Age-related differences in care receipt and symptom experience of elderly cancer patients dying at home: Lessons from the DEATH project

Background:   Data on the differences between older and younger elderly cancer patients dying at home is sparse. To clarify age-related differences in symptom experience and care receipt of elderly cancer patients at end-of-life, we conducted a subanalysis study of the Dying Elderly at Home (DEATH) project, a multicenter study of 240 elderly aged 65 and older dying at home.
Methods:   We assessed the frequency of symptom experience and end-of-life care receipt in home elderly patients during the last 2 days of their lives and evaluated the differences between younger elderly (aged 65–74) and older elderly (aged 75+) cancer decedents. The general practitioners were asked to fill out a questionnaire immediately after the death of study patients. A total of 66 younger and 51 older elderly cancer decedents were included in the analysis.
Results:   Coma and dementia were common among younger and older elderly patients. Older decedents were less likely to experience anxiety, but, after adjustment for baseline characteristics, this age-related difference did not clearly appear. Older decedents were also less likely to receive opioids than younger decedents. There were no significant differences in volume of i.v. hydration between the two groups.
Conclusions:   Our results suggested that there were no differences in symptom experience and care receipt among older and younger decedents, except in opioid use, at end-of-life. These findings imply a similar need of end-of-life care for younger and older elderly cancer patients who opt for home death.     

Factors associated with carotid atherosclerosis in community-dwelling oldest elderly aged over 80 years

Background:   Hypertension, hyperlipidemia, impaired glucose tolerance and smoking have been known to be risk factors for atherosclerosis. Recently, it was shown that hyperhomocysteinemia is also a risk factor for cerebral vascular disease and atherosclerosis. However, it is unknown if these are also risk factors in the oldest elderly population aged 80 years or older. We carried out a cross-sectional analysis to determine the associated factors with carotid atherosclerosis in the oldest elderly living in the community.
Methods:   Subjects consisted of 136 oldest elderly aged 80 years or older living in the community. Blood pressure, orthostatic change of blood pressure, blood chemical parameters, height and bodyweight, lifestyle and medical history were examined. The thickness was measured of the total carotid artery intima-media complex (IMT) by carotid artery ultrasonography and used the maximum thickness (max IMT) for analysis.
Results:   The factors that correlated with max IMT were age and low γ-glutamyl transpeptidase in males, and serum homocysteine levels in females. The subjects were divided into two groups: those with a max IMT of less than 1.0 mm and those with that of 1.0 mm or more. Factors associated with max IMT were age and abstinence from alcohol in males, and orthostatic blood pressure change in females. Factors significantly associated with higher carotid artery IMT were aging in males and orthostatic blood pressure change in females.
Conclusion:   The factors associated with carotid artery IMT as an indicator of carotid atherosclerosis in community-dwelling oldest elderly aged 80 years or older were sex, aging, orthostatic blood pressure change and no alcohol intake. There were differences in risk factors for carotid atherosclerosis between the male and female population.     

Difference in subjective well-being between ethnic Korean and Japanese elderly residents in an urban community in Japan

Background:   The ethnic Korean community in Japan has witnessed the increasing aging of their population structure. The purpose of our study was to clarify the differences in standards of living between elderly ethnic Korean and elderly Japanese populations living in Japan, and to examine whether there is any difference in subjective well-being between the two populations.
Methods:   We conducted a cross-sectional questionnaire-based survey that consisted of items addressing ethnicity, age, gender, literacy, living conditions, mental health, "sense of purpose in life", activities of daily living (ADL), medical history, quality of life (QOL), and receipt of pension benefits and public assistance; the participants were 425 elderly people (ethnic Korean residents in Japan, n  = 204; Japanese, n  = 221) aged 65 and older living in a community in Osaka City. Findings from the two groups were compared using the Student's t -test and the χ² test. We also employed multiple linear regression analysis.
Results:   We found that the ethnic Korean group had less formal education ( P  < 0.001), lower ADL ( P  < 0.05) and QOL ( P  < 0.001), higher illiteracy ( P  < 0.05) and depression rates ( P  < 0.001), and a higher prevalence of hypertension, myocardial infarction and diabetes mellitus than the Japanese group. Ethnicity was a significant variable for subjective well-being in simple linear regression analysis. After adjusting for literacy, absence of sense of purpose in life and mental health in multiple regression analysis, ethnicity remained a significant variable.
Conclusions:   The present findings indicate that ethnic Korean elderly have poor health and social situations compared with the Japanese group, and that there was a difference in subjective well-being between the two ethnic groups.     

