Journal of Clinical Gerontology and Geriatrics最新文献

Background/Purpose

Psychotropics are administered to control behavioral and psychological symptoms of dementia. In 2005, the Food and Drug Administration (FDA) issued alerts regarding their use as antipsychotics in elderly patients with dementia-related psychosis. Guidelines on psychotropic use were also recently established in Japan; however, few studies have reported on the actual usage of psychotropics among patients with dementia in clinical settings. The aim of this study was to estimate the frequency of psychotropic use in patients with Alzheimer's disease receiving donepezil.

Methods

Data from six prospective, postmarketing studies of donepezil in patients with Alzheimer's disease conducted between 1999 and 2011 were pooled for analysis. Patient and clinical characteristics at baseline were analyzed descriptively. The proportion of psychotropics used concomitantly with donepezil was calculated for all patients and for patients divided into types of psychotropics used, sex, age, and study time period. As for the study time period, studies were divided into two groups: the period before the FDA alert was issued (1994–2004) and the period after (2005–2011).

Results

A total of 14,726 patients were analyzed (67.0% women, aged 79.3 ± 7.2 years). The overall proportion of psychotropic use was 24.2%. The number of psychotropics used was one in 8.2% of patients, two in 8.1%, and ≥ 3 in 5.5%. The types of psychotropics used were as follows: typical antipsychotics, 7.8%; atypical antipsychotics, 4.4%; antidepressants, 5.7%; anxiolytics, 6.4%; and hypnotics, 11.0% (% does not sum up to 24.2% due to multiple use). With regards to the time periods, in studies conducted between 1999 and 2004 versus those between 2005 and 2011, the proportions were 31.7% and 21.3%, respectively.

Conclusion

Psychotropic use was seen in a quarter of patients with dementia receiving donepezil in Japan. Additionally, the overall proportion decreased after the alert issued by the FDA in 2005.

Background

Total hip/total knee replacement (THR/TKR) surgery is becoming an increasingly common approach for the management of primarily lower limb osteoarthritis. A number of factors such as reducing mobility, structural joint changes, and pain may predispose those awaiting hip and knee surgery to falls, which may impact on pre- and postsurgery functions. The aim of this study was to identify the prevalence of falls in the year preceding THR/TKR surgery, and factors associated with falls.

Methods

Cross-sectional survey of patients scheduled for THR/TKR, including measures of joint disease severity, falls, falls efficacy, quality of life, pain, and depression. Comparisons across falls status (nonfaller, single faller, or multiple faller) and high/low disease severity for both THR and TKR groups were undertaken.

Results

A total of 282 people (mean age 67.3 years) completed surveys before the surgery (197 TKR). As much as 41% reported one or more falls in the preceding year, and participants reported that the affected joint contributed to the fall in 35% of the cases. TKR multiple fallers (≥ 2 falls) had significantly lower falls efficacy, worse function, greater pain catastrophizing and depression, and poorer 36-Item Short Form Survey Mental Component Scores than nonmultiple fallers. For both THR and TKR groups, several measures were significantly worse for those with greater disease severity, including falls efficacy, depression, pain catastrophizing, self-rated health, and physical activity.

Conclusion

Falls are common in the 12 months preceding total hip or knee surgery. A number of factors are associated with risk of multiple falls and with joint disease severity. Strategies to reduce falls risk should be a priority in the year preceding lower limb joint surgery to optimize presurgery and postsurgery outcomes.

An 89-year-old man presented with multiple cerebral infarction, and subsequently, thrombotic thrombocytopenic purpura (TTP) was diagnosed. He was treated with plasma exchange (PEX), however, despite the initial response, he was refractory to PEX. The addition of rituximab led to a sustained complete response. This case presents the oldest known reported TTP patient treated with rituximab and shows that rituximab can be administered successfully to very elderly patients with refractory TTP, and that therapeutic modalities similar to those for younger patients can be considered for this age group. This case also shows that elderly TTP patients may present with uncommon symptoms.

Background/Purpose

Oxidative stress is thought to be involved in the development of vascular dysfunction. Arterial stiffness is one of the most significant manifestations of aging and vascular disease. We investigated whether increased malondialdehyde-modified low-density lipoprotein (MDA-LDL), which is responsible for oxidative stress, was associated with increased arterial stiffness, independent of confounders of cardiovascular disease.

Methods

The participants comprised 10 men aged 70 ± 7 years (range, 61–82 years) and 86 women aged 67 ± 7 years (range, 53–81 years). Peripheral arterial stiffness was evaluated by the mean of the right and left brachial to ankle pulse wave velocity (baPWV).

Results and conclusion

Both right and left baPWV values of Tertile-2 (61–81 U/L) and Tertile-3 (82–218 U/L) categorized by tertiles of the MDA-LDL level were significantly higher than those of Tertile-1 (34–60 U/L; p = 0.022 and p = 0.018, respectively). The multivariate-adjusted baPWV increased significantly from the lowest to the highest MDA-LDL group. Both baPWV values of Tertile-2 (61–81 U/L) and Tertile-3 (82–218 U/L) were significantly higher than those of Tertile-1 (34–60 U/L) (p = 0.044 and p = 0.044, respectively). To further investigate whether MDA-LDL can explain baPWV levels independent of other known confounding factors, multiple linear regression analyses for baPWV were conducted, which showed that MDA-LDL levels (β = 0.164, p = 0.037) were independently and significantly associated with baPWV as well as gender, age, and presence of raised blood pressure. In addition, we found that a slightly high–normal MDA-LDL level within a normal range is significantly associated with a higher baPWV. MDA-LDL levels are associated with an increased risk of arterial stiffness in community-dwelling persons.

