Cancer has become the main cause of death in 1981 and various measures have been taken, but it is still a serious threat to the life and health of the people. In 2012, the number of cancer deaths was 360 thousand, which is one-third of the total death. Of those, 294,000 elderly people (81.4% of all cancer deaths) accounted for more than aged 65 or over, and 207,000 people (57.2% of all cancer deaths) accounted for over 75 years old. Meanwhile, late elderly people are excluded in “the reduction of deaths due to cancer (age-adjusted mortality rate under 75 years old: 20%)” which is the goal of the Basic Plan to Promote Cancer Control Programs. Also, in cancer screening rate targeting 50%, subjects to be counted are limited to 40 to 69 years old. However in cancer screening the upper limit of age is not set. It should be an appropriate target considering the balance between the benefits and disadvantages of screening in the elderly. The idea of treatment for the elderly depends on whether the time of cancer death will happens before the average life expectancy or not. If it is predicted “yes”, evaluate physical function, daily activity level, cognitive function, etc. If he (she) has no problem, perform the standard treatment as non-elderly people. If he has a serious problem, select supportive or palliative care. If he has a problem, but some treatment is possible, select a treatment suitable for each patient. Development of new minimally invasive treatment based on the characteristics of elderly cancer is desired. The “Cancer Registration Promotion Act” was implemented since 2016, and nationwide cancer registration began. It is possible to grasp the incidence and survival rate of all type cancers as measured values. In addition, it is expected that the detailed situation of elderly cancer will be clarified. It is hoped that it will contribute to setting goals for cancer prevention/treatment and outcome evaluation.
The concept of Locomotive Syndrome (Locomo) was proposed by the Japan Orthopedic Association in 2007 when Japan statistically became a super-aged society. The term refers to being restricted in one’s ability to walk owing to a dysfunction of locomotive organs. As the condition becomes worse, nursing care will become necessary or the risk of such necessity increases. The concept of Locomo is that when common diseases occur in elderly people, they are linked and compounded in the body. They deteriorate the functions of locomotive organs causing further diseases and progressing to a decline in mobility (gait disorder). With further deterioration, nursing care becomes necessary. Locomo is evaluated by using a simple questionnaire for identifying Locomo by oneself (called LOCOCHECK), and a Locomo risk test that quantitatively measures Locomo. The latter consists of two functional examinations, a stand-up test and a two-step test, and LOCOMO 25 which measures physical conditions and living conditions. Locomo risk level 1 is the beginning of Locomo and involves a stand-up test: cannot stand up 40 cm on one leg, the two-step test: less than 1.3, and LOCOMO 25: 7 points or more. Locomo risk level 2 involves a stand-up test: cannot stand up 20 cm in both legs, two-step test: less than 1.1, LOCOMO 25: 16 points or more. In the case of a diagnosis of Locomo risk level 1, we recommend the person to make their own efforts; in the case of Locomo risk level 2, the person should visit an orthopedic surgeon. We also recommend performing one-leg stands with the eyes open to improve the balance ability, and performing squats to strengthen the muscles, and named them LOCOTRA. There are various concepts concerning the various obstacles faced by the elderly, and at present there is no consensus on their relationships. To avoid confusion and competition, greater order and collaboration would be of benefit to people.
Between 2015 and 2030, the number of people living with dementia is forecast to increase from 500 million to 700 million in Japan. In the world, the increase by 2050 is estimated to be twofold in high income countries and more than threefold in low/middle income countries. Dementia has a huge economic impact. The total estimated worldwide cost of dementia will become US$ a trillion by 2018 and two trillion by 2030. There is evidence that multi-domain intervention (diet, exercise, cognitive training, vascular risk monitoring) may improve or maintain cognitive functioning in at-risk elderly people, but the effect size is not large. Thus, development of the disease modifying therapy (DMT) that can arrest the pathological process of Alzheimer’s disease (AD), the cause of more than a half of dementia subjects, has emerged as one of the highest priority issues in the world. Two major neuropathological hallmarks of AD, the amyloid b-protein (Ab) and tau protein deposits, are the targets for the development of both DMT and AD-specific biomarkers. Recent progress in the AD biomarker studies indicates that AD lesions appear 20 to 30 years prior to the occurrence of dementia and reach an advanced stage at the onset of dementia. Thus, to obtain significant effect, the intervention by DMT may need to be started before the clinical onset of AD. Then, clinical trials to develop DMT against AD have faced a number of barriers: high cost and long time to screen for appropriate subjects because of the low incidence of preclinical/prodromal AD cases in the non-demented aged population, and years-long trial periods to obtain the reliable results. Nevertheless, we must overcome such difficulties, presumably, by establishing the international collaborative effort and the public-private-partnership.
