The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study

Abstract

BackgroundRenal function decreases with age. Dosage adjustment according to renal function is indicated for many drugs, in order to avoid adverse reactions of medications and/or aggravation of renal impairment. There are several ways to assess renal function in the elderly, but no way is ideal. The aim of the study was to explore renal function in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful to patients with renal impairment.Methods243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification of Diet in Renal Disease (MDRD) and cystatin C-estimated glomerular filtration rate (GFR). Concomitant medication was registered and four groups of renal risk drugs were identified: metformin, nonsteroidal anti-inflammatory drugs (NSAID), angiotensin-converting enzyme -inhibitors/angiotensin receptor blockers and digoxin. Descriptive statistics and the Kappa test for concordance were used.ResultsReduced renal function (cystatin C-estimated GFR < 60 ml/min) was seen in 53%. Normal s-creatinine was seen in 41% of those with renal impairment. Renal risk drugs were rather rarely prescribed, with exception for ACE-inhibitors. Poor concordance was seen between the GFR estimates as concluded by other studies.ConclusionsThe physician has to be observant on renal function when prescribing medications to the elderly patient and not only rely on s-creatinine level. GFR has to be estimated before prescribing renal risk drugs, but using different estimates may give divergence in the results.

Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis

“…In addition, certain centers of the brain associated with dual-task processing showed less activation posttraining, implying reduced processing demands posttraining 102. Some studies have also implied this training maneuver to act as a cognitive therapy for patients with attentional deficits and cognitive impairments 34,52. Furthermore, this review identified dual-task training regimes to also allow benefits in cognitive performance 38,52.…”

“…Some studies have also implied this training maneuver to act as a cognitive therapy for patients with attentional deficits and cognitive impairments 34,52. Furthermore, this review identified dual-task training regimes to also allow benefits in cognitive performance 38,52. According to Hiyamizu et al36 and Wollesen and Voelcker-Rehage,38 enhancements in cognitive performance might lead toward smoothening of cognitive activities while maintaining static and dynamic postures, resulting in preventing falls.…”

“…This training maneuver has recently drawn a lot of interest as compared to its older counterpart and speculations persist as to which protocol overlays beneficial effects on postural stability among different population groups 47,48. Recent review studies evaluating the effects of dual-task training in elderly38,49 and population groups with neurological diseases50,51 conclusively report the beneficial effects of dual-task training for enhancing cognitive abilities and stability, whereas some review studies report no identifiable benefits 33,52. The studies also mentioned the increased heterogeneity of the training protocols within the studies to cause difficulties in identifying a specific method’s effectiveness.…”

Where attention falls: Increased risk of falls from the converging impact of cortical cholinergic and midbrain dopamine loss on striatal function

“…This main effect of age is typically interpreted as reflecting a decrease in the overall capacity for information processing or a decline in the executive management of such resources (Craik et al, 2010; Tombu and Jolicæeur, 2003). In healthy older adults as well as patients with PD, impairments in a range of measures of divided as well as sustained attentional performance are a robust predictor for freezing of gait and falls (Allcock et al, 2009; Lord et al, 2010; Naismith et al, 2010; O’Halloran et al, 2011; Persad et al, 2008; Woollacott and Shumway-Cook, 2002; Yarnall et al, 2011). …”

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“…Generally serum creatinine is one of the parameters to measure the kidney function. However, this is inaccurate in geriatrics due to muscle breakdown, and they have a moderate decrease in renal function 9,10 . Creatinine clearance is a valid predictor of nephritic function.…”