Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics

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ISSN 0300-9173

Publications in this journal

  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):2-3. DOI:10.3143/geriatrics.52.2
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    ABSTRACT: The purpose of this study was to investigate whether the degree of improvement in cognitive function achieved with an exercise intervention in community-dwelling older Japanese women is affected by the participant's baseline cognitive function and age. Eighty-eight women (mean age: 70.5±4.2 years) participated in a prevention program for long-term care. They completed the Square-Stepping Exercise (SSE) program once a week, 120 minutes/session, for 11 weeks. We assessed participants' cognitive function using 5 cognitive tests (5-Cog) before and after the intervention. We defined cognitive function as the 5-Cog total score and defined the change in cognitive function as the 5-cog post-score minus the pre-score. We divided participants into four groups based on age (≤69 years or ≥70 years) and baseline cognitive function level (above vs. below the median cognitive function level). We conducted two-way analysis of variance. All 4 groups improved significantly in cognitive function after the intervention. There were no baseline cognitive function level×age interactions and no significant main effects of age, although significant main effects of baseline cognitive function level (P=0.004, η(2)=0.09) were observed. Square-Stepping Exercise is an effective exercise for improving cognitive function. These results suggest that older adults with cognitive decline are more likely to improve their cognitive function with exercise than if they start the intervention with high cognitive function. Furthermore, during an exercise intervention, baseline cognitive function level may have more of an effect than a participant's age on the degree of cognitive improvement.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):162-9. DOI:10.3143/geriatrics.52.162
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):99. DOI:10.3143/geriatrics.52.99
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    ABSTRACT: The AD8 is a brief, sensitive informant interview tool for detecting dementia. However, there are no reports of a Japanese version of the AD8. Our aim was to establish the reliability and validity of the AD8 for screening for dementia in older adults 75 years of age or older in Japan. We acquired the author's permission to translate the AD8 from English to Japanese. A total of 572 community residents 75 years of age or older living in Kurihara, Northern Japan agreed to participate in this study. Of these participants, 214 scored a Clinical Dementia Rating (CDR) of 0 (healthy), 289 scored a CDR of 0.5 (mild cognitive impairment) and 69 scored a CDR of 1 or above (dementia). Analysis 1. Reliability of the Japanese version of the AD8. Analysis 2. Validity of the AD8: Receiver operating characteristic (ROC) curve for nondemented (CDR 0+0.5) vs. demented (CDR 1 or above) individuals. For the Japanese version of the AD8, the Cronbach' s coefficient alpha was 0.88 and the Guttman's split half method coefficient was 0.85. For the patients with CDR values of 0+0.5 vs. 1 or above, the area under the ROC curve was 0.89 (p<0.0001) and the cut-off score was 1/2, with a sensitivity of 88.4% and specificity of 68.4%. We established the reliability and validity of the Japanese version of the AD8 for screening for dementia in older adults 75 years of age or older in the community.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):61-70. DOI:10.3143/geriatrics.52.61
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    ABSTRACT: A 70-year-old man with a 28-year history of type 2 diabetes mellitus was admitted due to persistent vomiting and neurological abnormalities in Nov 2012. He had developed gait disturbance and diplopia for six months during antiplatelet therapy, which was initiated following the diagnosis of a cerebellar infarction in June 2012. He had nystagmus, truncal ataxia and an ocular motility disorder, and the MRI study showed increased FLAIR and DWI signals in the peri-third ventricle and periaqueductal region, in addition to the cerebellar vermis. Wernicke encephalopathy was suspected according to his symptoms, and thiamine administration dramatically improved his condition. He did not have a history of alcohol abuse or poor eating habits; however, various coexisting factors, including diabetes mellitus, pyloric stenosis and the use of antiulcer drugs and insulin, were considered to be responsible for Wernicke encephalopathy. This case demonstrates the importance of distinguishing Wernicke encephalopathy from cerebrovascular disease in elderly patients.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):177-83. DOI:10.3143/geriatrics.52.177
