コウレイシャ テンカン ノ モンシンヒョウ ニヨル ソウキ ハッケン : ニンチショウ トノ カンレン ニオイテ

本研究の目的は高齢者てんかんを問診票の活用により、物忘れ外来を含む高齢者複合施設における高齢者てんかんの実態を明らかにすることにある。物忘れ外来を含む高齢者複合施設を調査期間中に利用した417名を対象に、高齢者てんかん問診票を用い、てんかん有病率を算出した。また、新規に高齢者てんかんと判定された者の特徴を記述した。その結果、すでにてんかんの診断ありが7名（1.7%）、問診票の回答内容からてんかんの疑いありは33名（7.9%）、その中から医師の診断により新規に高齢者てんかんが判定された者は14名（3.0%）であった。施設別有病率では、物忘れ外来7名（5.0%）、ショートステイ利用者、グループホーム入所者は2割前後であった。新規に高齢者てんかんと判定された者の問診項目では、意識減損がもっとも多かった。さらに、新規にてんかんが判明したすべての者が何らかの認知症を有していた。本研究により物忘れ外来を含む高齢者複合施設において、高齢者てんかんが潜在していることが明らかとなり、これらの早期発見のため高齢者てんかんの問診票の必要性が示された

日本人老年科医師における経管栄養療法に対する適応判断と実践；多職種アプローチの影響

京都大学0048新制・課程博士博士(人間健康科学)甲第17472号人健博第5号新制||人健||1(附属図書館)30238京都大学大学院医学研究科人間健康科学系専攻(主査)教授 木下 彩栄, 教授 桂 敏樹, 教授 横出 正之学位規則第4条第1項該当Doctor of Human Health SciencesKyoto UniversityDA

Identifying cognitive dysfunction using the nurses’ rapidly clinical judgment in elderly inpatients

: The aim of this study was to examine the relationship between nurses’ clinical judgment on cognitive function by fall risk assessment and mini-mental state examination (MMSE) scores in elderly inpatients. : We studied 61 consecutive hospitalized patients who received both comprehensive geriatric assessment (CGA) and fall risk assessment at the Department of Geriatric Medicine in Kyoto University Hospital from January 2006 to June 2010. During the fall risk assessment at admission, primary nurses evaluated the cognitive function by four items (with or without disorientation, impaired judgment, lack of comprehension, and memory loss), while a trained clinical assistant performed CGA including MMSE. Patients were divided into three groups according to the MMSE scores. The association between the four items of judgment by nurses and MMSE scores was then studied. : The mean age was 80.1 years and 55.7% of the patients were female. The percentage of patients judged to have impaired judgment, lack of comprehension, and memory loss was higher in patients with lower MMSE scores (impaired judgment, p for trend = 0.001; lack of comprehension, p for trend = 0.043; memory loss, p for trend = 0.001). The percentage of patients judged to have at least one of the four abnormalities was also significantly higher in patients with lower MMSE scores (p for trend : These data indicate that a comprehensive evaluation using all the four items on cognitive impairment is more effective in detecting cognitive impairment in elderly than using individual items, although one-third of cognitively impaired elderly patients may miss detection despite the use of the four items. Better approaches should be developed to identify cognitively impaired elderly patients by nurses

Urban-rural differences in physical performance and health status among older Japanese community-dwelling women

[Background/Purpose]Assessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities. [Methods]The Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ2 test, Independent-Samples t test and Mann Whitney U-test. [Results]Rural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02). [Conclusion]Our findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location

Evaluation of the fall risk assessment tool among patients with neurological disease

科学研究費補助金研究成果報告書研究種目: 若手研究(スタートアップ)研究期間: 2007～2008課題番号: 19890269研究代表者: 荻田 美穂子（滋賀医科大学・医学部・助教）研究協力者: 宮松 直美（滋賀医科大学・医学部・教授）研究協力者: 盛永 美保（滋賀医科大学・医学部・講師

