Japanese Journal of Geriatrics最新文献

Myocarditis is a group of inflammatory diseases that primarily affect the myocardium. It includes various pathological conditions. In addition to viruses, which are the main etiological agents, other causal agents, including bacteria, toxic substances, autoimmunity, and drugs, including vaccines, can also induce the disease.In Japan, an outbreak of coronavirus disease 2019 (COVID-19) began in January 2020, and COVID-19 messenger RNA (mRNA) vaccinations have been widely used since February 2021.Myocarditis after vaccination is reported to be more common in young males, particularly after the second vaccination. We report the case of an 80-year-old woman with no history of cardiovascular disease who was hospitalized with acute pulmonary edema one week after receiving her third dose of mRNA vaccine. She had elevated myocardial markers, new complete left bundle branch block, and a decreased left ventricular ejection fraction relative to before the onset; however, there was no stenosis or coronary artery occlusion that could have caused the disease. Although a myocardial biopsy could not be performed, myocarditis after vaccination was diagnosed based on detailed clinical findings. With noninvasive positive pressure ventilation and diuretics without steroids, the patient improved and was discharged on the 11th day. However, 1.5 years later, she developed a complete atrioventricular block and a permanent pacemaker was implanted. This case suggests that even older women can develop myocarditis after the third vaccination dose. We should carefully consider whether vaccination should be administered, even in older patients.

Aim: The dementia support team (DST) is an initiative established based on the knowledge that, when individuals with dementia or older people at risk for delirium are hospitalized because of physical illnesses, there are often cases in which their cognitive symptoms rapidly deteriorate. However, the activities of each hospital are unknown. Therefore, a nation-wide survey of DSTs was conducted.

Methods: A questionnaire survey was conducted among 1,032 hospitals throughout Japan.

Results: A total of 422 responses were obtained, of which 292 were valid. The main results were as follows: number of beds (200 to <500 beds, n=171), number of types of medical staff (≥4 types, n=248), number of patients for intervention/month (30 patients to <100 patients, n=164), number of team meetings/week (1/week, n=240), cognitive function assessment (Hasegawa Dementia Scale Revised [HDS-R], n=141), advice regarding medication (n=279), rehabilitation (n=243), reduction of physical restraint (n=274), nutrition (n=200) and discharge adjustment (n=233). Patients were divided into 2 groups for analyses: those requested by the other divisions (n=121; 41.4%) and those managed by DST (n=171; 58.6%). There was a higher rate of requested by the other divisions than the managed by the DST related advice for medications and rehabilitation. However, the differences were not statistically significant.

Conclusions: The present study revealed that requests from other divisions involved a higher rate of advice on medication and rehabilitation than the managed by the DST. Further studies are required to confirm this hypothesis.

Objective: Peer support, including family associations and dementia cafés, helps reduce the psychological burden on patients with dementia and their caregivers. By considering various aspects of peer support, this study aimed to determine its psychological impact on caregivers, efficacy, and related challenges.

Method: In June 2023, we conducted a web-based questionnaire survey of caregivers of people with dementia.

Results: Among 3,318 respondents, 29.3% were aware of peer support, but only 14.0% participated. The important determinants of participation were low time-related and psychological barriers. Among the participants, 46.4% learned about peer support from a care manager, which is a significantly higher proportion than from other sources (p<0.001). The question of whether the means of obtaining information was "psychologically positive" was answered positively by more peer support participants (62.4%) than by non-participants (individuals who obtained information outside of peer support; 59.5%; p=0.390). Participation was rated as "psychologically positive" by a significantly higher proportion (93.9%) of caregivers still participating in peer support than by those who no longer participated (55.9%; p<0.001). Reasons for continued participation included ease of participation and enjoyment.

Discussion and conclusion: The survey revealed a positive psychological impact of peer support, which was higher among those who continued to participate. Caregivers of people with dementia need to be informed about the availability and efficacy of peer support soon after a dementia diagnosis. To ensure the continuous provision of support, the convenience and design of peer support needs to be improved in response to various care needs.