Geriatrics and Gerontology International 2005; 5: 159–167

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Blackwell Science, LtdOxford, UKGGIGeriatrics and Gerontology International1444-15862005 Blackwell Publishing Asia Pty LtdSeptember 200553159167Original ArticleComprehensive geriatric assessment in LaosK Okumiya

et al.

Accepted for publication 22 December 2004.

Correspondence: Dr Kiyohito Okumiya, MD, PhD, Research Institute for Humanity and Nature, 335 Takashima-cho, Kamigyo-ku, Kyoto 602-0878, Japan. Email: okumiyak@chikyu.ac.jp

ORIGINAL ARTICLE

Comprehensive geriatric assessment for community-

dwelling elderly in Asia compared with those in Japan: IV.

Savannakhet in LaosKiyohito Okumiya,1 Masayuki Ishine,2 Taizo Wada,2 Matheus Cruz,2 Idiane Cruz,2

Naoko Ishine,2 Teiji Sakagami,3 Tohru Kita,4 Eiko Kaneda,5 Kazuhiko Moji,5 Tiengkham Pongvongsa,6 Satoshi Nakamura,7 Tomoya Akimichi,1 Boungnong

Boupha,8 Toshiko Kawakita,9 Mutsuko Fushida9 and Kozo Matsubayashi10

1Research Institute for Humanity and Nature, Departments of 2Field Medicine, 3Psychiatry and 4Cardiology and 10The Center for South-east Asian Studies, Kyoto University, Kyoto University and 9Kyoto Preventive Medical Center Foundation, Kyoto, 5Institute of Tropical Medicine, Nagasaki University, Nagasaki, and

7International Medical Center of Japan, Tokyo, Japan, 6Station of Malariology Parasitology and Entomology, Savannakhet Province, and 8National Institute of Public Health, Vientiane, Lao PDR

Background: The objective of the present study is to compare the findings of compre-hensive geriatric assessments (CGA) of community-dwelling elderly people living in LaoPeople’s Democratic Republic (Laos) with those in Japan.

Methods: A cross-sectional, interview- and examination-based study was undertaken.The subjects consisted of community-dwelling elderly people in Songkhon, a rural districtin Laos and in Sonobe, a rural town in Kyoto, Japan. Two hundred and ninety-four peopleaged 60 years and over in Laos and 411 aged 65 years and over in Japan were examinedusing a common CGA tool. Interviews pertaining to activities of daily living (ADL), med-ical and social history, quality of life (QOL) and Geriatric Depression Scale as well asanthropometric, and blood chemical examinations were included in the assessment.

Results: All scores for basic and instrumental ADL, intellectual activity and social roles,body mass index, prevalence of hypertension, mean total and HDL cholesterol levels werelower in Laos than in Japan, while prevalence of depression, impaired glucose toleranceand anemia were higher in Laos than in Japan.

Conclusion: Differences in lifestyle and medical status were found between economi-cally developing Laos and highly developed Japan. Almost all comprehensive geriatricfunctions such as ADL, QOL, mood and nutritional condition in blood chemistry werelower in the elderly in Songkhon than in Kyoto. Of particular note were the higher prev-alence of diabetes mellitus and anemia and lower prevalence of hypertension in the elderlypopulation in Songkhon district, which should be examined in future studies.

Keywords: ADL, community-dwelling elderly, comprehensive geriatric assessment, Laos,quality of life.

Introduction

The elderly population in Japan is growing at the fastestrate in the world. In response to the increasing popula-tion of the elderly, how to provide efficient and effective

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health care to older persons has become an issue ofintense debate.

