International Journal of Gerontology

Application of Gold in Biomedicine: Past, Present and Future

2012-03-21

Summary: Gold has been used in medicine for thousands of years. Nowadays, gold compounds contribute to the treatment of rheumatoid arthritis; gold alloys are used in implants in various fields of medicine; and colloid gold is used in immunogold electron microscopy. Advances in nanotechnology have resulted in novel gold nanoparticles, which possess distinct physical properties such as fluorescence. We have developed fluorescent gold nanoclusters (FANCs) that contain gold nanoparticles with a core dimension < 2nm. Initial studies have shown that FANCs are a highly biocompatible marker with a fluorescence half-life of 9 days, and are suitable for in vitro and in vivo tracking of endothelial and endothelial progenitor cells. FANCs may also have novel chemical properties involved in regulation of endothelial cell function. This minireview discusses the future directions of biomedical research for FANCs.

Factors Associated with Depressive Mood in the Elderly Residing at the Long-Term Care Facilities

Ying-Yueh Tu, Yuen-Liang Lai, Shou-Chuan Shin, Hong-Jer Chang, Li Li — 2012-03-26

Summary: Background: Demands for long-term care facilities for the elderly increased rapidly due to longevity of the current population and a trend toward nuclear families with fewer offspring. A study showed that the prevalence of depression is 8–15% and 30% among the community-dwelling and the institutionalized elderly, respectively, in the USA compared with 29.5% and 39.2% in Taiwan. The major goal of this study was to investigate the prevalence of depression in the elderly residing at long-term care facilities in Taiwan, to explore the relationship between demographic characteristics, health status, social support, and the participation in leisure activities with the development of depression in the elderly, and finally to propose possible interventional items for clinical use and further interventional study design.Methods: A cross-sectional survey of the elderly was conducted through interview using questionnaire. A total of 309 subjects, aged 65 and above, in six long-term care facilities were enrolled in this study. The questionnaire collected information on their characteristics, health condition, the level of social support and daily activity, and depression status.Results: Thee prevalence of depression among the elderly residing at long-term care facilities was 37% in Taiwan, and self-funded elderly had a higher depression rate than those in government-sponsored facilities. Participants with advanced ages, religious practices, literacy, longer facility stay, better instrumental activities of daily living (IADLs), more leisure activities, and strong social support had lower association with depression. Factors strongly associated with depression included better self-assessed health status, ability to perform IADLs, level of social support (especially social companionship), and leisure-activity involvement.Conclusion: We summarized the perceptions for preventing the elderly residing at facilities from developing depression, including increased interactions provided by caregivers, more family visits and social companionship, and more frequent leisure activities. Further interventional studies with a larger group of participants and longitudinal design should be conducted to confirm our recommendations.

The Effects of Xylocaine Spray for Pain Control Caused by Endotracheal Tube in Critical Care

2012-03-26

Summary: Background: The purpose of this study was to evaluate the efficacy and safety of Xylocaine spray for the pain caused by endotracheal tube, and its impact on patients’ satisfaction of intensive care.Methods: A quantitative evaluation of the effect before and after Xylocaine spray on endotracheal tube pain relief, and a qualitative interview study of the impact of this intervention on patients’ satisfaction of intensive care in a prospective, clinical investigation. Those in the medical intensive care unit being endotracheal intubated and being able to clearly communicate with the caregivers were enrolled after providing their inform consent. We prescribed Xylocaine 10% pump spray as frequently as demanded.Results: Nineteen patients were eligible for this study. The numerical rating scale of the throat pain before local Xylocaine spray were 8.82±0.79, 7.98±0.92, 7.07±0.76, 6.37±0.83 and 5.47±1.23, sequentially, compared with after therapy results, which were 3.84±0.86, 3.57±0.74, 3.06±0.70, 2.61±0.77 and 1.96±0.88 (p<0.01). The interval between Xylocaine demanded gradually increased with time after endotracheal tube intubation, and was also different between the daytime and the night-time on the first day of admission (p<0.001). Most of the patients suffered from throat pain due to endotracheal intubation, and they agreed their satisfaction was affected by the factors, the level of throat pain being controlled (correlation: 0.89, p<0.01), and the caregivers’ attitude with regard to the pain control (correlation: 0.46, p<0.05).Conclusion: Xylocaine spray is demanded is an effective therapy to manage the pain caused by endotracheal tube, which is also crucial to meet patient satisfaction in intensive care.

