Nonsteroidal anti-inflammatory drug-associated azotemia in the very old

Article Abstract:

Nonsteroidal anti-inflammatory agents, also called NSAIDs, are commonly used for the treatment of rheumatologic conditions such as arthritis. The elderly have an increased risk for these conditions and are among the highest users of this group of medications. NSAID-associated kidney dysfunction is a particular concern in the elderly, who because of their age may already have reduced kidney function. Patients residing in long-term care facilities, such as nursing homes, usually have several chronic diseases and receive multiple medications. This study was designed to determine the frequency and risk for NSAID-associated azotemia, a condition caused by failure of the kidneys to remove excess waste products, such as urea, from the blood. For this study, azotemia was defined as a greater than 50 percent increase in the serum urea nitrogen (SUN) level over the original amount, or the baseline level. Elderly patients that were receiving an NSAID for at least five days were studied and their kidney function was assessed by laboratory testing, which included measurement of SUN. A total of 114 patients who received an NSAID (primarily ibuprofen) were studied. Patients who received an NSAID had a significant elevation in SUN levels when compared with patients who did not receive a drug of this category. Fifteen patients met the definition for azotemia and had SUN levels up to 89 percent over baseline. Elderly patients who have additional risks for development of azotemia, including use of other drugs, should be cautiously given NSAIDs. The lowest possible effective dose should be given for the shortest time necessary to achieve the desired result. For an elderly patient requiring more than just a few days of treatment with an NSAID, laboratory monitoring should include measurement of SUN levels. Continued use of an NSAID in an elderly patient should be based on the results of this testing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Complications and side effects, Risk factors, Nonsteroidal anti-inflammatory drugs, Nonsteroidal anti-inflammatory agents, Kidney diseases, Azotemia

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High-intensity strength training in nonagenarians: effects on skeletal muscle

Article Abstract:

It is clear that muscle strength declines with aging, but the biologic process of aging may not be fully responsible; lack of activity, diseases, and poor nutrition may contribute as well. It has been suggested that at least part of the decrease in muscle strength in the frail elderly could be reversed with strength training. The aspect of muscle weakening that would respond to this therapy would be the atrophy of disuse, referring to muscle fiber breakdown from lack of exercise. Greater muscle strength in frail older persons would most likely help prevent falls, fractures, and disability. Ten frail elderly patients living in an institution volunteered for this study; their average age was 90 years. For eight weeks, the subjects performed leg exercises in which they lifted and lowered a controlled amount of weight with each leg. The load was increased gradually and they were carefully monitored throughout. Muscle strength was found to be greater in subjects with greater regional muscle mass and more fat-free body mass, which includes all body tissues except fat. For the nine patients who finished the program, the average gain in strength was 174 percent. They also achieved a 9 percent increase in midthigh muscle area and a 48 percent improvement in tandem gait (walking) speed. Two subjects no longer needed a cane to walk and one became able to get out of a chair without using the arms to push up. The authors conclude that high-resistance weight training was successful at bringing about significant improvements in muscle strength and size as well as functional mobility in frail nursing home patients as old as age 96. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aging, Research, Physical fitness, Muscle strength, Muscles, Fractures (Injuries), Fractures, Nursing home patients

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The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials

Article Abstract:

Exercise programs for the elderly may reduce their risk of falling. Almost one-third of those over 65 fall at some time, resulting in significant injuries and disabilities. Researchers analyzed data from eight sites participating in the Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) trial. All of the sites compared the rate of falls and injuries in elderly people who learned flexibility, resistance and balance exercises compared to those who did not. The risk of falls was significantly lowered at several sites that taught balance exercises, including Tai Chi. The number of falls that resulted in injuries was significantly lowered at some of the sites.

Exercise, Exercise for the aged

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