[An attempt to estimate geographical accessibility to day service facilities among the elderly with a geographical information system]

OBJECTIVE

The objective of this study was to assess inequality in geographical accessibility to day service among the elderly in a municipality using a geographical information system (GIS). We also examined problems in measuring geographical accessibility and ways to validate results.

METHODS

The target was Hachioji City. The following two data sets were constructed: a data set for day service facilities for all of Hachioji City and a data set for the people aged 65 and over, living within 1 km meshes in Hachioji City. These were integrated and displayed on a digital map with GIS software. Geographical accessibility was estimated by measuring the shortest road distance from the center point of each mesh to day service facilities.

RESULTS

There were 47 day service facilities serving Hachioji City in October, 2000 and 139 meshes that had elderly residents. Their center points were all located within Hachioji City, which was estimated to have 73,760 elderly in 2000. The mean distance from the center point of each mesh to the nearest day service facility was 1.99 km (SD = 1.75, max = 9.21, min = 0.03). The proportions of the elderly who had 5 or more facilities within 3 km and 5 km from their residence were estimated to be 57.3% and 96.4%, respectively.

CONCLUSIONS

The results of this study suggest that there is variation in geographical accessibility to day service facilities among the elderly living in a relatively large municipality. It is now necessary to examine whether the difference in geographical accessibility to day service affects the service utilization.

[Vitamin A, B1 and C status of elderly living alone]

A cross-sectional survey was performed to examine the vitamin A, B1 and C status and relating factors among the elderly aged over 65 years and living alone in the western parts of Hachioji, Tokyo. Of 159 subjects, 17 men and 81 women participated in this survey. A questionnaire and interview on the socioeconomic conditions, state of health and life-style and easting habits, and a medical examination were conducted and blood collected and analyzed. Vitamin A, B1 and C status was evaluated on the basis of serum vitamin A concentration, whole blood vitamin B1 concentration and serum vitamin C concentration, respectively. Most of the participants were those who were comparatively active in daily life. Thirty-three percent of the participants were assessed to be in poor vitamin B1 status, while 1% and 4% were assessed to be in poor vitamin A and C status, respectively. Significant correlations were found between whole blood vitamin B1 and serum vitamin A concentrations and between whole blood vitamin B1 and serum vitamin C concentrations. About 10% of the participants had blood vitamin B1 concentrations as below 35 ng/ml and at the same time, significantly lower serum vitamin A and C concentrations than others. Thus, inadequate nutrient intakes or inappropriate diet intakes were suggested as a cause. While good vitamin status was linked with use of vitamin preparations or vitamin supplements, lowered vitamin status was found to be closely associated with such dietary practices or behavior as dietary indifference to food combinations, a higher preference of rice as the staple food and having a reported difficulty in preparing meals.

A comparative study of monoclonal gammopathies and immunoglobulin levels in Japanese and United States elderly

OBJECTIVE

To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians.

DESIGN

Survey study

SETTING

Community Center in Yokohama, Japan and Retirement Community in the United States.

PARTICIPANTS

Convenience sample of community-dwelling elderly subjects (age 63-95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects.

INTERVENTION

None

MEASUREMENTS

Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry.

RESULTS

Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 +/- 520 mg/dL versus 1,118 +/- 402 mg/dL for the American group; mean quantitative IgA levels were 283 +/- 116 mg/dL versus 226 +/- 116 mg/dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population.

CONCLUSION

The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross-cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.