A Pilot Study for Reliability and Validity of Mini-Physical Performance Test for Chinese Male Elders

Da-Wei Chen, Jin-Wen Chen, Wei Xu, Wei Liu, Wen-Jin Du, Hua-Jun Li — 2012-03-26

Summary: Background and purpose: Physical frailty may predict many adverse events, and it is important to identify a stable and easy clinical measurement to assess physical function for Chinese elders.Methods: We modified the mini-Physical Performance Test (PPT) of Wilkins et al by adding one-leg standing test and simulating the 15 meters timed walk with a 6 meters timed walk to construct the Chinese version mini-PPT (CM-PPT). A total of 170 elderly individuals were tested by CM-PPT and mini-mental state examination (MMSE). Twenty-three randomly chosen individuals were tested again by the same rater and another rater in a week, and the 15 meters timed walk and the Barthel index (BI) were also evaluated.Results: The Cronbach’s coefficient of CM-PPT was 0.868, and the test–retest and inter-rater reliability were 0.96 and 0.99, respectively (p<0.001). When the diseases influencing PPT other than cognitive disorders were excluded, CM-PPT was associated with MMSE (r=0.420, p<0.01) and age (r=−0.649, p<0.001) in 47 participants. CM-PPT was also correlated with BI (r=0.667, p<0.001), while 65% of the participants acquired full marks for BI and only 9% of the participants did so for CM-PPT. Of the 170 participants, 31 had different results between tandem and one-leg positions (p<0.001). Of these participants, 90% were only able to do tandem position and 10% were only able to do one-leg position. There was no difference between the scores in 6- and 15 meters timed walk (p=0.49).Conclusion: CM-PPT is a stable test and more sensitive than the BI. It is moderately associated with MMSE in the elderly without diseases influencing PPT other than cognitive disorders.

New Application of Bioelectrical Impedance Analysis by the Back Propagation Artificial Neural Network Mathematically Predictive Model of Tissue Composition in the Lower Limbs of Elderly People

2012-03-26

Summary: Background: The accurate evaluation of muscle mass by a non–invasive and easy method is the first step to help prevent falling events in elderly people.Methods: To develop greater predictive accuracy and precision in the measurement of body composition in lower limbs by bioelectrical impedance analysis (BIA), the Back Propagation Artificial Neural Network (BP–ANN) was used to calculate predictive results and was compared with data from dual–energy X–ray absorptiometry (DXA) in 22 male and 16 female elderly people in Taiwan. Fat–free mass (FFM), tissue weight, and fat mass (FM) of the lower limbs were directly measured by DXA, and the BIA values (Z) of left side hand to right side foot in the standing position were measured by BIA. The parameters of height, weight, age, gender and BIA values were combined to create the BP–ANN mathematical model, which was developed to predict the FFM and FM in lower limbs in elderly.Result: A relatively lower correlation coefficient (r2) of 0.964 and standard deviation (2SD) of 0.01 ± 3.64% were obtained for the prediction of FFM and FM by BIA with the BP–ANN mathematical model, whereas the linear regression analyzing model had an r2 value of 0.845 and 2SD of 0.12 ± 7.68%, respectively. The performance of the BP–ANN mathematical model at BIA measurement was superior to that of the current linear regression model.Conclusion: In summary, the greater predictive accuracy and precision made the application of BIA with the BP–ANN mathematical model more feasible for the clinical measurement of FM and FFM in the lower limbs of elderly people.

Sleep Duration and Obesity among Adults Under 65 Years of Age and the Elderly in Taiwan

Meng-Ting Tsou — 2012-03-26

Summary: Background: This study investigated the determinants of obesity in adults younger than 65 years of age and those older than 65 years, focusing on the relationship between sleep duration and obesity after controlling other factors.Methods: The data were obtained from the National Survey on Knowledge, Attitude, and Practice of Health Promotion 2002 in Taiwan. A total of 23,809 participants completed this survey, including 3731 elderly persons (65 years of age and older) and 20,078 adults (between 18 and 64 years of age). A multiple logistic regression model was adopted, and obesity was defined as a binary dependent variable by the criteria of body mass index (BMI) ≥27kg/m2.Results: A U-shaped correlation between obesity and sleep duration was identified in this study. Adults <65 years who slept for 7 hours/night (males/females: OR=0.74/0.92) and elderly people who slept for 6 hours/night (males/females: OR=0.84/0.77) showed a lower risk of obesity than the control group (5 hours/night).Conclusion: Self-reported habitual sleep duration had a U-shaped relationship with obesity in the two populations. The conflict of interest was that the cut-off point of sleep duration differed by 1h (< 65-year-old adults: 7h; elderly: 6h). To preclude the possible bias introduced by self-reporting, using multiple measurements of sleep parameters is recommended in future research.