The coming epidemic of obesity in elderly Americans

Objectives: To estimate the prevalence of obesity in elderly Americans in 2010 and to discuss the health and economic implications of these estimates.
Design: Three methods of generating future point-prevalence estimates using data from consecutive cross-sectional studies.
Setting: All regions of the United States.
Participants: Estimates were based on five nationally representative surveys of the adult population of the United States, conducted from 1960 to 2000, and population estimates from the U.S. Census Bureau.
Measurements: Changes in obesity (body mass index (BMI) ≥30 kg/m²) and normal weight (BMI <25 kg/m²) prevalence for men and women by 10-year U.S. birth cohorts were examined. The prevalence of obesity and normal weight in the elderly in 2010 was estimated under three different scenarios of obesity prevalence change.
Results: It was estimated that the prevalence of obesity in adults aged 60 and older will increase from 32.0% in 2000 to 37.4% in 2010 (range 33.6–39.6%). The number of obese adults aged 60 and older will increase from 14.6 to 20.9 million (range 18.8–22.2 million). Similarly, it was estimated that the prevalence of normal weight among adults aged 60 and older will decrease from 30.6% in 2000 to 26.7% in 2010 (range 31.0–24.7%).
Conclusion: The prevalence of obesity in elderly Americans will likely continue to increase, challenging healthcare delivery and financing systems in the United States.     

The rural elderly support in China and Thailand

Aims:   This paper aims to investigate support mechanisms for the elderly in rural China and rural Thailand, and to take lessons from each other on its rural elderly support and the policy interventions.
Methods:   Using data from secondary sources, the situation of the rural elderly was investigated from different aspects. Policies and programs designed for the rural elderly were then summarized in the following section.
Results:   China and Thailand are both under tremendous social changes and economic development processes, with Thailand more economically developed. Family remains the main source of support for the rural elderly in both countries, however, it has been suffering increasing difficulties and problems such as industrialization, modernization, and rural-to-urban migration have been taking place. This calls for attention and the development of social security services to support the elderly in rural areas.
Both countries have set up a number of policies, plans, and programs toward supporting the elderly, the coverage, however, is relatively low.
Conclusions:   Governments should introduce policies for integrating the rural elderly into national development strategies. Family should be empowered to become strong sociocultural units, as well as an economic resource and a focal point for the preservation of social and moral values in providing support for the elderly. Health care should be given freely to the rural elderly. Programs providing support to the rural elderly should be gender-specific with more focus on female elderly.     

Comparison of public and private care management agencies under public long-term care insurance in Japan: A cross-sectional study

Aim:   Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies.
Methods:   The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55 000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined.
Results:   Public care management agencies favored younger subjects ( P  = 0.003), male subjects ( P  = 0.006) and people with a higher need for care ( P  = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies ( P  = 0.02).
Conclusion:   Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.     

Prevalence and correlates of functional disability in Chinese older adults

Aim:   This article examines the prevalence of functional disability as well as sociodemographic correlations among Chinese older adults based on the most recent China National Sample Survey on Disability in 2006.
Methods:   Functional disability was defined as lost motor function or limited movements and activities according to the International Classification of Function, Disability and Health, and physicians made the diagnosis of disability. Utilizing stratified, multiphase and cluster probability sampling design, a nationally representative sample of the non-institutionalized elderly Chinese population was studied. Factors associated with functional disability were determined using a logistic regression model.
Results:   The prevalence of functional disability was 8.1%. Major causes were vascular disease, osteoarthritis and accidents. In the non-institutionalized elders, increased age, rural residence, less education, lower income, unemployment, being unmarried, living in simple housing, and living with others or non-homeowners emerged as factors associated with functional disability in men and women.
Conclusion:   To face the challenge of the rising prevalence of functional disability, prevention strategies should focus on reducing the incidences of chronic disease and improving socioeconomic status of older adults.     

