 179 specimens, there were 134 which showed bacterial counts of over 10⁵/ml suggesting the presence of infection in urinary tract(74.9%). The cases in which only one kind of bacteria was involved in this infection were the largest in number (61.5%).
2. When urinary sediments were examined, 53.3% of the specimens had more than 10⁵/ml bacterial counts in the negative leukocytic groups.
3. The kinds of bacteria which were detected were mostly Escherichia coli and Proteus mirabilis, and these two kinds held a half of all the bacteria detected.
4. Escherichia coli were found sensitive to the largest number of antibiotics.
5. The number of cases in which more than 10⁵/ml bacterial counts were detected was larger among the patients who used diapers than those who did not, showing a significant difference between them.

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This research was based on 70 geriatric patients who had been admitted to psychiatric wards of Komoro National Sanatorium. We keep on putting questions to families of these patients, related to factors leading to psychiatric hospitalization. We camed to following opinions by statistic treatment of these response.
1. Families have relative strong torelans for psychopathic symptoms.
2. These patients had several problems leading to psychiatric hospitalzation, but most significant factor was harmful behavior.
3. The psychiatric treatment for the geriatric patient must aim at the improvement of these harmful behaviors.
We take up work to confirm the factor, which make improvement of these harmful behaviors after this.

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Rehabilitation is the main treatment in medical management of rheumatoid arthritis. In our clinic over 200 in-patients sufferd from rheumatoid arthritis are admitted in a year and in those the patients over 60 years of age are 20% of all.
Treating arthritis in elderly patient requires time, patience and act. Physical therapist should use the proper exercise to relieve pain, preserve function and prevent deformity. Physical therapy cannot be successful, however, if the patient and their famillies who assist him do not understand the gaol to be achieved. The physical therapist must evaluate periodically the patient's progress and review the therapy programs.

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During the period from August 1970 to March 1973, 1, 929 patients were discharged from our hospital. Cases of cerebrovascular disorders amounted to 282, of which 256 patients underwent rehabilitative treatments.
Seven fundamental actions were selected for ADL evaluation, and the scores before and after treatment were compared. While the intervals between the onset of the disease and the admission, i. e. the start of rehabilitation, exceeded 6 months in 48% of the cases, score improvement was observed in approximately 70% of our total subjects. Moderate or marked improvement was found in 24.6% of those admitted after 6 months of disease duration, and in 18% of those admitted after more than 1 year duration.
Our recent experience suggests that methodology of those who treat and morale of those who are treated can lead to considerable improvement despite the natural advisability of early treatment.
Current situations of gerontological treatments in our society leave much room for im-provements. We would like to emphasize the urgent necessity of the following progress especially in cases of cerebrovascular disorders:
(A) We set our therapeutical minimal goal to the self-supporting home life. Full-scale return to social activities is mostly difficult to attain in aged persons. Since those disorders together with numerous complications necessitate much time and labor on hospital sides, doctors and paramedical personnels should be amply secured, and special wards and hospitals should be established.
(B) Even those admitted after a long lapse expect early and complete recovery. Loss of morale, various aging phenomena and complications are frequent obstacles. Inevitably, therapy should last six months at a conservative estimate. Our efforts for enlightment should be based upon due consideration of these intricate factors.
(C) Warm familial relationship is an absolute necessity in many cases. We should fully recognize that satisfactory family life after discharge is a fundamental restoration of humanity for these patients.
(D) As administrative measures, establishment of (i) intermediate institutions between home and hospitals (ii) institutions devoted to occupational therapies and (iii) nursing homes is an urgent requirement. We should like to point out here that both specialization and collaboration should exist between hospitals and above-mentioned institutions. (iv) For the patients remaining at their own home, effective measures are desirable to improve home accomodations, and (v) helping hands should be given especially to bed-ridden patients.

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According to the increasing aging population, the rate of geriatric inpatient in our hospital is raised in recent years. The majority of the geriatric inpatients are suffering from cerebro-vascular disease.
The following results were obtained in our follow-up study on our rehabilitate stroke patients. The stroke patients at home, especially the dependent patients in ADL, have been lack in the opportunity for the medical examination. The mortality in the rare examined group has been higher than that in the frequent examined group.
These results apparently suggest the necessity of the aid of public health nurses and the necessity of the establishment of local examination center designed for the purpose of prevention, treatment, rehabilitation and after-care for aging disease including cerebrovascular disease. Therefore, it is clear that the principle of our hospital upon the rehabilitation and geriatric medication should conclude the systematic encouragement of medical examination for aging disease.

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