Relationships between Self-assessed Masticatory Ability and Higher Level Functional Capacity among Community-dwelling Young-old Persons

2012-03-22

Summary: Introduction: Higher level functional capacity is considered a crucial component for independent living among the elderly. The aim of the present study was to show the relationships between self-assessed masticatory ability and higher level functional capacity among young-old persons living independently in the community.Materials and methods: A total of 366 persons aged 67–74 years was enrolled in the study. Data on background factors and self-assessed masticatory ability were collected by questionnaires. Self-assessed masticatory ability was classified into one of three categories (ability to chew all kinds of food, only somewhat hard food, or only soft or puréed food). Higher level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index, which consists of three sublevels: instrumental self-maintenance, intellectual activity, and social role.Results: Significant differences were found in the total score (13-point scale), intellectual activity (4-point scale), and social role (4-point scale) among the three groups of self-assessed masticatory ability. Multivariate logistic regression analysis showed that severely impaired masticatory ability (the ability to chew only soft and puréed food) was significantly related to a loss of three points or more for the total score, and a loss of one point or more for intellectual activity and social role after adjustment for a number of confounding variables.Conclusion: Self-assessed masticatory ability is significantly and independently related to higher level functional capacity, especially intellectual activity and social role, among young-old persons living independently in the community. It is worthwhile noting masticatory ability when clinicians investigate factors associated with disability in independent living.

Community-Based Epidemiologic Study on Gallstone Disease among Elderly Patients with Type 2 Diabetes in Kinmen, Taiwan

Wu-Yu Hou, Tao-Hsin Tung, Hung-Ju Shen, Tein-Yow Chang, Pesus Chou, Jorn-Hon Liu — 2012-03-21

Summary: Background: The purpose of this study was to explore the prevalence and associated factors of gallstone disease among elderly patients with type 2 diabetes (≥ 60 years) in Kinmen, Taiwan.Methods: In 2001, a panel of specialists performed ultrasound sonography screening on 594 elderly type 2 diabetic patients identified in 1991–1993. Of these, 298 (50.2%) patients were examined.Results: Fifty-one out of 298 elderly type 2 diabetic patients were diagnosed with gallstone disease. The overall prevalence was 17.1% (men: 14.5%, women: 19.0%), which included the presence of single stone, 9.1% (n = 27); multiple stones, 4.4% (n = 13); and cholecystectomy, 3.7% (n = 11). The significant risk factors of gallstone disease based on multiple logistic regression analysis were body mass index [odds ratio (OR) =1.21, 95% confidence interval (CI): 1.09–1.37] and alanine transaminase (OR = 1.06, 95% CI: 1.03–1.10).Conclusion: The elderly type 2 diabetic population had a slightly higher prevalence of gallstone disease than the general population but no statistical significance. A higher body mass index and alanine transaminase may increase the risk of developing gallstone disease.

Profile of Hospitalized Elderly Patients Treated for Falling

Yu-Ling Hsiao, Chia-Chi Chang, Ching-Min Chen — 2012-03-26

Summary: Background: Elderly people are at the highest risk for falling. This study was conducted to examine the characteristics of the elderly who were hospitalized for treatment of fall-related injuries.Method: Secondary analysis was applied to retrieve data from the Taiwan National Health Insurance database. Descriptive and correlational research designs were applied to compare the characteristics of patients in terms of gender, age, season, patterns of treatments, and hospitals.Results: Falls account for 3.29% of total elderly hospitalizations, and elderly patients represent 47.5% of overall hospitalizations due to falls in Taiwan. Elderly hospitalization for falling was more prevalent in females in northern Taiwan, and the rate increased as age increased. Most elderly patients hospitalized for falling (61.8%) were treated in orthopedics departments, and 64.6% of these cases were diagnosed as fractures. The length of stay varied from 1 to 110 days (mean=8.67). There were more hospitalizations due to falls in winter than in other seasons. The average medical expense was 56,355.11 NTD ($1761) per person. Age was positively correlated with the length of stay and cost for hospitalization.Conclusion: This study utilized actual nationwide data to provide a profile of elderly patients treated for falling in Taiwan. Based on the results of this study, fall prevention should especially target the female elderly, and should be given more emphasis during the winter season, in terms of clinical and policy applications.

A Case of Dysphagia Aortica in an Elderly Patient

Sang-Wook Song, Ju-hye Chung, Se-Hong Kim — 2012-03-22

Summary: Dysphagia aortica is a mechanical dysphagia caused by compression of the esophagus by the dilated aorta, and it occurs mainly in elderly women with short stature, hypertension and kyphosis. We present the case of an 85-years-old woman who developed dysphagia aortica associated with a thoracic aortic aneurysm. The patient presented with dysphagia to solid food, which started several weeks ago. Chest computed tomography showed compression of the esophagus by a dilated thoracic aortic aneurysm. Extrinsic compression of the esophagus by the thoracic aorta was also shown in the barium swallow test. With diet control and the treatment of associated heart failure, the dysphagia symptom improved rapidly. Dysphagia aortica is a rare cause of dysphagia but can be treated by conservative or surgical treatment and should not be ignored.