Quantitative analysis of carotid atherosclerotic lesions and high-sensitivity C-reactive protein in community-dwelling elderly 80 years or older

Aim:   To investigate the association between the carotid atherosclerotic lesions assessed by high-resolution ultrasonography and high-sensitivity C-reactive protein (hs-CRP) in the community-dwelling elderly aged 80 years or older.
Methods:   One hundred and seventy-nine community-dwelling elderly aged 65 years or older (78 ± 6 years, 69 men and 113 women) participated in this study. High-resolution B-mode ultrasonography was performed on the common carotid arteries. Intima-media thickness (IMT) was measured using automatic measuring system and compared with standardized examinations included blood pressure, body mass index, hemoglobin-A1c, cholesterol, creatinine, uric acid, fibrinogen and hs-CRP.
Results:   Subjects were divided into two age groups: young-old aged 65–79 years (113 subjects, 74 ± 3 years) and old-old aged 80 years or older (66 subjects, 84 ± 3 years). The maximum (max) IMT was significantly increased in the old-old compared to that of the young-old (1.7 ± 1.0 vs 1.4 ± 0.6 mm; P  = 0.02). Multivariate analysis showed that hs-CRP was the strongest predictor of thickened max IMT in the young-old ( P  = 0.022). However, it was not the predictor of thickened max IMT in the old-old.
Conclusions:   Depending on age, hs-CRP may have different meanings in the atherosclerotic process. In particular, the predictive power of hs-CRP as a marker of atherosclerotic process was less significant in subjects aged 80 years or older.     

Current admission policies of long-term care facilities in Japan

Background:   The rapidly aging society in Japan is putting demands on long-term care facilities for the elderly who require care. In Europe and the USA, there is ongoing reform of elderly care services, but the establishment of system based on social insurance is still being explored in Japan.
Methods:   Two studies were conducted, the first in 2000 and the second in 2001, involving 91 long-term care facilities located in or around the city of Nagoya. Questionnaires were sent to facility directors, chief administrators or head nurses to inquire about their admission policies for six major patient categories. Two educational lectures on methicillin-resistant Staphylococcus aureus (MRSA) and urinary incontinence were given between the distribution of the questionnaires.
Results:   For all six categories featured on the questionnaire, the acceptance rate in both studies was the highest in geriatric hospitals, and an improvement in acceptance rates was seen in the second study in all three types of care facilities. When the effect the lectures had on changes in admission policies at these facilities was examined, no correlation was found.
Conclusions:   Lectures should be given to facility management and personnel to raise their awareness of key issues and improve their efficiency.     

Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil

Aims   To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT).
Design   Cross-sectional study.
Setting   A town in southern Brazil.
Participants   A representative sample of 1260 people aged 15 and over.
Measurements   Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Findings   Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class ( P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61–13.16) compared with women. A linear trend was found ( P  = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91–5.58) and ex-smokers (OR 1.30; CI 0.56–2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35–4.56) of presenting a positive test.
Conclusions   The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.     

Analysis of comprehensive geriatric assessment of elderly residents in a social welfare home for the aged compared with those in a residential care home in an urban area in Japan

Background:   The purpose of the present study was to clarify the influence of the socioeconomic factors during the middle age on the results of comprehensive geriatric assessments in later stage of life.
Methods:   A cross-sectional, questionnaire-based study was conducted of elderly residents in a welfare home for the aged in Osaka and those in a residential care home in Kyoto. Results of questionnaires pertaining to activities of daily living (ADL), quality of life (QOL) and a 15-item Geriatric Depression Scale as well as medical and social histories of the two groups were compared by unpaired T -test and χ² test.
Results:   Elderly residents in the welfare home were significantly younger and more were both male and unmarried or divorced than among those in the residential care home. Scores in ADLs and QOLs were significantly lower and the prevalence of depression was significantly higher in residents in the welfare home than in the residential care home.
Conclusion:   The ADLs, mental mood and subjective QOLs of residents in the welfare home were significantly lower than those of residents in the residential care home. The reason for these differences is suggested to be due to both the differences in the lifestyles of the residents in their middle age and the difference in the quality and quantity of care the residents are receiving. Local social welfare government should pay more attention to lower ADLs and QOLs of residents in welfare homes and increase efforts to improve the quality and quantity of care for them.     

