The Relationship between Psychological Distress and Physical Frailty in Japanese Community-Dwelling Older Adults: A Cross-Sectional Study

BACKGROUND

Older adults' mental health and physical frailty have been a frequent research focus, but few studies have investigated the relationship between them.

OBJECTIVES

To investigate the association between mental health and physical frailty in community-dwelling older Japanese people.

DESIGN

Cross-sectional study from the Itoshima Frail Study.

SETTING

Itoshima City, Fukuoka, Japan.

PARTICIPANTS

A total of 919 community-dwelling older individuals aged 65-75 years.

MEASUREMENTS

Physical frailty was measured based on five criteria proposed by the Fried scale, and the subjects were classified into three groups: robust, pre-frailty, and frailty. Psychological distress was used to assess the subjects' mental health, with the Kessler 6-Item Psychological Distress Scale (K6) score; the subjects were divided into three groups based on their K6 score: 0-1, 2-4, and ≥5. Psychological distress was defined by K6 score ≥5. Ordinal logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) between the psychological distress and physical frailty status.

RESULTS

Psychological distress was identified in 190 subjects (20.7%). Forty-six subjects (5.0%) presented with physical frailty, and 24 subjects (2.6%) had both psychological distress and physical frailty. With the increase in the K6 score, more subjects had pre-frailty and physical frailty (p<0.001). Significant positive associations were observed between psychological distress and the risks of pre-frailty (OR 2.94, 95%CI: 1.95-4.43) and frailty (OR 10.71, 95%CI: 4.68-24.51), even in a multivariable-adjusted analysis. In a subgroup analysis of components of frailty, one-point increment in K6 score was associated with higher odds of shrinking and fatigue.

CONCLUSION

A severe psychological distress was associated with increased risks of physical frailty and the frailty sub-items of shrinking and fatigue in community-dwelling older Japanese adults.

Endoscopic decompression procedure in acute obstructing colorectal cancer

BACKGROUND AND STUDY AIMS

In the treatment of acute obstructing colorectal cancer, a nasoenteric ileus tube is not capable of providing sufficient decompression of the enlarged intestine immediately, and it may cause the patients throat pain. We therefore assessed the effectiveness of an endoscopic decompression procedure using a transanal ileus tube for acute obstructing colorectal cancer.

PATIENTS AND METHODS

Five patients (five women, mean age 62) with colorectal cancer ileus underwent endoscopic decompression procedures between July 1994 and March 1999. The stricture was first negotiated using a guide wire 300 cm in length, and was then dilated using 8 Fr and 26 Fr dilating catheters. Immediately after a transanal ileus tube 120 cm in length with an outside diameter of 22 Fr was inserted, the intestinal tract was cleaned.

RESULTS

No leakage from a colorectal anastomosis occurred during this endoscopic decompression procedure. Immediately after insertion of a decompression procedure tube, radical surgery could be performed after adequate preoperative examination and colorectal preparation.

CONCLUSIONS

This procedure may be helpful in allowing immediate preoperative examination and scheduling of a radical operation for acute obstructing colorectal disease.

An in vitro chemosensitivity test for colorectal cancer using collagen-gel droplet embedded cultures

This study evaluated in vitro assay for chemosensitivity test using a collagen-gel droplet embedded culture drug sensitivity test (CD-DST) for colorectal cancer. CD-DST was performed in 24 patients with Dukes B, C colorectal cancer. Primary cultures of tumor cell samples from 87.5% (21/24) patients with colorectal cancer were successful. The efficacy rates assessed by CD-DST of five anticancer drugs evaluated were: 60.4% for adriamycin, 58.9% for etoposide, 56.7% for cisplatin, 53.4% for 5-fluorouracil, for 31.1% for mitomycin C, and 9.5% for vindesine. The present study demonstrated the clinical usefulness of CD-DST in evaluating the response to chemotherapy in colorectal cancer.

Two cases of biliary hemorrhage after percutaneous transhepatic biliary drainage in which transcatheter arterial embolization was effective

Patient No. 1 was a 66-year-old male who was diagnosed as having cancer of the caput pancreatis, and underwent percutaneous transhepatic biliary drainage (PTBD). Since the tube slipped out, percutaneous transhepatic gallbladder drainage (PTGBD) was performed. After PTGBD, biliary hemorrhage was observed for two to three days, then hemorrhage disappeared and bile flowed smoothly. Since the tube was likely to slip out, the tube was replaced. After replacement of the tube, biliary hemorrhage was noted for two to three days, then spontaneously subsided again. After icterus was reduced, pancreatoduodenectomy was performed. During surgery, a number of massive blood clots were noted in the bile duct. The PTGBD tube was removed, and a transjejunal tube was placed. On the 11th day after the surgery, hemorrhage occurred in the bile duct tube, and the patient went into shock. Emergency abdominal angiography was performed. A false aneurysm was detected in A6 and embolized using a microcoil. After transcatheter arterial embolization (TAE), hemorrhage stopped, and the patient was discharged. Patient No. 2 was a 68-year-old male who was diagnosed as having cholelithiasis and underwent PTBD. On the 21st day after PTBD, biliary hemorrhage occurred and the patient fell in shock status. Emergency abdominal angiography was performed. A false aneurysm was detected in A3 and embolized using a microcoil. After TAE, cholangioscopic lithectomy was performed and the disease alleviated. Thereafter the patient was discharged. It is necessary to consider false aneurysm when biliary hemorrhage occurs after PT(G)BD.