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Secular improvement in self-care independence of old people living in community in Kahoku, Japan
Figure: Secular trend by age group in percentage of people aged 65 or over who were independent in ADL, 1991-95 From Logistic regression model, adjusted for age (by five years age band) and sex. The control groups are constituted of other cancers excluding cancers of the liver, kidney, thyroid, lymphomas and myelomas. The reference groups (or unexposed to dialysis) Include all cancer cases, or all other cancer cases diagnosed m the Varese cancer registry m the period 1983-87.
Table: Risk of developing
cancer
in
patients
on
dialysis
considered. 44 023 patient years were available for the study, 25 684 in men and 18 339 in women. 479 cases of cancer at all sites was recorded. The average age at diagnosis was 59-5 years and the cases were on dialysis for an average of 6-37 years. There were statistically significantly raised risks of primary liver cancer, kidney cancer, thyroid cancer, lymphoma, and multiple myeloma. There were significantly decreased risks of cancers of the oral cavity and larynx, and a non-significant decrease in cancer of the oesophagus (table). The excess of nonHodgkin’s lymphoma is similar to that found in recipients of renal transplants. The excess of liver cancer might be linked to materials used during dialysis. Longer and better survival of patients with end stage renal disease undergoing renal replacement therapy means that there are many elderly patients receiving therapy. Our results highlight the need for careful follow-up and for early detection of cancers in these patients. *G Buccianti, Barbara Ravasi, Donata Cresseri, P Maisonneuve, P Boyle, Francesco Locatelli *Divisione di Nefrologia e Dialisi, Ospedale Maggiore di Milano,
IRCCS 20122, Milan, Italy; Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan; and Dialysis and Transplant Registry of Lombardy, Milan
1
Pope JC, Koch MO, Bluth RF. Renal cell carcinoma in patients with end-stage renal disease: a comparison of clinical significance in patients receiving haemodialysis and those with renal transplants. Urology 1994; 44: 497-501.
improvement in self-care independence of old people living in community in Kahoku, Japan
Secular
SiR-Any secular trends in the prevalence of functional dependency among old people living in the community is important for the planning of care programmes for the elderly. Since 1991 we have annually assessed the activities of daily living (ADL) dependency of those aged 65 or more living in Kahoku, a town in Japan whose nearest city is Kochi 30 km away. 30% of the population was 65 years or 60
Rate for all ages 565 than in 1991 (*p<0.01,
’significantly higher in 1993, 1994, and 1995 tp<0.05, X2 test). over in 1991 and 32% in 1995. We assessed eight items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, grooming, and taking medicine) noting the help required on a validated disability rating scale.’ The annual numbers interviewed in 1991-95 were 1488, 1578, 1618, 1643, and 1710, these numbers being, respectively, 91%, 90%, 91%, 91%, and 92% of Kahoku residents aged 65 or more. Predictably, the proportion of the elderly who were independent in every ADL item decreased with advancing age. Notably, the total proportion of the independent elderly significantly increased after 1993 (75%) compared with 1991 (71%), and comparison between 1991 and 1995 revealed a significant increase not only in the total proportion of independent elderly (from 71% to 83%) but also in the rate of independence within each age group
(figure). Our serial cross-sectional data do suggest that in Kahoku the proportion of disability in non-institutionalised old people is not as high as previous studies have suggested.2 *Kozo Matsubayashi, Kiyohito Okumiya, Tomoko Wada, Yasushi Osaki, Yoshinori Doi, Toshio Ozawa *Department of Medicine and Geriatrics, Kochi Medical School, Kochi, Nankoku City 783, Japan; and Tokyo Metropolitan Hospital, Tokyo
1
2
Pace WD. Geriatric assessment in the office setting. Geriatrics 1989; 44: 29-35. Jette AM, Branch LG. The Framingham Disability Study II: physical disability among the aging. Am J Publ Health 1981; 71: 1211-16.
