Japanese Journal of Geriatrics最新文献

Aim: In recent years, the impact of walkability, a measure of the residential environment, on public health has gained importance. However, few studies have examined the relationship between walkability and the cognitive function in older people. This study examined the cross-sectional and longitudinal associations between neighborhood walkability and the cognitive function among community-dwelling older adults, stratified by age group and gender.

Methods: This study analyzed data from the SONIC study, involving 1,675 participants 70±1 and 80±1 years old. A cross-sectional analysis assessed the relationship between walkability and cognitive impairment, while a longitudinal analysis focused on 268 participants with a normal cognitive function at baseline. Cognitive decline was defined as a MoCA-J score of <25. Walkability was evaluated using the Walk Score^®, categorized into three groups: Car-dependent (0-49), Walkable (50-89), and Walker's Paradise (90-100).

Results: In the cross-sectional analysis, the adjusted odds ratio for cognitive decline was significantly lower in the Walkable group than in the Car-dependent group for both sexes and those in their 70s. In the longitudinal analysis, the odds ratio for new-onset cognitive decline was significantly lower in men in the Walker's Paradise group than the Car-dependent group, at 0.146 (95% confidence interval: 0.025-0.855).

Conclusions: Higher neighborhood walkability is associated with a lower prevalence of cognitive decline and a lower incidence of new-onset cognitive decline in men in community-dwelling older adults. Creating walkable environments may be effective in the primary prevention of cognitive decline.

Objective: To examine the association between barriers to social participation and the risk of undernutrition in older adults with diabetes.

Methods: The subjects were outpatients with diabetes ≥60 years old at Ise Red Cross Hospital. The risk of undernutrition was measured using the Mini Nutritional Assessment Short Form, and a total score of ≤11 was defined as being at risk. The Social Participation Barriers in Patients with Diabetes (SPBD) questionnaire, which consists of 10 items, was used to measure social participation barriers. A logistic regression analysis was performed using the respective SPBD score quartiles (Q1-Q3) for men and women, with the risk of undernutrition as the dependent variable and SPBD score (based on the Q1 group) as the explanatory variable.

Results: In total, 310 patients (187 men and 123 women) were included in the analysis. In men, the adjusted odds ratios for the risk of undernutrition in Q2 and Q3 based on Q1 were 1.56 (95% confidence interval [CI], 0.63-3.83; p=0.328) and 4.52 (95% CI, 1.78-11.46; p=0.001), respectively. In women, the adjusted odds ratios for the risk of undernutrition of Q2 and Q3 based on Q1 were 2.87 (95% CI, 0.85-9.61; p=0.087) and 3.73 (95% CI, 0.88-15.82; p=0.073), respectively.

Conclusion: The results of this study in older people with diabetes showed that barriers to social participation were associated with a risk of undernutrition in men. In particular, hyperglycemia, diabetes treatment, and value-based barriers to social participation were associated with the risk of undernutrition. It is important to raise awareness of the barriers to social participation from the viewpoint of nutrition in older people with diabetes.

A 72-year-old woman with a history of hypertension who had already been taking calcium channel blockers and angiotensin II receptor blockers was prescribed additional indapamide (1 mg/day) due to inadequate blood pressure control. Two weeks later, she experienced loss of appetite and fatigue. Seeking medical attention, she was diagnosed with significant hyponatremia with a serum sodium level of 110 mEq/L at a local clinic, leading to her referral and subsequent admission to our department. Although her consciousness remained clear, laboratory findings revealed a serum sodium level of 116 mEq/L, blood urea nitrogen of 7 mg/dL, blood glucose of 96 mg/dL, and plasma osmolarity of 239.8 mOsm/kg·H₂O, consistent with hypotonic hyponatremia induced by indapamide. Indapamide was discontinued and normal saline was administered. By the 6th day of hospitalization, her serum sodium level had improved to 130 mEq/L, and her symptoms had resolved.Thiazide-like diuretics can induce hyponatremia as a side effect with diverse symptoms and variable onset. However, in this case, hyponatremia was promptly detected shortly after the initiation of indapamide therapy, and no gastrointestinal symptoms other than anorexia were observed. When initiating thiazide-like diuretics, it is essential to be vigilant for hyponatremia and to provide appropriate medication guidance to patients in addition to monitoring their serum sodium levels.

Aim: The present study clarified the relationship between the temperature of bath water, the presence of systolic hypertension, the presence of antihypertensive medication, and the pulse rate during bathing, focusing on the variation of systolic blood pressure.

Methods: Twenty community-dwelling men 61 to 87 years old were included in the study. The subjects were randomly divided into 2 groups, based on bath temperature 39°C and 41°C. They were then given a full-body bath for 10 minutes.

Results: The variables significantly related to the change in systolic blood pressure from 2 to 8 minutes after bathing were the presence or absence of antihypertensive medication, and the interaction between the presence of antihypertensive medication and the change in pulse rate from 2 to 8 minutes after bathing.

Conclusions: Antihypertensive medication had a favorable effect on the reduction of systolic blood pressure during bathing.

Aim: Very few reports have investigated the association between frailty and postoperative outcomes in total knee arthroplasty (TKA) and total hip arthroplasty (THA), making the accumulation of evidence an urgent task. This study aimed to clarify the effect of preoperative frailty on short-term postoperative outcomes in patients undergoing TKA/THA.

Methods: This prospective cohort study, conducted from December 2023 to September 2024, included 19 patients (mean age±standard deviation, 73.8±7.2 years) scheduled for TKA/THA. Frailty was assessed preoperatively using the Questionnaire for Medical Checkup of Old-Old (QMCOO) and the Japanese version of the Cardiovascular Health Study (J-CHS) criteria, along with the Functional Independence Measure (FIM). FIM scores were also evaluated one week postoperatively. Postoperative FIM scores were compared based on frailty status.

Results: Of the 19 patients, 6 (31.6%) were classified as having frailty based on the QMCOO (score≥5) and 7 (36.8%) met the frailty criteria according to the J-CHS. With regard to the preoperative to postoperative FIM score change, the QMCOO≥5 group showed a significantly larger decline (-23.2±10.1 points, [median, -19.5]) in comparison to the QMCOO<5 group (-13.8±4.7 points, [median, -15.0]) (p=0.029). Similarly, patients classified as having frailty according to the J-CHS (-23.1±8.8 points, [median, -20.0]) experienced a greater FIM decline than the non-frailty (-13.1±4.4 points, [median, -13.5]) (p=0.004). Moreover, patients classified as frail according to J-CHS had lower FIM scores at one week postoperatively (p<0.001), with a significantly higher proportion of patients scoring < 110 points (p=0.017).

Conclusions: Preoperative frailty may negatively affect short-term postoperative outcomes after TKA/THA.