The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience

Abstract

Rhabdomyolysis is a syndrome caused by injury to skeletal muscle. There is limited data of rhabdomyolysis in the elderly. The objective of this study is to investigate demographic data, etiologies, laboratory values, prognostic factors, and mortality of rhabdomyolysis in the geriatric population. A 4-years retrospective chart review study was conducted. Our inclusion criteria were age above 65 years and creatinine kinase level excess five times of normal upper limit. Among 167 patients, 47.3% were male. The median age at diagnosis was 80.11 (66-101) years. The duration of follow up in the study ranged from 0 to 48 months. Fall (with or without immobilization) was the most frequent cause of rhabdomyolysis in 56.9%. The mean baseline glomerular filtration rate (GFR), GFR at diagnosis, and peak decline in GFR was 76.94, 48.96, and 54.41 cc/min respectively. The mean CK at diagnosis and peak CK was 5097.22 and 6320.07. There were 45 deaths (21%) over the span of 4 years. Multivariate analysis demonstrated that number of medications pre-admission (Meds No.), peak decline in GFR, and acute kidney injury (AKI) are independent predictors for overall survival for rhabdomyolysis in the elderly. To our knowledge, this is the first epidemiological study of rhabdomyolysis in the elderly. Falls (with and without immobilization) were the most common etiology. Meds No. (>8), peak decline in GFR (<30 cc/min), and evidence of AKI are associated with shorter overall survival and can serve as potential independent prognostic markers for rhabdomyolysis in elderly patients.

Rhabdomyolysis diagnosed in an older woman with dementia on examination after a wandering episode

“…While alcohol consumption, illicit drug use, infection, ischemia and seizure are the most common etiologies of rhabdomyolysis in adults, different etiologies, such as falls, injuries and immobilization, predominate in older adults. 3 In the present case, the patient was found 10 km away from her house. However, there were no injuries, except for facial abrasions and a maxillary sinus fracture.…”

“…Although she had been taking the same medication for nearly 10 years without rhabdomyolysis, donepezil was difficult to exclude as a cause, because the drug can cause rhabdomyolysis. 4 Moreover, dehydration is generally a contributing factor of rhabdomyolysis, 5 and aging is reported to be a poor prognostic factor of rhabdomyolysis, 3 both of which are related to wandering. Therefore, we presumed that her wandering and its associated features, such as dementia medication, strenuous exercise, dehydration and aging, had led to rhabdomyolysis.…”

“…Although a previous study on rhabdomyolysis in an older patient showed that acute kidney injury and peak decline in glomerular filtration rate were prognostic factors, wandering might result in the patient going missing, potentially resulting in death. 3 There is limited evidence regarding treatment for wandering in dementia. Although antipsychotic medications are associated with increased mortality, 6 few studies have showed the effect of risperidone on behavioral and psychological symptoms of dementia, including wandering.…”

Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study

“…Second, we could not accurately capture falls in our administrative data, which is another common reason for rhabdomyolysis in older patients. 35 Third, as only adults older than 65 years were included in our study, the results may not be generalizable to dementia in younger adults, which can be more variable and secondary to other comorbidities. 36 Next, we excluded patients with doses outside recommended routine prescribing practices.…”

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

“…Falls are the leading cause of rhabdomyolysis in older people. 23 The post-ED consequences of long lies include fear of falling and consequential reduced levels of activity, which then increases the risk of subsequent falls via rapid deconditioning. 22,24 Evaluating falls in the ED A structured approach to search for the aetiology of fall(s) may guide assessment to simultaneously identify fall injuries and aetiology.…”