In the twenty-first century, the elderly population ineach country in South-east Asia will grow rapidly as ithas done in Japan. In Lao People’s Democratic Republic(Laos), the percentage of elderly people aged 65 yearsand over is projected to increase from 5% in 2000 to14% in 2050.1 We have carried out comprehensiveassessments of the medical functions of community-dwelling elderly and provided efficient education to pro-mote healthy lifestyles in the elderly population ofJapan.2–12 Adding to the longitudinal geriatric interven-tion study in Japan, we also investigated older subjectsliving in Singapore,13 Korea,14 Indonesia and Viet-nam.15,16 As a result, diseases and frailty in community-dwelling older people are found to be influenced bysuch ecologic differences as the natural environment,historical background, lifestyle, personal habits, religionand health promotion policies in the area. With longerlife spans and decreasing birth rates, demographic agingis now an established trend not only in Western coun-tries but also in Asian ones. The issue of efficient health-care for the elderly is therefore becoming more urgenteven in the South-East Asian countries. To achieveappropriate policies to detect ecology-related risk fac-tors for frailty in the elderly and to help prevent the dis-abilities in the elderly population, and also to provideuseful welfare services to the frail elderly, further inves-tigation is needed, such as comprehensive field-worksurveys with regard to health and the prevalence of dis-ease in community-dwelling elderly people.

Comprehensive geriatric assessment involves theevaluation of the physical, psychosocial and environ-mental factors that impact on the well-being of olderindividuals. The use of an organized approach withobjective measurements helps target key areas of func-tional status. Important areas include the evaluation ofactivities of daily living, cognition, mood, social sup-ports, gait and falls, nutrition, sensory impairment,incontinence, polypharmacy, elder abuse, pressuresores, pain and advance directives. The provision of pri-mary and secondary prevention is also increasinglyimportant for older individuals.17 The ComprehensiveGeriatric Assessment program can improve functionalstatus; reduce the use of medications, nursing homesand medical services; it can also reduce mortality ratesand the length of the initial hospital stays and of sub-sequent readmissions. A well-targeted ComprehensiveGeriatric Assessment program and the control ofpatients’ adherence to recommendations are effective inimproving the well-being of elderly patients.18–20

Aging is inevitable and therefore universal, but thereis diversity in aging. Aging is associated not only withgenetic factors but also with culture and environmentalfactors. That’s why we are conducting this comparativefield-work survey of community-dwelling elderly in

Asian countries to examine the association amonghuman health and aging, culture and nature. We haveshown the association between health status and sub-jective economic satisfaction in West Papua and highprevalence of hypertension in Singapore.21,22 But therehas been no international comparative study of compre-hensive geriatric assessments of community-dwellingelderly.

Laos is one of the developing countries in South-EastAsia and there are many differences in lifestyles, medicalconditions, economic status, ethnicity and natural ecol-ogy compared with Japan.23 In this paper, one of a seriesof five consecutive studies of geriatric comparisonsbetween Asian countries and Japan, we report on geri-atric indicators such as activities of daily living (ADL)and quality of life (QOL) as well as blood pressure andblood chemical findings in the elderly living in six vil-lages in Songkhon District in Savannakhet Province inLaos. This medico-ecologic study is intended to clarifythe actual medical and geriatric conditions of elderlypeople in Laos and may contribute to future strategiesto promote the health of the elderly in Laos as well as inJapan.

Methods

Subjects

The study population consisted of 294 community-dwelling elderly subjects aged 60 years and older (male:female = 121/173; mean age: 69.6 years) living in six vil-lages (Lahanam Thong, Bngkhamlai, Thahkamlian,Dong Bang, Lahanam Tha, Kokphok) in Songkhon dis-trict in Savannakhet Province in Laos, and 411 peopleaged 65 years and more (male : female 174 : 237; meanage: 71.7 years) living in Sonobe town in Kyoto in Japan(Fig. 1). The six villages in Songkhon have a total pop-ulation of 4233 people with 369 people who were60 years old and more and we were able to examine 294

Figure 1 Map of the study area.

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elderly people (79.7% of eligible subjects). Sonobe townhas a population of 16 700 with 3340 of 65 years ormore and we were able to examine 411 elderly (12.3% ofeligible subjects). The geriatric survey for community-dwelling elderly living in Japan and in Laos was carriedout in April 2003 and February 2004 respectively.

Items of comprehensive geriatric assessment

Items of comprehensive geriatric assessment includedADL, assessment of depression and quantitative assess-ment of QOL, as well as medical and anthropometricalindicators.

