Dementia and Other Risk Factors for Mortality in the Institutionalized Japanese Elderly

Abstract

In order to evaluate the risk factors on the mortality of the institutionalized Japanese elderly, the cohort study was carried out. We studied the outcome of 114 residents in a skilled nursing home for the elderly in Fukuoka, Japan.Sixty-seven of the residents were demented. During the five-and-a-half year follow-up, the survival rate was lower in the residents with than in those without dementia. (31% vs. 70%). In a univariate analysis, the risk for death increased when factors such as age or systolic blood pressure increased, while it decreased when factors such as the score of Hasegawa's dementia rating scale, the serum albumin level or the activity of daily living score increased.The existence of hypertension, cancer or dementia increased the risk for death, while the ability to urinate and have bowel movements by oneself or that to take meals by oneself decreased it. In a multivariate analysis, dementia, old age, high systolic blood pressure, cancer and the inability to take meals by oneself were risk factors for mortality. Since the treatment of hypertension may sometimes accelerate dementia and limit activities of daily living through a further decreased cerebral blood flow after a blood pressure fall, it seems to be advisable to avoid an excessive blood pressure fall while the treatment of hypertension may be recommended in the elderly. J Epidemiol, 1995; 5 : 117-123. dementia, elderly, ADL, hypertension, mortality With a rapid increase in the proportion of the elderly population among the total population, the increase in number of the elderly with dementia has become a serious problem in Japan.The prognosis of Japanese elderly with dementia has been reported to be poor1-6). At present, however, there have been only a few reports that describe the risk for death among the elderly population after controlling for dementia and other confounding factors such as age or the activities of daily livings (ADL)1-2). Furthermore, these reports did not provide information on either the nutritional state or complicated diseases such as hypertension, diabetes mellitus, cerebrovascular diseases and cancer.A cohort study was thus carried out to evaluate the risk factors for mortality of the residents in the nursing home for the elderly with dementia and/or an impaired ADL. In this paper, we compare the survival rate among the elderly according to the type of dementia such as nondementia, senile dementia of Alzheimer type (SDAT) and vascular dementia including multi-infarct dementia (MID) and Binswanger type dementia (BD). Furthermore, we describe the risk of the elderly with dementia after controlling for other confounding factors including age, ADL, nutritional state and complicated diseases. SUBJECTS AND METHODS Evaluation of SubjectsOn the first of April 1988, there were 114 elderly persons (21 males and 93 females), with a mean age of 82.0 and

Effects of Dementia on Mortality in the Radiation Effects Research Foundation Adult Health Study

“…Although relatively few death certificates report dementia [1,2], it is a cause of increased mortality according to longitudinal studies in Europe [3,4], the US [5], and Japan [6,7]. Pneumonia and cardiovascular diseases are the predominant immediate causes of dementia-associated deaths [8][9][10][11].…”

Prevalence of dementia in a Japanese population

“…Since the survival rate of AD is higher compared to the rate of VD, 3,4 women may have the greater prevalence of AD because they live longer than men. I would like to ask Yamada et al to show age‐ and sex‐specific prevalence of AD, as it may be helpful for readers to know whether women have higher age‐adjusted prevalence of AD compared with men.…”