Purpose : This study aimed to explore the factors which interfere with advance decision-making with regards to artificial hydration and nutrition (AHN) in the senescent population.
Methods : Subjects were local residents aged 60 years or older who were leading an independent life and who could go out by themselves. A cross-sectional study using a self-administered questionnaire was conducted from August to November 2011. Valid responses were obtained from 116 subjects, for a valid response rate of 90.6%. Advance AHN decisions, knowledge about AHN, intentions regarding advance directives and end-of-life care, experience providing long-term care, in addition to other questions, were analyzed using a multiple logistic regression model.
Results : With respect to advance decisions regarding AHN, 25 respondents (21.6%) indicated that they could not make a decision, while 91 respondents (78.4%) could. Sixteen respondents (13.8%) desired some component of AHN, while 75 respondents (64.7%) did not desire any AHN. Factors related to difficulty with advance decisions regarding AHN were : 1) lack of adverse experiences associated with decreased cognitive function (“experience of failure”) (OR=12.0, 95%CI=1.42-100.41, p<.022), 2) lack of experience providing long-term care for a family member (“experience of caring”) (OR=3.0, 95%CI=1.04-8.53, p<.042), and 3) desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision (“reliance on others”) (OR=5.6, 95%CI=1.95-16.24, p<.001).
Conclusion : Factors related to difficulty with advance decisions regarding AHN in the senescent population were lack of adverse experiences associated with decreased cognitive function, lack of experience providing long-term care for a family member, and desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision.

The School of Medicine, University of Tsukuba, was founded in 1974 and had graduated 1, 561 students by 1994. From 1980 through 1987, 44% to 73% of graduates became hospital staff, 16% to 40% became university staff, and 0% to 8% became general practitioners. More than 80% of graduates did a 2-year residency (sotsugo-kenshu) at our university hospital and 40% completed a 6-year residency. Almost 10 years of postgraduate training was required to become an established medical practitioner. This length of time indicates that postgraduate training is the most important part of the medical career. About 80% of graduates earned doctor of philosophy (Ph. D.) degrees, whereas 93% became registered specialists, indicating that graduates tended to become specialists rather than to pursue Ph. D. degrees. This difference is more evident among female graduates: 85% became specialists whereas only 53% received a Ph. D. Most graduates considered the School of Medicine to have a good curriculum, but some younger graduates had complaints. The graduates chose their career specialties on the basis of their own interests and aptitudes. We should take these data into account to prepare a system of life-long education and learning.

Disease risk among elderly smokers is considered to be doubled due to their smoking habits and age as compared with elderly non-smokers. The investigators conducted risk assessments of smoking for respiratory symptoms among elderly people.A questionnaire survey on smoking habits and respiratory symptoms was conducted among 3, 000 persons of 56 years of age and over who were randomly selected from suburban residents in a prefecture in Japan in October, 1997. A total 1, 954 or 65.1% of individuals responded, consisting of 42.8% for men and 57.2% for women, with an average age of 73.6 years.In addition to descriptive analysis, multiple logistic regression analysis was conducted. The results are summarized as follows:Smokers accounted for 28.1% of men and 3.6% of women. Among all age-groups, the highest rate of smokers was observed in men of 56-69 years old (34.7%) which was lower than the national average rate for the 60-69 year-old group (56.1% of men and 14.5% of women in ‘97). The odds ratios and 95 percent confidence interval (95%CI) for “having phlegm every day” and “having phlegm for more than 4 days a week” among smokers were 2.06 (95%CI=1.41-3.01) and 2.77(95%CI=1.80-4.27). Significantly higher odds ratios among smokers were also observed for “wheezing” and “shortness of breath when hurrying”.Odds ratios for some respiratory symptoms including “having phlegm for more than 4 days per week” among inhalers were significantly high compared with non-smokers, whereas those among non-inhalers were not significantly different from 1.0.Odds ratios for symptoms of phlegm and wheezing were significantly higher (Odds ratio ≥2.0) among heavy smokers (Brinkman Index [B. I.] >900) compared to non-smokers, while odds ratios of the same symptoms were not different from 1.0 among light smokers (B.I. ≤500).
symptoms <1> ; Respiratory ; Smoking ; Elderly ; Male population group

Background: We investigated how individual home care services by nurses, care workers, and therapists at patients' homes are related with the continuation of home medical care service provided by medical doctors.Methods: This research retrospectively analyzed primary insured patients registered with the Japanese long-term care insurance system who had newly started using home medical care service, and whose care level was between 1 and 5 according to national long-term care insurance system claims data. We performed multivariable logistic regression analysis to evaluate patients who used home medical care continuously for >3 months and the utilization of each home care service adjusted for patient age, gender, and care level.Results: A total of 26,590 patients were analyzed. Multivariable analysis revealed that the following home care services were associated with longer continuation of home medical care service compared with home medical care alone: day service (OR, 2.10; 95% CI, 1.98-2.23), home help service (1.91; 1.81-2.01), day care including rehabilitation (1.88; 1.69-2.10), home-visit rehabilitation (1.49; 1.31-1.69), and home-visit nursing (1.23; 1.16-1.31).Conclusions: Our results demonstrated a correlation between utilization of home care services and longer continuation of home medical care from the start. These findings may help medical doctors who provide home medical care service collaborate with other home care services by nurses, care workers, and in-home care therapists.

Methods: Twenty vertebrae (T12 and L1) from 10 patients with osteoporosis (two males and eight females; mean age, 74.7 years) were obtained to create the 10 FE models. First, a single screw was placed with TT and SEPST/DEPST, and the fixation strength was compared by axial pullout strength (POS) and multidirectional loading tests. Second, two screws were placed on the bilateral pedicles with TT and SEPST/DEPST, and the fixation force of the vertebrae in the constructs in flexion, extension, lateral flexion, and axial rotation was examined. Results: SEPST and DEPST had 140% and 171% higher POS values than TT, respectively, and the DEPST result was statistically significant (p =0.007). The multidirectional fixation strength was significantly higher in DEPST and SEPST than in TT in the cranial, caudal, and medial directions (p <0.05) but not in the lateral direction (p =0.05). The vertebral fracture strength at the lower instrumented vertebra of the DEPST tended to be higher than that of TT. The vertebral motion angles in SEPST and DEPST were significantly smaller in lateral bending (p =0.02) and tended to be smaller in flexion and extension than in TT (p =0.13). Conclusions This study may provide useful information for spine surgeons in deciding whether to choose the SEPS or DEPS technique for augmenting fixation in osteoporotic vertebral fracture surgery.