This study was conducted to examine the prevalence of undernourished elderly in community-dwelling elderly people, and to analyze the correlation between under-nutritional status and health status and physical fitness of the elderly.The subjects comprised 1758 residents (757 men and 1001 women) aged 70 or over living in Itabashi-ku, Tokyo, who took part in an interview and biochemical blood examination as part of the “OTASHA-KENSHIN”. In this study, we set the ‘under-nutrition group’ as serum albumin level ≤ 3.8 g/dL (normal group serum albumin level ≥ 3.9 g/dL). Based on this standard, 124 subjects (72 men and 52 women) were found to be undernourished. Physical fitness was measured by handgrip strength, knee extension power, and walking capability (usual and maximal walking speed).The prevalence of undernourished elderly was significantly higher in men than in women, and in those living alone or with a spouse compared with those living with children. It became clear that the lifestyle and health status of the under-nutrition group was generally poor compared with those of the normal group. Handgrip strength and knee extension power were significantly lower in the under-nutrition group than in the normal group of men. Although usual and maximal walking speed tended to be lower in the under-nutrition group, there was no significant difference. In women, a significant difference in handgrip strength, knee extension power, and walking capability was not seen between the two groups.These results suggest that an intervention program for the undernourished elderly living in the community should target an improvement not only of nutrition but also of physical fitness.

Background: High heart rate (HR) has been associated with an increased risk of cardiovascular disease and mortality due to all causes. The present study was conducted to examine the effect of exercise adherence on longitudinal changes in resting heart rate among a population of community-dwelling elderly.Methods: The subjects were 133 men and 209 women aged 65 and older who participated in a baseline survey in August 1992 and were subsequently followed annually for 8 years. Resting HR was measured in the sitting position. The independent variable was the longitudinal change in differences of HR (Δ) from 1996 to 2000. Dependent variables were age, heart rate, smoking habit, TMIG index of competence score, and states of exercise adherence during the period 1992-1996.Results: Multiple regression analysis showed that heart rate in 1996 and smoking in men, and heart rate, TMIG index of competence score, and exercise adherence during the period 1992-1996 in women were significantly associated with longitudinal change in HR.Conclusion: Exercise adherence reduced the increase in HR of elderly women. These results suggest the importance of exercise adherence in elderly women.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

　　A 63-year-old woman was admitted with complaints of thirst and polyuria about 1 year after ceasing therapy in November, X and in October, X+1. Her blood glucose levels at the beginning of her admissions were 347 at the first admission and 486 at the second admission. We administered glargine, a long-acting type insulin, 8U/day, and　a short-acting insulin, glulisine, 4U/day, during the first admission. We administered glargine, a long-acting type insulin, 4U/day, and a short-acting insulin, glulisine, 3U/day, during the second admission. We also administered a GLP-1 receptor agonist, liraglutide, 0.3mg/day. Blood glucose levels (mg/dl) during the 5 days of the first admission were as follows: first, -, -, 347, and 180; second, 273, 266, 109, and 188; third, 75, 192, 186, and 182; fourth, 93, 194, 91, and 144; fifth, 78, 95, 124, and 127. In the second admission, blood glucose levels were as follows: first, -, -, 486, and 299; second: 140, 137, 195, and 128; third: 101, 122, 114, and 108; fourth: 101, 123, 123, and 137; and fifth, 89, 136, 111, and 129. CGM data showed an average of 128mg/dl and standard deviation of 34 during the first admission. CGM data showed an average of 125mg/dl and standard deviation of 20 during the second admission. The reduction of insulin and rapid flattening of blood sugar were achieved by GLP-1 receptor agonist with promotion of insulin secretion and suppression of glucagon secretion.