Japanese Journal of Geriatrics最新文献

Aim: This study aimed to evaluate the use of potentially inappropriate medications (PIMs) and to examine the number of oral medicines based on the swallowing function and activities of daily living (ADL) categories in a geriatric medical care ward.

Methods: A prospective investigation of oral medication use of 124 consecutive patients (male, n=58; female, n=66) admitted to a geriatric medical care ward was conducted from November 2019 to October 2020. Nutritional routes and ADL categories were quantitatively assessed, and the respective medication quantities were subjected to a statistical analysis.

Results: The average number of oral medications was 5.8 at acute care admission, 4.4 upon transfer to the geriatric medical care ward and 4.8 at discharge. Approximately 30% of oral medications were classified as PIMs, including antithrombotic agents, diuretics, antidiabetic drugs, magnesium oxide, sleep and anxiolytic medications, and antipsychotic drugs. Magnesium oxide, antipsychotic drugs, sleep and anxiolytic medications were frequently discontinued during the patient's stay at the geriatric medical care ward. The proportion of PIMs significantly decreased from 35.1% at admission, to 28.8% at ward transfer, and 24.3% at discharge (P<0.01). The number of oral medicines at discharge varied based on the nutritional route, with averages of 5.5 for oral intake, 3.6 for enteral nutrition, and 0.7 for venous nutrition. It also varied based on ADL categories, with averages of 6.0 for ADL 1, 5.8 for ADL 2, and 3.8 for ADL 3.

Conclusion: The use of PIMs decreased in the geriatric medical care ward. A reduced swallowing function and lower ADL were associated with a decrease in the quantity of oral medicines.

Aim: Proton-pump inhibitors (PPIs) are widely used. However, reports of their adverse effects are increasing. Older patients are prone to developing hyponatremia due to various factors. The special environment of a geriatric healthcare facility tends to subject these patients to long-term medication use. Therefore, we hypothesized that nursing home residents receiving PPIs will present hyponatremia.

Methods: The residents of Shonan Silver Garden, a long-term care health facility for older adults, were divided into two groups: a control group (n=61) which did not receive proton-pump inhibitors and a PPI group (n=29), which received proton-pump inhibitors for at least 6 months. The PPI group was further divided into the lansoprazole group (LPZ group) and the other PPI group. Other PPI users were excluded due to small numbers. The blood test results were compared between the control and LPZ groups. In the LPZ group, blood samples were taken 1 month after the discontinuation of lansoprazole, and serum Na level was compared to the level before discontinuation.

Results: Blood Na levels in the PPI were lower than those in the control group, and hyponatremia (<136 mEq/L) was more frequent in the LPZ group than in the control group. There were no significant differences in other blood test parameters between the control and LPZ groups. At one month after the discontinuation of lansoprazole, serum Na levels were significantly increased; however, they remained lower than those in the control group.

Conclusion: A higher rate of hyponatremia was induced in older residents of long-term care facilities who took lansoprazole for >6 months in comparison to those who did not take lansoprazole.

Aim: The purpose of this study was to categorize and clarify transitions in the health status of older adults living in the community during the coronavirus disease (coronavirus disease 2019: COVID-19) pandemic.

Methods: The participants were older adults (≥65 years of age) who lived in Takasaki City, Gunma Prefecture. The survey items included basic information and subjective health perception (questionnaire for medical checkup of old-old). Latent class analyses were conducted for the first (baseline) and second surveys (6 months). The scores for each item were compared to identify the characteristics of each class at baseline and at 6 months. In addition, transitions in class affiliation from baseline to 6 months were summarized.

Results: A total of 434 of 1,953 participants (mean age: 79.1 years, 98 males and 336 females) completed the survey (22.2%). In both time periods, the responses were categorized into four classes: 1) good, 2) poor physical, oral and cognitive function, 3) poor social status and lifestyle, and 4) poor in all except social status and lifestyle. During 6 months of follow-up, a transition from the generally good class to the poor physical, oral and cognitive functions class was observed in many cases.

Conclusions: The health status of the older adults living in the community was classified into four classes, and changes in health status occurred even within a short period of time during the COVID-19 pandemic.

Robot-assisted radical cystectomy (RARC) has become a gold standard therapeutic option for muscle-invasive bladder cancer and selected cases with T1 bladder cancer. Due to the rapid aging worldwide and the outstanding performance of the da Vinci surgical system, the surgical indication of RARC in elderly men is often a matter of controversy. In this manuscript, we investigated previous literature regarding the complication rates and frailty among elderly patients undergoing RARC for bladder cancer.

A 79-year-old woman was admitted to our hospital with a diagnosis of acute noncardioembolic stroke on division of the left middle cerebral artery with non-fluent aphasia. Although she was treated with dual antiplatelet therapy of aspirin and clopidogrel at first, she suffered a second stroke with enlargement of the same stroke lesion and worsening aphasia symptoms. There were only 46 days between the initial onset and recurrent stroke event.She had been diagnosed with polycythemia vera (PV) based on an increase in the blood cell count and a JAK2 mutation. The administration of hydroxyurea was effective for normalizing the blood cell count and preventing stroke recurrence. Cerebral infarction with or without any risk factors accompanied by an elevated blood cell count with a hematocrit value >45% can be PV, so it is necessary to start cytoreductive therapy as soon as possible in such cases.