Activities of daily living

For basic-ADL assessment, each subject rated his/herindependence in regard to seven items (walking,ascending and descending stairs, feeding, dressing,making his/her toilet, bathing, grooming) as to the helpneeded. The items were rated from 3 to 0 : 3, completelyindependent; 2, need some help; 1, need much help;0, completely dependent). The items were added togive scores ranging from 0 to 21, with low scores indi-cating disability.2,11–16 Information-related function wasdefined as scores summed from four items (visual acu-ity, hearing acuity, conversation and memory in oneday) using a rating scale from 0 (cannot at all) to 3 (com-pletely independent) producing total scores in the rangeof 0–12. For higher-level functional capacity, eachsubject rated his/her independence in the Tokyo Met-ropolitan Institute of Gerontology (TMIG) index ofcompetence.24,25 This assessment consists of a 13-itemindex including three sublevels of competence: (i)instrumental ADLs (five items: the ability to use publictransport, buy daily necessities, prepare a meal, pay billsand handle banking matters, rated on a yes/no basis); (ii)intellectual ADLs (four items: the ability to completeforms, read newspapers, read books or magazines andtake interest in television programs or news articles onhealth-related matters, rated on a yes/no basis); and (iii)social ADLs (four items: the ability to visit friends, giveadvice to relatives and friends who confide, visit some-one at the hospital and initiate conversation withyounger people, rated on a yes/no basis).

Depression and QOLs

We screened for depressive symptoms using the Japa-nese version of the 15 item-Geriatric Depression Scale(GDS-15), which was also translated into Lao.26,27 Wedefined depression as a GDS-15 score of 6 or more,with a score of 6–9 indicating ‘mild depression’, and ascore of 10 or more indicating ‘severe depression’.QOLs were assessed using a 100 mm visual analog scale(worst QOL on the left end of the scale, best on the

right) in the following five items; subjective sense ofhealth, relationship with family, relationship withfriends, financial status and subjective happiness.28,29

Social, anthropometrical and medical assessments

Living conditions, lifestyle (current exercise levels,alcohol consumption, smoking and so on) and medi-cal histories (histories of stroke, heart disease andosteoarthropathies, as well as taking antihypertensivedrugs) were also assessed. Two blood pressure mea-surements taken in a sitting position by auto-sphygmomanometer (HEM 757, Omron, Japan) wereaveraged to produce the blood pressure level of thesubjects. Physical examination and blood chemicalanalysis (total cholesterol, HDL-cholesterol, creati-nine, blood sugar, hemoglobin, uric acid, GOT andGPT) were performed.

Statistical analysis

Statistical analysis was performed using StatView ver.5for Macintosh (SAS institute, Inc., Cary, NC). The Stu-dent’s t-test was used for continuous variables and c2

test was used for categorical variables. P-values less than0.05 were used to indicate statistical significance.

Results

Table 1 shows the comparison of baseline characteris-tics between the elderly subjects living in Songkhon inLaos and those in Kyoto in Japan. The elderly subjectsin Songkhon were significantly younger (69.6 years old)than those in Kyoto (71.7 years old). There was no dif-ference in the male–female ration between two areas.The percentage of widowed individuals was higher inSongkhon (33.6%) than in Kyoto (18.8%). Most of theelderly in Songkhon (88.8%) were living with childrenor parents, while the percentage of elderly living with aspouse only or living alone was lower in Songkhon(5.9%, 0.4%) than in Kyoto (38.2%, 7.6%). Consump-tion of alcohol ‘every day’ and smoking ‘currently’ werelower in Songkhon (1.7%, 4.1%) than in Kyoto (22.0%,13.8%), while the percentages of elderly drinking alco-hol ‘sometimes’ and ‘past’ smokers were higher inSongkhon (41.4%, 29.7%) than in Kyoto (26.7%,14.1%). The rate of elderly subjects taking any medica-tion ‘every day’ was lower in Songkhon (24.3%) than inKyoto (47.2%), while the rate of elderly subjects takingany medication ‘sometimes’ was higher in Songkhon(52.1%) than in Kyoto (9.8%). The rate of elderly sub-jects taking antihypertensive medication was muchlower in Songkhon (4.5%) than in Kyoto (34.0%), butthere were more people who did not know if they hadbeen taking antihypertensive medication or not inSongkhon (44.3%) than in Kyoto (1.0%). Actually most