A Case of Primary Gastric Small-Cell Carcinoma in an Elderly Patient

2012-03-21

Summary: We report a case of primary small-cell carcinoma of the stomach in a 75-year-old man. The patient was admitted to our hospital with a 1-week history of intermittent tarry stool. An upper gastrointestinal examination revealed a large stage A2 ulcer in the greater curvature of the body of the stomach, and pathological findings from biopsy specimens revealed small-cell carcinoma. The tumor cells were small-sized, composed of hyperchromatic nuclei with scant cytoplasm, and stained positive for cytokeratin, synaptophysin, and chromogranin A. The patient was diagnosed with primary small-cell carcinoma of the stomach. He declined further evaluation and received palliative management. This is a rare carcinoma of the stomach, with aggressive manifestations and a poor prognosis. The mean survival of patients with primary gastric small-cell carcinoma is reported to be 7 months. The choice of treatment for this disease is still controversial. This rare gastric tumor should be listed in the differential diagnosis of gastric carcinoma in the elderly.

Successful Treatment of Multiple Organ Failure After Wasp Stings in an Elderly Patient

2012-03-26

Summary: Although all kinds of complication have been reported after wasp stings, multiple organ failure following wasp attacks is very rare. In the past, the mortality of patients with multiple organ failure treated by conventional therapy after wasp stings was very high. Here, we report on a 65-year-old individual who developed multiple organ failure following wasp stings. When the patient was admitted at our hospital, 3 days after he had been stung by the wasps, he was unconscious. He was suffering from acute renal failure, hepatic, respiratory, and circulatory failures, and intravascular hemolysis. In addition to conventional therapy, plasma exchange was applied twice and followed by continuous venovenous hemofiltration. In the end, this elderly patient made a complete recovery, with his renal function returning to normal.

Hirschsprung’s Disease in Patients of Advanced Age

2012-03-22

Summary: Hirschsprung’s disease is a congenital motility disorder that is easily overlooked as a cause of chronic refractory constipation in adults. We present a case of Hirschsprung’s disease in a patient 70 years of age with a history of long-standing constipation, chronic use of laxatives, and recurrent episodes of colonic obstruction. Presumptive preoperative diagnosis was chronic ischemic sigmoid stenosis or intermittent sigmoid volvulus before Hirschsprung’s disease was suspected based on intraoperative colonoscopy and surgical findings. The diagnosis was confirmed by the absence of intrinsic ganglion cells on histopathologic examination of the surgical specimen and the absence of the rectoanal inhibitory reflex on postoperative manometry. A conservative surgical approach that limited the resection to the grossly diseased rectum successfully restored normal defecation despite the anastomosis being performed on the distal aganglionic rectum. This approach, which avoids extensive rectal dissection, may be suitable for older or frail patients. Heightened awareness of Hirschsprung’s disease is necessary to ensure its prompt recognition in the elderly.

Transmesenteric Internal Herniation of Small Bowel in an Elderly

Lu-Chih Kung, Yu-Jang Su, Yen-Chun Lai — 2012-03-21

Summary: A 68-year-old male complained of epigastric pain and coffee ground vomitus for hours. Emergent panendoscopy revealed diffuse esophageal ulcers, mild hiatal hernia, and gastric erosion. An abdominal computed tomography (CT) scan was performed due to the persistent abdominal pain with peritonitis. CT scan without enhancement showed transmesenteric internal herniation of the small bowel with strangulation. The condition of the patient deteriorated and he died from extreme shock and peritonitis after 3 hours of observation in the surgical intensive care unit.

CT Findings in the Afferent Loop

I-Tsung Lin, Ming-Jong Bair — 2012-03-21

A 77-year-old man was brought to our emergency department due to acute onset of epigastric pain with brownish vomiting. He had a history of gastrectomy with Billroth II anastomosis because of a bleeding gastric ulcer that was treated 40 years prior. He was febrile (38.5°C) and demonstrated tachycardia (120 beats/minute). On physical examination, upper abdominal tenderness was detected. Plain film of the abdomen demonstrated segmental dilated bowel loops over the upper-mid abdomen. Laboratory work-up indicated leukocytosis with left shift and elevated amylase and lipase levels. Transverse echogram of the upper-mid abdomen revealed a markedly dilated bowel loop crossing over midline located in front of the inferior vena cava (IVC) and abdominal aorta (AA) (). A computed tomography (CT) scan revealed a dilated afferent loop with fluid between the aorta (large arrow) and superior mesenteric artery (small arrow). None of the oral contrasting agent passed into the afferent loop. In addition, a “whirl sign” (triangle) was found in front of the afferent loop (). Laparotomy demonstrated congested and obstructive afferent loop caused by kinking.