Relationships between working status and health or health-care utilization among Japanese elderly

Background:   As we have previously proposed redefining elderly from "65 years and over" to "75 and over" in Japan, many elderly Japanese now keep working beyond the traditional retirement age, around 60–65 years of age, in this rapidly aging society. It is important to assess the influence of working status on health and health-care utilization among elderly Japanese.
Methods:   We evaluated a random sample of community-dwelling Japanese elderly, aged 55–74 years. Data were collected using a health diary strategy. For health-related quality of life (HRQOL), we used SF-8 with a physical component summary (PCS8) and a mental component summary (MCS8). Health-care utilization included visiting physicians as well as using dietary and physical complementary and alternative medicine (CAM).
Results:   Among 679 participants aged 65–74 years (40.6% men), there were 254 (37.4%) working and 425 (62.6%) non-working. PCS8 and MCS8 were not significantly different between the working status groups. There were no differences in the rate for visiting physicians and using dietary and physical CAM between the working and non-working, except for those aged 70–74 years, who exhibited a higher rate for visiting a physician among the non-working. A higher annual personal income showed a significant association with better PCS8 ( P  = 0.031) and a trend towards better MCS8 ( P  = 0.055). The older participants were more likely to report better MCS8 than the young regardless of working status ( P  = 0.007).
Conclusion:   Working status itself does not appear to associate with health and health-care utilization among elderly Japanese. Working with a higher income may potentially improve HRQOL.     

Substance use disorder among older adults in the United States in 2020

Aims   This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020.
Design   Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002–06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020.
Setting   Non-institutionalized US residences.
Participants   Representative sample of the US civilian, non-institutionalized population.
Measurements   Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders , 4th edition.
Findings   Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002–06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups.
Conclusions   Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.     

Preventive home visits for community-dwelling frail elderly people based on Minimum Data Set-Home Care: Randomized controlled trial

Background:   Although preventive home visits for the elderly are mandatory in Japan, there has been little research into their effectiveness. The present study used the Minimum Data Set-Home Care (MDS-HC) as the basis for assessing community-dwelling frail elderly persons.
Methods:   The present study was a randomized controlled, community-based investigation of 368 elderly people aged 65 years and older who were dependent in the instrumental activities of daily living, but independent in activities of daily living. The participants were randomly assigned to an intervention group (184) or a control group (184). For 18 months, the intervention group received scheduled home visits by public health nurses who had been instructed that the primary objective of these visits was human interaction. The MDS-HC was used to assess the elderly person at each visit. The primary outcome was the EQ-5D score of the EuroQol and secondary outcomes were five items constituting the EQ-5D, self-rated health, and health behaviors. The types of advice given and subject compliance were also analyzed.
Results:   Intervention had no effect on the EQ-5D score, and positive results were limited to some aspects of health behavior. Subgroup analyses showed that the home visits were effective for elderly people who perceived their own health as poor at baseline, and for participants who complied with advice.
Conclusions:   The preventive home visits based on the MDS-HC were effective in selected groups of frail elderly people. Further modification in the use of the MDS-HC and more focused targeting are needed to make the visits more effective.     

