Japanese Journal of Geriatrics最新文献

In elderly diabetes patients with an impaired cognitive function and activities of daily living, multiple daily insulin injection (MDI) therapy is associated with poor injection rates. However, patients with insulin-dependent conditions, such as type 1 diabetes, need to continue insulin therapy. Intermittently scanned continuous glucose monitoring (isCGM) and smart insulin pens have recently emerged as devices for blood glucose management. Smart insulin pens are devices that automatically record the insulin injection time and injection units of insulin and wirelessly transfer the data to a smartphone application. We herein report an elderly patient with type 1 diabetes who was treated with a smart insulin pen.An 84-year-old woman was diagnosed with type 1 diabetes at 45 years old and had been receiving MDI therapy. She had frequent unconscious hypoglycemia and thus had isCGM introduced at 80 years old. Her Mini-Mental State Examination score was 20 points, indicating mild cognitive decline, and isCGM revealed repeated hyperglycemia due to forgetting her insulin injection and hypoglycemia due to over-dose of insulin. When she was hospitalized for diabetic ketosis at 84 years old, a smart insulin pen was introduced. Following this introduction, her family and medical staff checked her insulin records and encouraged her to perform injections. She subsequently no longer experienced hyperglycemic crisis or severe hypoglycemia.Elderly patients with type 1 diabetes often have difficulty with self-management of MDI therapy. Smart insulin pens are expected to reduce the rate of forgetting insulin injections and improve injection rates.

Aim: This study investigated the issues experienced by home care workers in providing home care support for older adults on insulin therapy.

Methods: Semi-structured interviews were conducted with six home care workers, and the resulting data were coded. Data with approximate semantic content were aggregated, organized, and divided into categories and subcategories. The participants were asked about the nature of the support they provided to older adults with diabetes requiring insulin therapy, the difficulties they experienced in doing so, and their thoughts on solutions.

Results: A total of 290 codes were extracted from the narratives of home care workers. The codes were then aggregated and categorized. Support provided to diabetic older adults requiring insulin therapy was organized into seven categories, such as "substitution of family care"; problems in providing this support were organized into eight categories, such as "substitution of medical care" and "gap between the system and needs"; and ideas on solutions for the future were organized into five categories, such as "improvement of expertise in home care," "creation of an organization and system for providing support to diabetic older adults requiring insulin therapy," and "information sharing and establishment of a cooperative system with medical personnel."

Conclusion: Home care workers provide support to older adults with diabetes who require insulin therapy in place of medical personnel and family caregivers. Furthermore, home care workers cannot cooperate with medical personnel. These findings suggest that the system for training home care workers to provide support to older adults with diabetes requiring insulin therapy and the scope of their duties should be reviewed. In addition, information on insulin therapy should be shared among professionals related to home care, and a system of cooperation and collaboration should be established to ensure that home care workers do not need to replace medical care workers.

Aim: This study investigated the relationships between loneliness, health status (including frailty), sense of purpose in life, and lifestyle behaviors among individuals with disabilities living in officially designated depopulated areas. Participants held either a disability certificate or a medical certificate for intractable diseases.

Methods: Self-administered questionnaires were distributed via mail or employment support facilities. Based on the median score on the UCLA Loneliness Scale ("UCLA score"), participants were divided into high- and low-loneliness groups. The Mann-Whitney U test was used for continuous variables (age, age at onset, and BMI), while chi-square or Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis identified the factors associated with high loneliness.

Results: In total, 173 valid responses were obtained (response rate: 100%). The Hosmer-Lemeshow test showed a good model fit (p = 0.94). Two significant factors associated with higher UCLA scores were as follows: (1) a strong feeling of not living an enjoyable or purposeful life (odds ratio = 2.169, 95% confidence interval = 1.371-3.431, p = 0.001) and (2) frailty status (odds ratio = 5.528, 95% confidence interval = 2.497-12.240, p < 0.001).

Conclusion: Individuals with disabilities living in depopulated areas may face increased frailty as they transition to long-term care. Integrating social prescribing, an approach expected to reduce loneliness, into existing disability welfare programs may help prevent further health deterioration.

An 88-year-old woman was referred to our hospital due to body weight loss (9 kg) over one year. Bronchoscopy revealed Mycobacterium avium, and antimicrobial treatment was initiated. Three months later, a chest CT scan revealed a mass shadow in the left lingular segment. After a second bronchoscopic examination, a pathological diagnosis of diffuse large B-cell lymphoma was made. After one course of chemotherapy, the mass in the left middle lobar significantly decreased in size. We report a case of malignant lymphoma with NTM in an elderly patient. Impaired immunity may have played a role in the development of both diseases. In an aging society, complications associated with both diseases may increase. Careful and detailed examination is essential.

Aim: The social isolation of older Japanese adults with infrequent contact with others diminishes appetite, reduces food intake, and worsens their nutritional status. However, there is insufficient evidence regarding the association between social isolation and nutritional status, with studies primarily confined to rural and suburban areas. This cross-sectional study aimed to investigate the association between social isolation and nutritional status among older adults residing in urban areas.

Methods: This cross-sectional analysis included 1,052 adults (mean age, 78 years). Nutritional status was assessed using the Mini Nutritional Assessment^® Short Form, with a score of 11 or below indicating malnutrition. Applying the abbreviated Lubben Social Network Scale, a score < 12 was considered indicative of social isolation. Logistic regression was applied to the entire population, then the population was separated by sex, with social isolation as the independent variable and malnutrition as the dependent variable. The covariates included age, living alone, economic status, health, daily activities, smoking habits, drinking habits, and years of education.

Results: Social isolation was observed in 41.7% (n = 439) of the total population, while malnutrition was observed in 27.4% (n = 288). Social isolation was significantly associated with malnutrition (odds ratio: 1.41, 95% confidence interval: 1.06-1.88). Sex subgroup analyses revealed that a significant association was retained only among female participants.

Conclusions: Social isolation has been associated with malnutrition among older urban adults in Japan. Future longitudinal studies of the nutritional status of socially isolated individuals are essential.