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    ABSTRACT: To clarify the routes of nutrition and types of diet and their relevance to the risk of mortality and hospitalization among community-dwelling dependent elderly provided various home care services under the long-term care insurance program. The present study consisted of the collection of baseline data of participants in the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE) and data regarding mortality and hospitalization during a three-year follow-up period. The study population consisted of 1,872 subjects, and the baseline data included demographic characteristics, basic activities of daily living (ADLs), comorbidities, nutritional routes and types of diet, which were evaluated by trained visiting nurses. Among the participants, 1,786 were on oral nutrition (solid regular-texture diet: 1,487 (79.5%); modified-texture diet (minced/pureed texture): 299 (16.0%), 82 (4.4%) were on enteral nutrition and four (0.2%) were on parenteral nutrition. During the three-year follow-up period, 453 participants died and 798 participants experienced admission to the hospital (pneumonia-related death and hospitalization: n=103 and 155, respectively). Cox regression models revealed that a modified-texture diet and tube feeding are associated with all-cause mortality and hospitalization. In particular, feeding tube use showed a high risk of pneumonia-related mortality and hospitalization, even after adjusting for potential confounders, including comorbidities and the ADL status.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):170-6. DOI:10.3143/geriatrics.52.170
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    ABSTRACT: To investigate the validity and reliability of a novel performance test, called the "Trail Making Peg" (TMP) test, for evaluating the cognitive function. We recruited 632 community-dwelling older adults (mean age: 73.3±5.2 years) as subjects for the assessment of the validity of the test and 319 adults (mean age: 73.1±5.2 years) as subjects for the assessment of reliability. Five cognitive tests (5-Cog) were used to evaluate the cognitive function, and the degree of cognitive decline was delineated for subjects scoring below 1 SD from the mean 5-Cog score. A receiver operating characteristic analysis was employed to calculate the cut-off point. There were no sex differences in the TMP scores (P=0.951), and the TMP and 5-Cog scores were found to correlate significantly (r=-0.63) with each other. The Trail Making Peg test demonstrated an area under the curve of 0.855 for discriminating between non-cognitive decline and cognitive decline. At this cutoff point, the sensitivity was 85% and the specificity was 69%. The intraclass correlation coefficient of the TMP was 0.746. The TMP exhibits sufficient validity and reliability. Our results suggest that TMP is a useful screening test for detecting cognitive decline.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):71-8. DOI:10.3143/geriatrics.52.71
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    ABSTRACT: We examined the longitudinal association between the change in the Mini-Mental State Examination (MMSE) score per year and the incidence of a certified need for care in the long-term care insurance system among community-dwelling older Japanese subjects. A total of 773 adults 65 years of age or older who participated in a baseline survey (2002 to 2007) underwent MMSE reevaluation at least once until Wave-1 (2003 to 2008). The incidence of a certified need for care in the long-term care insurance system until Wave-2 (Wave-1 to 2013) was examined in all subjects. During an average follow-up of 1,195 days (baseline survey to Wave-1), the change in the MMSE score per year was greater than 0 in 511 (66.1%) participants, 0 to -0.5 in 94 (12.2%) participants, -0.5 to -1 in 66 (8.5%) participants, -1 to -2 in 56 (7.2%) participants, and less than -2 in 46 (6.0%) participants. During an average follow-up of 1,802 days (Wave-1 to Wave-2), 104 participants (13.5%) were newly certified with a need for care in the long-term care insurance system. After controlling for important confounders, elders with a change in the MMSE score of 0 to -0.5, -0.5 to -1, -1 to -2 and less than -2 per year were 1.73 (95% confidence interval, 0.93-3.23), 1.94 (1.01-3.45), 1.95 (1.02-3.76) and 3.16 (1.68-5.98) times as likely to be newly certified with a need for care in the long-term care insurance system, respectively, compared those with a change in the score greater than 0. The extent of change in the MMSE score per year independently predicted the incident certified need for care in the long-term care insurance system in a general population of older Japanese subjects. A decrease of greater than 0.5 points per year may be a useful cutoff value for clinically evaluating elders.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):86-93. DOI:10.3143/geriatrics.52.86
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):100-1. DOI:10.3143/geriatrics.52.100
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    ABSTRACT: Our aim in this study was to explore individual factors that make it likely for Japanese older adults to engage in communication with important other persons regarding their preferences for end-of-life care. We conducted a questionnaire survey of outpatients at Tokyo Metropolitan Geriatric Hospital in the last six days of March 2012. Nine-hundred and sixty-eight outpatients consented in writing to participate in this survey. Two items on the questionnaire concerned the participants' attempts to communicate their preferences regarding end-of-life care; that is, whether they had discussed this issue with their significant others and whether they had written notes indicating how they want to be cared for in the final days of their lives. The participants who had designated a surrogate decision-maker were more likely to report answers of both than only discussion (OR=2.52) and less likely to reports answers of no communication than only discussion (OR=0.37). In addition, (a) those who did not wish to rely on artificial nutrition or hydration (OR=0.68) and (b) those who often thought about their death were more likely to be in the only discussion group than in the no communication group, although these factors were not significantly associated with whether the participants were likely to be in the both or only discussion groups. Our findings indicate that individuals often attempt to clarify their preferences in order to make it easier for their significant others to make end-of-life care decision on their behalf, so that they may receive their desired care.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):79-85. DOI:10.3143/geriatrics.52.79