In geriatric practice, primary care physicians or geriatricians need to consider not only diseases but also age-dependent impairment in their physical and mental functions to keep their health. This is obvious because frailty, which is difficult to be understood by disease-based concept, occupies large part of the cause of dependency in the old-old population. Therefore, the Japan Geriatric Society proposed a new expression of frailty as “Frail” in Japanese, and advocated that appropriate prevention of “Frail” is important to postpone the process toward disability. There are two representative models to capture frailty, such as the accumulated deficit model by Rockwood et al. and the phenotype model by Fried et al. The previous studies indicated that both models could predict the incident adverse health outcomes. These studies support that frailty is an important concept in geriatric medicine. However, frailty assessment is not unified yet, therefore a lot of screening tools and assessments of frailty do exist at present. The important preventive measures are to support an intake of balanced foods and regular exercises in daily lives for frail older adults. Recently, a higher protein-intake is recommended for older adults to keep their muscle mass in the nutrition field. In terms of physical exercise, resistance training is thought to be beneficial for preventing muscle weakness but the acquiring the habit of regular exercise may be more important for frail seniors. Frailty has been the center of geriatrics because it could be an effective concept for identifying the pre-disability state with reversibility which may be the best for preventive intervention. The concept of frailty is thought to be necessary for the healthy longevity.
Objectives: In Japan, about 20% of people are current smokers. There are more current smokers in their 30s and 40s. We investigated smokers’ interest to quit smoking, their attention to passive smoking, and non-smokers who have antipathy to passive smoking at the workplace. Methods: The subjects were 815 workers from two manufacturing workplaces. We asked age, gender, workplace, smoking habits, and health consciousness toward smoking. In addition, for current smokers, we asked the number of cigarettes smoked per day, interest to quit smoking, attention to passive smoking, knowledge about the influence to the health of passive smoking, and reasons to quit or reduce smoking. For non-smokers, we asked whether or not they have antipathy to cigarette smoke. The χ2 test or Fisher’s exact test was performed to evaluate the relation between smokers’ desire to quit and age, gender, workplace (A or B), health consciousness, number of cigarettes (<21 or ≥21) and knowledge about passive smoking. Frequency analyses were also performed between smokers’ attention and the same variables. Results: A total of 44.3% of the workers were current smokers. And 48.5% of them didn’t have any desire to quit. More workers at workplace (B), workers who smoke more than 21 cigarettes, or who have low health consciousness, didn’t want to quit. The reasons to quit or reduce smoking were the detrimental influence to their health, cost, and the increase in smoke-free areas. Smokers who didn’t pay attention to non-smokers were 40.7%. Many of them didn’t know about passive smoking. Non-smokers who have antipathy to smoke were 91.4%. Conclusions: The information about the influence to the health would make smokers want to quit. In addition, the cost benefits and increasing smoke-free areas would help smokers quit. More information about passive smoking would make smokers pay more attention to non-smokers.
Objective: Glaucoma is the leading cause of posteriori blindness in many Japanese people. Normal tension glaucoma (NTG) is more prevalent in Japanese people than other glaucomas. In the Japan Glaucoma Society epidemiological survey (Tajimi Study), 5.0% of the Japanese people over 40 years of age had glaucoma, and 72% of them had NTG. However, the fundus examination effective for detecting glaucoma is not being conducted except for on some subjects in a specific health examination in 2008. Recently, an inexpensive, small, and lightweight device called a frequency doubling technology (FDT) screener has been developed. We conducted a mobile medical examination of adult eyes and verified the effectiveness and usefulness of the fundus and FDT inspection in the adult eye test. Methods: In total, 892 people (738 men, 154 women) were examinees, out of 2,392 participants of a regular medical examination performed by a single corporation in Chiba in 2012. The agreed examinees underwent a FDT screener test, fundus examination, vision screening, and an interview after obtaining informed consent. The diagnosis of glaucoma was made using the Japan Glaucoma Society criteria, and we placed examinees under the industrial physician management for probable glaucoma from inspected results in the fundus examination (0.7 ≤ cup-to-ratio < 0.9) and a FDT test negative. We have introduced the examination of ophthalmologist, from inspected results in the fundus examination (0.9 ≤ cup-to-ratio) or FDT test positive. Results: Of the 85 examinees that have been detected in the adult eye examination, seven examinees were diagnosed with glaucoma by precision inspection. The glaucoma prevalence (after correction) was 1.67%. The glaucoma (including glaucoma-related disease) positive predictive value of the eye screening was 89.5%. Eleven examinees not detected with a disease in the fundus examination, were detected in FDT. Breakdown of that examinees were one glaucoma, one retinal nerve fiber bundles, and three retinal macular degeneration. Conclusions: Our results suggested that FDT in addition to the fundus examination was effective for early detection of glaucoma.