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Table 1 Baseline characteristics between the community-dwelling elderly living in Laos and those living in Japan

Songkhon in Laos(n = 294)

Kyoto in Japan(n = 411)

P

Mean age 69.6 ± 7.6 71.7 ± 4.8 < 0.0001Male/female 121/173 174/237 NSMarital state (%) < 0.0001

Widowed 33.6 18.8Unmarried 2.1 0.2Divorced 2.8 0.7

LifestyleResidential situation (%) < 0.0001

With children or parents 88.8 53.4With spouse only 5.9 38.2Alone 0.4 7.6Others 4.9 0.7

Drinking alcohol (%) < 0.0001Every day 1.7 22Sometimes 41.4 26.7None 56.9 51.4

Smoking (%) < 0.0001Current 4.1 13.8Past 29.7 14.1Never 66.2 72

MedicalTaking any medication (%) < 0.0001

Everyday 24.3 47.2Occasionally 52.1 9.8No 23.6 43

Taking anti-hypertensive medication (%) < 0.0001Yes 4.5 34No 51.2 65Do not know 44.3 1

Recognition of blood pressure < 0.0001Normal 10.3 60.6High 7.2 37Do not know 82.5 2.4

History of stroke (%) < 0.0001Yes 27.1 4.0No 71.6 96.0Do not know 1.4 0.0

History of heart disease (%) < 0.0001Yes 15.5 21.2No 43.6 78.8Do not know 40.9 0.0

History of osteoarthropathy (%) NSYes 58.2 59.4No 41.1 40.6Do not know 0.7 0.0

History of fall (%) 31.5 12.8 < 0.0001

NS, not significant.

Comprehensive geriatric assessment in Laos

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people (82.5%) in Songkhon did not know how theirblood pressure had been. The rate of subjects recogniz-ing their apparent history of stroke was higher inSongkhon (27.1%) than in Kyoto (4.0%). The rate ofsubjects recognizing their apparent history of heart dis-ease was 15.5% in Songkhon and 21.2% in Kyoto, butmany elderly in Songkhon (40.9%) did not know if theyhad suffered heart disease or not. The rates of osteoar-thropathy were common in elderly subjects in bothSongkhon and Kyoto (58.2%, 59.4%). A history of fallsin the last year was more frequent in Songkhon (31.5%)than in Sonobe (12.8%).

Table 2 shows the comparison of averaged scores onADLs, GDS-15 score and quantitative QOLs betweencommunity-dwelling elderly living in Songkhon andthose living in Kyoto. In ADLs, all scores of basic,instrumental, intellectual and social ADL were lower inSongkhon than in Kyoto. Information-related functionin Songkhon was also lower than in Kyoto. Conse-quently the percentage of independence (rate of fullscale) of all ADLs in Songkhon were also lower than inKyoto. The differences in instrumental and intellectualADL were more distinct than those of basic ADL andsocial ADL.

The mean score of GDS-15 and the prevalence ofmild or severe depression (GDS ≥ 6) were both signifi-cantly higher in elderly subjects in Songkhon (48.3%)than in Kyoto (22.7%). The elderly of Songkhon hadsignificantly lower scores in all QOL items of subjectivesense of health, family relationships, relationships withfriends, financial satisfaction and subjective happinessthan the elderly in Kyoto. The differences in QOL insubjective health and financial satisfaction were distinct.

Table 3 shows the comparison of anthropometricalindicators and blood pressure measurements betweenthe two elderly groups. Height, weight, body mass indexand systolic blood pressure were significantly lower inthe elderly in Songkhon than in those of Kyoto. theprevalence of hypertension defined as systolic pressure>140 mmHg or diastolic pressure >90 mmHg based onthe measurements of casual blood pressure was lower insubjects in Songkhon (39.5%) than in Kyoto (48.7%).