Background

There have been no local studies on the duration and risk factors for vancomycin-resistant enterococcus (VRE) colonization in a postacute convalescence hospital. Our aim was to investigate the duration of VRE colonization and risk factors for prolonged carriage among patients admitted to a convalescence hospital.

Methods

The case records of patients admitted to a 400-bed convalescence care hospital with rectal swab or stool culture samples positive for VRE from January 2010 to December 2014 were retrieved. The clinical characteristics associated with clearance of colonization within the hospitalization period were analyzed, and logistic regression was set up to detect for factors associated with inpatient and 1-year mortality.

Results

A total of 121 patients (mean age, 81.45 years) were colonized with VRE. The inpatient clearance rate was only 35.5%. The median time to VRE clearance during the hospital stay was 43 days. The independent predictors for VRE colonization during hospitalization were old-age-home residents [odds ratio (OR) = 2.72; 95% confidence interval (CI), 1.14–6.48] and antibiotics use (OR = 4.27; 95% CI, 1.89–9.62). Inpatient mortality was higher among those with persistent VRE colonization upon discharge (39.7% vs. 18.6%, p = 0.017). Presence of wound or bed sores (OR = 4.58; 95% CI, 1.16–13.2), chair/bed bound status (OR = 3.64; 95% CI, 1.27–10.46), and persistent VRE colonization (OR = 12.4; 95% CI, 3.16–42.52) were predictors for 1-year mortality.

Conclusion

The strongest risk factor for prolonged VRE carriage was old-age-home residents. Survival is adversely affected by VRE carriage and functional mobility. Patients with these factors should be managed more carefully, and active surveillance should be focused on this high-risk group to prevent spread of transmission.

Background/Purpose

We examined whether a 3-month Japanese drum exercise program can ameliorate depressive mood and improve physical fitness in community-dwelling older women.

Methods

The participants were 40 community-dwelling older women aged 65 years and older who satisfied one or more of the mood items on the Kihon checklist. They were divided into two groups: a 3-month Japanese drum exercise group and a control group. The study included 21 women who participated in Japanese drum exercises (mean age, 76.8 ± 5.2 years) and 19 control participants (79.8 ± 5.4 years). To evaluate the participants' psychological status, we used the depression item (D) on the short form of the profile of mood states. The body composition of participants was determined using bioelectrical impedance analysis. In addition, gait speed, grip strength, and scores on the morale scale, the geriatric depression scale, the trail making test, and the mini-mental state examination were measured before and after the intervention.

Results

After the 3-month intervention, we found no significant main effect-induced differences (p = 0.135) in Profile of Mood States between the groups. No significant difference was found between groups for any of the psychophysiological or physical fitness measures after the intervention.

Conclusion

Our results did not support the hypothesis that the Japanese drum exercise can improve depressive mood in older women. However, depressive mood showed a slight improvement in the intervention group, suggesting that a longer or more frequent session of intervention might have had an effect.

Background/Purpose

This study aims to study the factors that affect the stamina of elderly patients during trospium treatment.

Methods

To carry out the experiment, 843 men and women older than 60 years (average age, 68.4 years) who had been taking trospium for 12 months were selected. The questionnaire survey on demographic and social status, financial statement analysis, academic certificates, Overactive bladder Questionnaire short form and Medical Outcomes Study-Short Form questionnaires, bladder diaries, and uroflowmetry were used for studies of adherence to treatment.

Results

The average time of reaching the 30-day trospium-treatment-free period (compliance “survival rate”) was 191 days. The percentage of patients who remained compliant for 6 months and 1 year were 58.3% and 44.0%, respectively. According to our data, the percentage of highly educated (59.3%), married (63.8%), and city (70.6%) residents who are aware of the nature of their disease (77.5%) are significantly higher in the cohort of consistent patients; yet the percentage of caffeine abusers is lower (10.9%). In this cohort, the percentage of income spent on trospium purchase (3.1%) was lower, but income and payment level for medical expenses were higher (p ≤ 0.05 and p ≤ 0.01, respectively, compared with other cohorts). An analysis of regressive models of changes in squared percentage of income and trospium costs has confirmed the hypothesis of the impact of these factors on treatment compliance. In the cohort of consistent patients, the average number of points of role physical, social functioning, role emotional, and mental health values that describe the health impact on the quality of life turned out to be significantly higher. Severe incontinence symptoms (70.8%) and overactive bladder (35.9%) prevailed among patients of this cohort, which were also associated with high treatment efficacy and a significantly lower number of side effects (9.3%).

Conclusion

High trospium treatment compliance among elderly men and women is determined by several uneven demographic, social, economic, and medical factors.