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    ABSTRACT: In Japan, the imbalance in the medical workforce has caused a deterioration of rural medicine. We explored the differences in speciality preferences and career determinant factors among students to identify keys to increase the recruitment of physicians to rural areas. We conducted a survey of first- and fifth-year medical students, using a questionnaire enquiring about their specialty preference and career determinant factors. The data were analyzed with a chi-square test. A higher percentage of first-year students preferred to be basic medicine scientists, while fifth-year students considered internal medicine subspecialities, obstetrics and gynecology, anesthesia, and ophthalmology to be the most desirable. The factor analysis yielded five factors responsible for these findings; high social approval of the specialty, working hours, income, advice from senior classmates and doctors, and the work environment. The percentage of students who considered rural practice as a choice for thier future plan and had an awareness of the collapse of rural medicine was lower in the fifth-year students than in the first-year students. To increase the medical work force in provincial areas, it is necessary to strengthen not only the medical system with regard to general medicine, but also to offer better medical education in rural areas. More information about rural practice should therefore be transmitted to medical students.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):48-54. DOI:10.3143/geriatrics.52.48
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    ABSTRACT: This study sought to investigate the influence of intervention by therapists at night on the patient's ADL's, number of falls, etc. On convalescent rehabilitation units in order to examine the efficacy of the intervention. The study subjects included patients hospitalized on 11 convalescent rehabilitation units. The period of intervention by the therapists at night and the period of no intervention were each set for three months. The improvements in the ADL scores during each period were compared, and the changes in the number of falls were examined. In addition, a questionnaire survey was conducted among the night shift staff in order to examine the need for intervention. The patients who received intervention by therapists at night showed higher scores for BI, FIM, etc. and fewer falls than those treated without intervention. The results of the questionnaire survey indicated differences between the therapists and other professionals regarding their attitude toward working the night shift. Our findings suggest that intervention by therapists at night results in favorable outcomes, e.g., improvements in the patient's ADL's and a reduction in the number of falls. Although there are issues to be discussed with respect to raising awareness among therapists and concerns regarding work-related problems, intervention by therapists at night has the possibility to be used as a new treatment strategy on rehabilitation units.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(1):55-60. DOI:10.3143/geriatrics.52.55
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    ABSTRACT: An increasing incidence of extended-spectrum β-lactamase (ESBL-) producing Escherihia Coli poses a difficult problem for clinicians to establish an optimal strategy for the effective antibiotic treatment of urinary tract infections (UTI). (1) Fosfomycin/minocycline (FOM/MINO) or rifampicin/sulfamethoxazole-trimethoprim (RFP/ST) combinations and (2) levofloxacin (LVFX) alone were used as an internal medication, and (3) cefoperazone/sulbactam (CPZ/SBT) and (4) meropenem (MEPM) were administered through intravenous injection. The selection of antibiotics was done empirically, according to the history and severity of illness and urinary findings, and the presence of comobidities. The efficacy of the treatment was determined by the absence of any pathogenic bacteria from a urinary culture after treatment. ESBL-producing and LVFX resistant non-ESBL producing E. coli were detected by an initial urinary culture in 33 and 10%, respectively, of the specimens before treatment. All the ESBL-producing E. Coli colonies were resistant against LVFX. The efficacy of the treatment was 9/11 (82%) in the FOM/MINO-RFP/ST group, 9/14 (64%) in the LVFX group, 9/16 (56%) in the CPZ/SBT group, and 19/27 (70%) in the MEPM group. In the FOM/MINO・RFP/ST group, ESBL-producing E. Coli were detected in the urine before treatment in 5 out of 16 patients and those E. coli disappeared after treatment in all 5 patients. In the LVFX group, the drug