Table 4 shows the comparison of blood chemicalfindings between the two elderly groups. Levels of bothtotal- and HDL-cholesterol were much lower inSongkhon than in Kyoto. The atherogenic index in theelderly in Songkhon was higher (6.8) than in Kyoto(2.4). Averaged blood sugar in Songkhon (136.5 mg/dL)

Table 2 Comparison of activities of daily living (ADL) and quality of life (QOL) scores between the community-dwelling elderly living in Laos and those living in Japan

Songkhon in Lao PDR(n = 294)

Kyoto in Japan(n = 411)

P

ADLsScores of basic ADL (0–21) 20.2 ± 2.0 20.8 ± 0.7 < 0.0001% of Independence of basic ADL 70.2 89.2 < 0.0001Information-related function (0–12) 9.4 ± 1.6 11.7 ± 0.8 < 0.0001% of Independence of information-related function 12 81.1 < 0.0001Scores of Instrumental ADL (0–5) 3.2 ± 1.5 4.9 ± 0.5 < 0.0001% of Independence of instrumental ADL 18.8 92.6 < 0.0001Scores of Intellectual ADL (0–4) 1.3 ± 1.3 3.7 ± 0.6 < 0.0001% of Independence of intellectual ADL 10.6 80.2 < 0.0001Scores of Social Role (0–4) 3.2 ± 1.1 3.5 ± 1.0 0.0005% of Independence of Social ADL 54.1 69.2 < 0.0001Scores of TMIG (0–13) 7.7 ± 3.2 12.1 ± 1.6 < 0.0001% of independence of TMIG 5.8 93 < 0.0001

DepressionScores of GDS (0–15) 5.6 ± 2.8 3.4 ± 3.2 < 0.0001% of GDS ≥ 6 48.3 22.7 < 0.0001% of GDS ≥ 10 6.5 5.1 NS

QOLs (0–100)Subjective health 55.4 ± 16.9 67.2 ± 17.8 < 0.0001Family relationship 71.7 ± 16.9 81.5 ± 16.9 < 0.0001Friend relationship 74.3 ± 17.4 79.8 ± 16.7 < 0.0001Financial satisfaction 50.0 ± 11.7 64.0 ± 21.5 < 0.0001Subjective happiness 66.2 ± 17.3 73.2 ± 17.6 < 0.0001

GDS, Geriatric Depression Scale; NS, not significant; TMIG, Tokyo Metropolitan Institute of Gerontology index of competence.

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was much higher than that in Kyoto (99.3 mg/dL). Con-sequently the prevalence of impaired glucose tolerance(blood sugar ≥ 140 mg/dL) was much higher inSongkhon (28.3%) than in Kyoto (4.4%). Averagedhemoglobin level in Songkhon (9.3 g/dL) was muchlower than in Kyoto (13.6 g/dL). The percentage of ane-mia, based on the World Health Organization’s the cri-teria (men: Hb < 13 g/dL, women: Hb < 12 g/dL), wasmarkedly higher in Songkhon (98.4%) than in Kyoto(12.0%). Creatinine, uric acid, GOT and GPT werehigher in Songkhon than in Kyoto.

Discussion

Laos gained independence from French Indochina, andfollowing the end of the Vietnam War in 1975, Laos wasset up. In 1997 Laos became a full member of the Asso-ciation of South-east Asian Nations (ASEAN). Laos is

one of the more slowly developing countries in ASEANwith a GDP per capita of $US1900, which is 6.5% of theGDP of Japan in 2004, $US29 400. The total populationof Laos is 6.2 million people and the proportion of thoseover 65 years of age is 3.2% in 2005. Life expectancy atbirth in Laos is 53.1 years for men and 57.2 years forwomen in 2005. While life expectancy at birth in Japanis 77.9 years for men and 84.6 years for women in2005.23 As it is known in many developing countries, thecauses of shorter life expectancy in Laos than in Japanare higher rates of death especially in infancy and child-hood, high prevalence of infections and other factorsrelated to hygiene level. Infant mortality rates in Laosand Japan are 85.2 and 3.3 deaths per 1000 live birthsrespectively in 2005.23

The Laos population is made up of over 60 ethnicgroups and traditionally divide themselves into threecategories; Lao Loum (lowland; 68%), Lao Theung