Vero cytotoxin-producing E coli 0157 infection associated with farms and colleagues reported haemorrhagic colitis in child after a visit to a farm centre, where the strains of Vero cytotoxin-producing Escherichia coli 0157 (0157 VTEC) from an animal and the child were indistinguishable.’ We investigated associations between human 0157 VTEC infection in Cornwall and West Devon and contact with animals, with the co-operation of the four local microbiology laboratories and the Veterinary Investigation Centre at Starcross. We found similar strains of 0157 VTEC in human cases and contact animals on four separate occasions. We report two children, one of whom developed haemolytic uraemic syndrome (HUS), and each
SiR-Parry a
Table: Risk of developing
cancer
in
patients
on
dialysis
considered. 44 023 patient years were available for the study, 25 684 in men and 18 339 in women. 479 cases of cancer at all sites was recorded. The average age at diagnosis was 59-5 years and the cases were on dialysis for an average of 6-37 years. There were statistically significantly raised risks of primary liver cancer, kidney cancer, thyroid cancer, lymphoma, and multiple myeloma. There were significantly decreased risks of cancers of the oral cavity and larynx, and a non-significant decrease in cancer of the oesophagus (table). The excess of nonHodgkin’s lymphoma is similar to that found in recipients of renal transplants. The excess of liver cancer might be linked to materials used during dialysis. Longer and better survival of patients with end stage renal disease undergoing renal replacement therapy means that there are many elderly patients receiving therapy. Our results highlight the need for careful follow-up and for early detection of cancers in these patients. *G Buccianti, Barbara Ravasi, Donata Cresseri, P Maisonneuve, P Boyle, Francesco Locatelli *Divisione di Nefrologia e Dialisi, Ospedale Maggiore di Milano,
IRCCS 20122, Milan, Italy; Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan; and Dialysis and Transplant Registry of Lombardy, Milan
1
Pope JC, Koch MO, Bluth RF. Renal cell carcinoma in patients with end-stage renal disease: a comparison of clinical significance in patients receiving haemodialysis and those with renal transplants. Urology 1994; 44: 497-501.
improvement in self-care independence of old people living in community in Kahoku, Japan
Secular
SiR-Any secular trends in the prevalence of functional dependency among old people living in the community is important for the planning of care programmes for the elderly. Since 1991 we have annually assessed the activities of daily living (ADL) dependency of those aged 65 or more living in Kahoku, a town in Japan whose nearest city is Kochi 30 km away. 30% of the population was 65 years or 60
Rate for all ages 565 than in 1991 (*p<0.01,
’significantly higher in 1993, 1994, and 1995 tp<0.05, X2 test). over in 1991 and 32% in 1995. We assessed eight items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, grooming, and taking medicine) noting the help required on a validated disability rating scale.’ The annual numbers interviewed in 1991-95 were 1488, 1578, 1618, 1643, and 1710, these numbers being, respectively, 91%, 90%, 91%, 91%, and 92% of Kahoku residents aged 65 or more. Predictably, the proportion of the elderly who were independent in every ADL item decreased with advancing age. Notably, the total proportion of the independent elderly significantly increased after 1993 (75%) compared with 1991 (71%), and comparison between 1991 and 1995 revealed a significant increase not only in the total proportion of independent elderly (from 71% to 83%) but also in the rate of independence within each age group
(figure). Our serial cross-sectional data do suggest that in Kahoku the proportion of disability in non-institutionalised old people is not as high as previous studies have suggested.2 *Kozo Matsubayashi, Kiyohito Okumiya, Tomoko Wada, Yasushi Osaki, Yoshinori Doi, Toshio Ozawa *Department of Medicine and Geriatrics, Kochi Medical School, Kochi, Nankoku City 783, Japan; and Tokyo Metropolitan Hospital, Tokyo
1
2
Pace WD. Geriatric assessment in the office setting. Geriatrics 1989; 44: 29-35. Jette AM, Branch LG. The Framingham Disability Study II: physical disability among the aging. Am J Publ Health 1981; 71: 1211-16.
Vero cytotoxin-producing E coli 0157 infection associated with farms and colleagues reported haemorrhagic colitis in child after a visit to a farm centre, where the strains of Vero cytotoxin-producing Escherichia coli 0157 (0157 VTEC) from an animal and the child were indistinguishable.’ We investigated associations between human 0157 VTEC infection in Cornwall and West Devon and contact with animals, with the co-operation of the four local microbiology laboratories and the Veterinary Investigation Centre at Starcross. We found similar strains of 0157 VTEC in human cases and contact animals on four separate occasions. We report two children, one of whom developed haemolytic uraemic syndrome (HUS), and each
SiR-Parry a