was changed to MEPM in 6 out of 15 patients soon after the presence of ESBL-producing/LVFX resistant E. Coli was identified by a urinary culture. In the CPZ/SBT group, ESBL-producing and/or LVFX-resistant E. coli disappeared in 4 out of 6 cases, while they were newly found in post-treatment urine cultures in 2 patients. In the MEPM group, 15 out of 28 patients initially had ESBL-producing/LVFX resistant E. Coli and those drug-resistant E. Coli disappeared from their urine after treatment in all patients. The drug susceptibility test of the urinary culture from all the patients with UTI showed CPZ/SBT-resistant colonies to be found in 19 out of 32 specimens, while AMPC/CVA-resistant ones were found in 9 out of 32 of ESBL-producing E. Coli. Our present study demonstrates that FOM/MINO or ST combinations were effective in the treatment of ESBL-producing E. Coli in mild cases of UTI and MEPM in severe cases. When using β-lactam/β-lactamase inhibitor combinations, the effect should be ascertained by examining post-treatment urinary specimens, because of the presence of ESBL-producing E. Coli strains which are resistant to those antibiotics.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2015; 52(2):153-61. DOI:10.3143/geriatrics.52.153
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    ABSTRACT: The Japan Geriatrics Society (JGS) published the JGS Guidelines for Decision-making in the Care of the Elderly Focusing on Indications for Artificial Hydration and Nutrition (AHN) in June 2012. While these guidelines have been implemented in medical practice, they have not pervaded the awareness of the common public, especially in the countryside. Therefore, we developed a set of guidelines and a support tool for the use of AHN in older adults in our community, northern Iwate Prefecture, Japan in accordance with the original guidelines. Our guidelines consist of three sections: "The wishes of the patient and his/her family members,"Evaluation of the patient's general medical condition" and "The selection of a facility for medical treatment." People from various occupations took part in our conference, including patients and their family members, attending doctors and nurses, social workers, speech therapists, nursing home staff and so on. The first and foremost priority is to consider whether the decision to extend a patient's life corresponds with that patient's own narrative. It is burdensome for non-experts to participate in a conference attended by a variety of professionals. Therefore, we created a support tool for introducing AHN in order to alleviate psychological stress among the participants of this conference. The tool consists of 28 items in which the participant is asked to answer all questions, in the expectation that this activity will reduce their mental burden. It is important to conduct such activities, as well as improve the quality of the content of the guidelines and support tool.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(3):271-6. DOI:10.3143/geriatrics.51.271
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(1):35-8. DOI:10.3143/geriatrics.51.35
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    ABSTRACT: Aim: The purpose of this study was to investigate changes over one year in the prevalence of kyphosis, the ability to perform activities of daily living and self-efficacy among elderly residents of mountainous areas. Methods: The subjects included 155 elderly residents of mountainous areas (68 males, 87 females) aged 65 or older who participated in both our initial and follow-up investigations. The investigations were conducted via interviews using questionnaires and the index of kyphosis (I/K). The subjects were divided into three groups (non-kyphosis, kyphosis without changes, kyphosis with worsening) according to the change in I/K. Results: The average patient age was 74.9±6.2 years. The average I/K on the initial investigation was 10.0±3.7 (2.4-20.0). On the follow-up investigation, the average I/K increased slightly to 10.2±3.6 (3.0-22.9). A particularly large number of females 65 to 69 years of age exhibited an increase in the I/K. The percentage of subjects with an I/K of 13.0 or above was 20.6%. The male kyphosis sufferers demonstrated a significant decrease in the health-related QOL categories of "able to fulfill everyday life roles (physical)" and "able to fulfill everyday life roles (mental)." There were no significant differences between the females with and without kyphosis. One year later, there were significant differences between the three groups in terms of the health-related QOL categories of "vitality" and "ability to live in society." Conclusions: Female kyphosis sufferers are affected by psychological factors. Kyphosis should be detected early and carefully followed up in elderly patients in order to prevent the need for nursing care, and appropriately estimating the patient's physical condition is required to prevent a decline in the lower limb function.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(1):60-8. DOI:10.3143/geriatrics.51.60
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(1):46-8. DOI:10.3143/geriatrics.51.46
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(2):135-7. DOI:10.3143/geriatrics.51.135
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(3):225-8. DOI:10.3143/geriatrics.51.225
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2014; 51(2):191. DOI:10.3143/geriatrics.51.191