Characteristic features of folate-deficient neurological diseases in the elderly

Background:  Folic acid (folate) deficiency causes neurological disorders in aged people, the characteristic features of which were examined.
Methods:  Serum folate levels were determined in 343 neurological patients by chemiluminescence. We found 36 folate-deficient patients (10.5%) who were divided into elderly ≥ 65 years old (12 cases) and younger group, < 65 years old (24 cases), and were administered folate (15 mg/day) for 60 days.
Results:   Serum folate levels were not different between the elderly and younger group, while folate levels were lower in elderly females than elderly males. Neuropathy was more frequent in elderly male than elderly female patients. Elderly neurological patients with neuropathy more readily responded to folate supplementation than those without neuropathy. Folate-deficient patients with dementia were older than those without dementia, although nine younger patients had dementia and four of nine cases showed frontal dementia. Anemia or female sex was more frequent and neuropathy was less frequent among elderly patients with central nervous system involvement. Serum folate levels were lower in elderly anemic than nonanemic patients. Tube feeding was more frequent in elderly folate-deficient neurological patients than in younger ones. Folate therapy was less effective in elderly patients with dementia, although three cases improved. Elderly folate-deficient patients treated with tube feeding did not respond to the folate supplement.
Conclusion:   Folate deficiency was not rare among aged neurological patients, and its features were different from younger patients. Since folate-deficient neuroencephalopathies are responsive to folate supplementation in the elderly, the examination of elderly patients' serum folate level is valuable.     

Dietary preferences in Japanese centenarians favoring dairy foods

Background:   Relatively few studies have considered the dietary preferences of the oldest elderly individuals. As persons aged over 100 years have survived for a particularly long period of time, the dietary habits of centenarians might be significant factors influencing late-life health.
Methods:   We compared the dietary practices of 94 centenarians living in Tokyo metropolitan with those of 30 other healthy elderly people (older controls) and 98 healthy middle-aged subjects (younger controls). Dietary intake was recorded for 3 successive days and was classified in terms of 18 food groups: cereals, potatoes, sugars, sweets, fats, nuts, legumes, fishes, meats, eggs, dairy products, vegetables, fruits, mushrooms, algae, beverages, seasonings, and processed foods. Dietary patterns were classified by a k-means cluster analysis based on the proportional intake of each food group. Each pattern identified was evaluated nutritionally.
Results:   While the daily intake of protein, fat, carbohydrate, and total calories was highest in younger controls and lowest in centenarians, no significant differences were evident when intake was evaluated relative to body weight. Four clusters of subjects preferred beverages, vegetables, dairy products, and cereals, respectively. Preference for beverages was most frequent in younger controls while preference for vegetables was relatively frequent in older controls. A pattern preferring dairy products was particularly characteristic of centenarians. Dairy products were advantageous for calcium intake while a preference for vegetables was of great advantage – assisting in the intake of vitamins and iron.
Conclusions:   Japanese centenarians showed a preference for dairy products which, therefore, means that their calcium intake is high.     

Prognostic factors in elderly multiple myeloma patients aged 65 years or older: Comparison with nonelderly patients with multiple myeloma

Background:   Although age is a prognostic factor in multiple myeloma (MM), the prognostic factors in elderly MM patients may be different to those in nonelderly MM patients due to the patient's age. The difference in the significance of prognostic factors between elderly MM patients and the nonelderly MM patients was studied.
Methods:   Forty-two elderly MM patients aged 65 years or older were compared with 68 nonelderly MM patients, who were less than 65 years of age. The characteristics of the elderly patients included: aged 65–81 years (median, 72 years); female/male ratio of 22 : 20; 24 IgG type cases, 13 IgA type cases, one non-secretory case and four cases of Bence-Jones type; one case of stage I, 12 cases at stage II and 29 cases at stage III. The prognostic factors were evaluated by means of univariate analysis and Cox's multivariate analysis.
Results:   The median survival time was significantly shorter in the elderly MM patients (24 months) than in the nonelderly patients (50 months) ( P  < 0.01). Of the univariate prognostic factors, corrected serum Ca (cCa), hemoglobin, serum P, bone marrow plasma cell and uric acid were significant prognostic factors in the elderly MM patients, while nine factors including those listed here, were significant in nonelderly controls. Multivariate analysis showed that serum cCa was the only independent prognostic factor ( P  = 0.019) in elderly MM patients, while serum P and bone lesions were significant prognostic factors in nonelderly MM patients.
Conclusion:   Corrected serum c. (cCa) was an independent prognostic factor in elderly MM patients.