Disproportionate subarachnoid space hydrocephalus-outcome and perivascular space

OBJECTIVE: We sought to identify the prevalence of MRI features of disproportionately enlarged subarachnoid space hydrocephalus in possible idiopathic normal pressure hydrocephalus (DESH-iNPH) and to describe the clinico-radiological features and outcomes of a community-based investigation (The Vienna Trans-Danube Aging study). METHODS: Of the 697 inhabitants (all 75 years old), 503 completed extensive neurological examinations at baseline and were followed up every 30 months thereafter with MRIs, mini-mental state examination (MMSE), and the Unified Parkinson Disease Rating Scale-Motor Section (UPDRSM). The DESH-iNPH participant data were compared with the data from participants with Evans index ratios >0.3 (ex vacuo hydrocephalus), cerebral small-vessel diseases, and normal MRIs. The widening of perivascular space was also evaluated by MRI in these groups. RESULTS: Eight participants with DESH-iNPH (1.6%) and 76 with ex vacuo hydrocephalus (16.1%) at baseline were identified. The mean MMSE in DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs was 26.4, 27.9, and 28.3, respectively, and the mean UPDRSM was 9.75, 2.96, and 1.87, respectively. After a 90-month follow-up, the mortality rates for DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs were 25.0%, 21.3%, and 10.9%, respectively. The perivascular-space widening scores were significantly smaller in the DESH-iNPH cases, particularly at the centrum semiovale, compared to cerebral small-vessel disease and ex vacuo hydrocephalus cases. INTERPRETATION: The prevalence of DESH-iNPH was 1.6% for participants aged 75 years and revealed significantly lower MMSE and higher UPDRSM scores compared to the ex vacuo hydrocephalus and controls. Moreover, it is suggested that perivascular-space narrowing is a morphological and pathophysiological marker of DESH-iNPH

Participation in health and frailty check-ups predicted functional outcomes and mortality in older adults in Japan.

Aim:This study aimed to examine the association between participation in health and frailty check-ups and functional outcomes and mortality, controlling for physical and cognitive function, or self-rated health among Japanese community-dwelling older adults.Methods:A cohort of 5093 participants aged ≥65 years (not disabled or institutionalized), completed the baseline survey in April 2013. Functional outcomes and mortality served as follow-up data from April 2013 to March 2018. However, the data did not include events, such as certified cases for long-term care and death for 12 months from the start of follow-up. We collated data on the use of the annual health check system in 2012 and frailty check-ups using the postal Kihon Checklist in 2013. Cox proportional hazards regression models were used to determine the association between participation in the check-ups, and functional outcomes and mortality, adjusting for potential confounders.Results:Long-term care and mortality risks were significantly lower among those aged <75 years who used health screening than among those who did not, despite adjusting for confounding factors (hazard ratios: 2.1-3.5). In those aged ≥75 years, the risk for long-term care was lower in individuals participating in both health and frailty check-ups and in those who participated in the frailty check-ups only, than in those who did not participate.Conclusions:The association between participation in health and frailty check-ups and adverse health outcomes differed among the age groups, indicating the potential benefit of health and frailty check-ups in older adults. Geriatr Gerontol Int 2023; 23: 348-354

Relationship between Carotid Intima-Media Thickness and the Center of Pressure Trajectories in the Randomly Selected Elderly Population

科学研究費補助金研究成果報告書研究種目: 基盤研究(C)研究期間: 2007～2008課題番号: 19500594研究代表者: 宮松 直美（滋賀医科大学・医学部・教授）研究分担者: 盛永 美保（滋賀医科大学・医学部・講師）研究分担者: 秦 朝子（滋賀医科大学・医学部・助教）研究分担者: 岡本 真優（滋賀医科大学・医学部・助教）研究分担者: 三宅 依子（滋賀医科大学・医学部・助教）連携研究者: 盛永 美保（滋賀医科大学・医学部・講師）連携研究者: 荻田 美穂子（滋賀医科大学・医学部・助教）連携研究者: 小河 望（滋賀医科大学・医学部・助手）連携研究者: 加藤 みのり（滋賀医科大学・医学部・助手）連携研究者: 門脇 崇（滋賀医科大学・医学部・助教）連携研究者: 上島 弘嗣（滋賀医科大学・医学部・教授