Table 3 Comparison of anthropometrical indicators and blood pressure between the community-dwelling elderly in Laos and those in Japan

Songkhon in Laos(n = 294)

Kyoto in Japan(n = 411)

P

AnthropometricalHeight (cm) 151.4 ± 7.3 154.2 ± 8.6 < 0.0001Weight (kg) 49.2 ± 10.1 53.9 ± 8.7 < 0.0001Body mass index 21.4 ± 3.8 22.6 ± 2.7 < 0.0001

Blood pressureSystolic blood pressure (mmHg) 136 ± 22 141 ± 20 0.004Diastolic blood pressure (mmHg) 80 ± 12 78 ± 11 NSPrevalence of hypertension (%)(SBP > 140 or DBP > 90)

39.5 48.7 0.016

DBP, diastolic blood pressure; SBP, systolic blood pressure.

Table 4 Comparison of blood chemical findings between the community-dwelling elderly in Laos and those in Japan

Songkhon in Laos(n = 294)

Kyoto in Japan(n = 411)

P

Total cholesterol (mg/dL) 161.7 ± 45.4 209.5 ± 35.0 < 0.0001HDL-cholesterol (mg/dL) 23.4 ± 8.7 65.6 ± 16.7 < 0.0001Atherogenic Index 6.8 ± 3.4 2.4 ± 0.9 < 0.0001Creatinine (mg/dL) 0.96 ± 0.53 0.89 ± 0.19 0.02Blood sugar (mg/dL) 136.5 ± 74.0 99.3 ± 21.1 < 0.0001% of Impaired glucose tolerance 28.3 4.4 < 0.0001Hemoglobin (g/dl) 9.3 ± 1.4 13.6 ± 1.4 < 0.0001% of anemia 98.4 12.0 < 0.0001Uric acid (mg/dl) 6.0 ± 5.2 5.0 ± 1.3 0.0001GOT (IU/L) 34.9 ± 25.4 25.5 ± 16.2 < 0.0001GPT (IU/L) 32.8 ± 21.8 20.8 ± 22.3 < 0.0001

Anemia is defined as: men, Hb < 13 g/Dl; women, Hb < 12 g/dL; impaired glucose tolerance defined as blood sugar levels ≥ 140 mg/dL.

Comprehensive geriatric assessment in Laos

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(upland; 22%) and Lao Soung (highland, including theHmong and Yao 9% and ethnic Vietnamese/Chinese1%): roughly classified according to the altitude atwhich they live.23

There are differences in living conditions, climate andeconomic status between Songkhon (rural village) inLaos (dry and wet tropical monsoon climate) andSonobe, a rural town in Kyoto, in Japan (temperate cli-mate). Accordingly there were substantial differences inlifestyle and medical conditions. More elderly subjectsin Songkhon live with children or parents and they hadless alcohol and tobacco consumption than those inKyoto. There were more elderly subjects in Songkhontaking medication than in Kyoto as they may take tra-ditional medicine more often. As most elderly subjectsin Songkhon were not aware of their blood pressure,many elderly did not know about antihypertensive med-icine and few were receiving any antihypertensive med-ication. The prevalence of osteoarthropathy was high inboth groups of subjects. There were more elderly whowere of aware of their own history of stroke and of fallsin Songkhon than in Kyoto and we should conduct fur-ther examination of this.

In the comparison of ADLs between Lao elderly sub-jects and Japanese ones, there were differences in allADL items such as basic and instrumental ADLs, intel-lectual activities, social activities and informationrelated functions. The subjects in Songkhon hadslightly lower scores for basic ADLs and a lower rate ofindependence than in Kyoto. Compared with the degreeof difference in basic ADL, that of higher functionalcapacity such as instrumental ADL and intellectualactivities were much more obvious between the twogroups. These higher functions may be more influencedby differences in economic status and education levelsbetween the two countries than basic ADLs. Theinstrumental ADL is associated with the economicactivities, such as using public transportation and shop-ping. Intellectual activities are associated with the abilityto read and write. The percentage of people (15 yearsold or over) who can read and write was 61.8% (67.5%of men, 38.1% of women) in Laos, while that in Japanwas 99.8% in 2003.23

A higher prevalence of depression and lower quanti-tative QOLs were also found in Laos than in Japan. Inparticular the QOL in subjective health and financialsatisfaction were much lower in Laos than in Japan andthis may reflect the objective differences of health andeconomic status.

