Hiromi Enoki

Underuse of medications for chronic diseases in the oldest of community-dwelling older frail Japanese

OBJECTIVES: To test the following hypotheses: (1) the rate of polypharmacy, defined as six or more prescribing medications, is lower in the oldest old (≥85) than in younger older people (65–84); (2) beneficial medication use is lower in the oldest old; (3) the underuse of these medications in the oldest old is associated with physical or cognitive impairment or comorbid conditions.

Association between masticatory performance and anthropometric measurements and nutritional status in the elderly.

Aim:  The association between chewing ability and physical constitution and nutritional status remains uncertain in the elderly. We examined the relationships between chewing ability and anthropometric measurements or nutritional status in the elderly.

Day Care Service Use Is Associated with Lower Mortality in Community‐Dwelling Frail Older People

OBJECTIVES: To clarify the association between day care service use and 21‐month mortality in community‐dwelling frail older people.

Impact of Caregiver Burden on Adverse Health Outcomes in Community-Dwelling Dependent Older Care Recipients

OBJECTIVE To determine whether caregiver burden is associated with subsequent all-cause mortality or hospitalization among dependent community-dwelling older care recipients. METHODS A prospective cohort study of 1,067 pairs of community-dwelling 65-year-old or older care recipients and their informal caregivers was conducted. The 1,067 pairs completed the baseline assessment including caregiver burden assessed by the Zarit Burden Interview and a 3-year follow-up for all-cause mortality and hospitalization. RESULTS During the 3-year follow-up, 268 recipients died and 455 were admitted to hospitals. The multivariate Cox proportional hazards model revealed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risks of all-cause mortality and hospitalization, respectively, in comparison with those with caregivers in the lowest quartile after adjustment for potential confounders. The highest quartile of caregiver burden was associated with all-cause mortality and hospitalization within nonusers of respite services including day-care services, home-help services, and nursing-home respite stay services. No apparent association was observed within the users of these services except for day-care services, for which users showed a statistically significant association between the highest quartile and the risk of hospitalization. CONCLUSIONS Heavy caregiver burden is associated with mortality and hospitalization among community-dwelling dependent older adults, even after adjusting for potential confounders. The reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.

Association Between Unmet Needs for Medication Support and All‐Cause Hospitalization in Community‐Dwelling Disabled Elderly People

OBJECTIVES: To clarify the association between unmet medication management need and 3‐year mortality and hospitalization for community‐dwelling older people with various levels of disabilities.

Information needs and sources of family caregivers of home elderly patients

Meeting the information needs of family caregivers in a timely and appropriate way is a key concern of home care. The present study aimed to explore the following two areas: (a) the priority information needs and sources of family caregivers of home elderly patients and (b) the differences in information needs according to severity of dementia. The subjects were 475 family caregivers of home elderly patients residing in Nagoya city. Data was collected through questionnaires. Severity of dementia was evaluated according to the criteria of the public long-term care insurance policy (levels 0-5). The top 3 items they perceived as of most concern were dementia, first aid, and available public long-term care insurance services. A few respondents felt the need for information on public long-term care insurance services. Nearly half of the caregivers were interested in food and nutrition. The respondents were more likely to receive information from their care managers or physicians than any other source. Caregivers of elderly dependents with severe dementia reported a greater need for information on the spread of dementia, dementia-specific care, or the negative effects of dementia on family and neighborhood. Our results provide useful information on how family caregivers should be educated.

J-SHAPED RELATIONSHIP BETWEEN RESTING PULSE RATE AND ALL-CAUSE MORTALITY IN COMMUNITY-DWELLING OLDER PEOPLE WITH DISABILITIES

To the Editor: It has been demonstrated that a high resting heart (pulse) rate (PR), particularly in adult men, is associated with greater risk for cardiovascular and all-cause mortality. Although there have been only limited studies that have examined the relationship between PR and mortality in older people, conflicting results have been published. In older women, there is reported to be a linear relationship between heart rate and mortality, although others have been unable to confirm this association. In addition, the association between mortality and resting PR in disabled older people remains unknown. In the present study, we examined the influence of PR on the all-cause mortality of community-dwelling older people with disabilities. The study analyzed the baseline data of a subgroup of participants in the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE) and mortality during a 3-year followup period. The study population consisted of 932 community-dwelling older people (347 men, 585 women; mean age standard deviation 80.4 7.9) who were provided with various home care services under a long-term care insurance program. The baseline data included the subjects’ demographic characteristics and a rating for basic activities of daily living (ADLs). Additional information obtained from records of care-managing centers included the following physician-diagnosed chronic conditions: ischemic heart disease, congestive heart failure, cerebrovascular dis-

Raised homocysteine and low folate and vitamin B-12 concentrations predict cognitive decline in community-dwelling older Japanese adults.

BACKGROUND & AIMS Recently, poor cognition and dementia have been associated with elevated homocysteine and low B vitamin concentrations. The aim of this study is to examine the association in community-dwelling older Japanese adults. METHODS Ninety-nine subjects (71 women and 28 men; mean age 75 years) were eligible for analysis after exclusion of subjects with high serum creatinine concentrations (1.3mg/dl and over) and those taking vitamin supplements. Fasting blood samples were analyzed for plasma total homocysteine, serum folate, and serum vitamin B-12. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE). RESULTS Multiple regression analysis revealed that homocysteine concentrations were predicted by concentrations of vitamin B-12 (p<0.001), folate (p<0.005), and creatinine (p<0.001) and age (p<0.005). Scores on the MMSE were associated with concentrations of homocysteine, vitamin B-12, and folate. The association between folate or vitamin B-12 concentrations and MMSE scores remained significant after adjusting for homocysteine concentrations. Folate concentrations, but neither homocysteine nor vitamin B-12 concentrations, were significantly associated with serum albumin concentrations. CONCLUSIONS Reduced folate and vitamin B-12 concentrations were independently associated with cognitive decline. The correlation between folate and albumin concentrations may imply that the reduction of folate in the Japanese older population is due to nutritional deficiency.

Accumulation of geriatric conditions is associated with poor nutritional status in dependent older people living in the community and in nursing homes.

To clarify the association between nutritional status and the prevalence of geriatric conditions in dependent older adults.

Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period

ObjectiveA number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period.MethodsParticipants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified.ResultsAt baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status.ConclusionsPoor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.