The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study

BACKGROUND@#The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly.@*METHODS@#Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis.@*RESULTS@#The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05-1.32) in the crude model and 1.12 (95% CI: 1.00-1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06-1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67-1.17).@*CONCLUSIONS@#This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.

Evaluation of Pressure Ulcers in 202 Patients with Cancer.

Countermeasures for pressure ulcers, which have been promoted as a national policy in Japan since 2002, have reduced the development of new pressure ulcers due to insufficient observation or treatment. On the other hand, it has become clear that pressure ulcers continue to develop in patients with cancer. The authors evaluated 419 patients (202 of whom had cancer) who had newly developed pressure ulcers. The following results were obtained: 1) among patients with terminal illnesses, cancer patients outnumbered noncancer patients; 2) there was no difference between the cancer patient group and the noncancer patient group regarding time required to heal ulcers; 3) there was no difference between the groups in the time from the development of pressure ulcer until the patients died; 4) patients with cancer were more likely to develop pressure ulcers compared to patients without cancer, even though their risk scores analysis were not high. In addition to providing enough anodynes, sedatives, and extra-soft mattresses, it is necessary to modify risk assessment measures because cancer is a risk factor for pressure ulcer development.

A Technique To Avoid a Dog-ear Deformity On the Buttock Using a "Pigeon Head" Modification of the Rotation Flap.

Gluteal fasciocutaneous (FC) rotation flaps can still be used to close sacral pressure ulcers but tend to develop a large dog-ear on the buttock. This study presents a new method of avoiding a dog-ear deformity (Burow's triangle) while achieving adequate repair of pressure ulcers on the buttock by using a modification of the bilobed rotation flap. This "pigeon head" modification of the rotation flap successfully covered all 7 sacral ulcers. In all cases, Burow's triangles were unobtrusive immediately after surgery. This technique is simple, can be performed quickly, has minimal associated morbidity, and yields a good outcome.