We are going to carry out further analysis for thedependent factors on the QOLs and depression in thissurvey. Analysis of factors other than physical or mentalones that could be contributing to lower QOLs in Laoelderly, such as social, economic or spiritual circum-stances remain to be determined due to the limitationsof this study.

A limitation of this research was that we could notcheck all community-dwelling elderly, because somefrail or housebound elderly could not come by them-selves to the health center or temple where the assess-ments were conducted in Songkhon. But as many as79.7% of eligible community-dwelling elderly inSongkhon were assessed, so it could be considered thatalmost all residents who could move were assessed. Thesubjects examined in Kyoto represented 12.3% of allresidents, so the findings regarding this group may bebiased and display some differences from those of all eli-gible elderly. It could be that a greater proportion ofsubjects with good functions and health status came tojoin our survey in Kyoto. To eliminate this bias, we ana-lyzed only the subjects whose basic ADL was indepen-dent; 205 elderly subjects (67.9 years) in Songkhon and362 subjects (71.4 years) in Kyoto. In this analysis allresults (Tables 1–4) remained almost the same exceptfor the scores of social role in ADL and relationshipswith friends in QOL in Table 2. Differences in thoseaveraged scores became insignificant between the twoelderly groups who were completely independent inbasic ADL.

In anthropometrical functions, Lao elderly peoplehad lower height, weight and BMI than the Japanese.Mean systolic blood pressure and the prevalence ofhypertension were lower in Lao elderly subjects than inJapanese in spite of a lower rate of treatment for hyper-tension elderly in Laos. Those differences are probablydue to different nutritional life style and to genetic dif-ference between Laos and Japan.

We examined elderly over 65 years old in Japan, but inLaos we examined elderly over 60 years old, because theretirement age is 60 years and life expectancy is shorterin Laos than in Japan. So the mean age in subjectsin Songkhon was slightly lower than that in Kyoto.For confirmation we also examined 204 elderly over‘65 years’ in Songkhon and analyzed comparatively with411 elderly in Kyoto over 65 years. In this analysis allresults (Tables 1–4) remained almost the same exceptfor the prevalence of hypertension. In this analysis themean age in Songkhon was higher (73.1 years) than inKyoto (71.7 years) and the difference in the prevalenceof hypertension was insignificant between two subjectgroups.

In blood chemical examinations, total cholesterol waslower and HDL cholesterol was much lower and con-sequently atherogenic index became higher in Laosthan in Japan. Of particular note was the higher preva-lence of anemia and impaired glucose tolerance in Laoelderly than in Japanese. This may be associated withthe differences in intake of nutrition, lifestyles, preva-lence of infectious diseases or other environmental,economic and hereditary factors between two groups.We are going to carry out further into why the preva-lence of impaired glucose tolerance and anemia were

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high in the Songkhon district and examine elderly inother areas in Laos in the near future.

Conclusion

Comparative findings of comprehensive geriatric assess-ment between community-dwelling elderly in Laos andin Japan were reported. Between the economicallydeveloping country and the highly developed one, therewere differences of lifestyle and medical conditions.Most comprehensive geriatric functions such as ADLs,QOLs, mood and nutritional condition in blood chem-istry were lower in the elderly in Songkhon (Laos) thanin Kyoto (Japan). But the prevalence of hypertensionand antihypertensive medication were lower in elderlyin Laos than in Japan. Of particular note was the highprevalence of impaired glucose tolerance in Laos. Lowerprevalence of hypertension and higher one of diabetesmellitus and anemia in the elderly population inSongkhon district should be examined in future studies.

Acknowledgments

We would thank all the elderly people who participatedin this study both in Laos and in Japan. We also thankthe public health nurses in Sonobe town for preparingexaminations and all the staff who helped us as trans-lators. We thank the National Institute of Public Healthin Vientiane, the Provincial Health Department inSavannakhet Province and the District Health office inSongkhon District.

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