Tuesday, November 16, 2010

Medical Updates for Older Adults

New clinical trials and published research is giving us information on how to improve health in elderly patients.  Here are some brief points from The Cleveland Journal of Medicine that were surprising to me:
  • Each year 30% of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important.  Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls.  A better dose is 1000mg a day in people who consume a low-calcium diet. 
  • Exercise boosts the effect of influenza vaccine.
  • The benefits of dialysis in older patients is uncertain as it does not improve  function in people over age 80.  We don't even know if it improves survival.  Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene and dressing) after starting treatment.
  • Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease but they all can have serious side effects.  Syncope (fainting),hip fractures, slow heart rate and the need for permanent pacemaker insertion were more frequent in people taking these drugs.  The benefits of these drugs on cognition is modest.
  • A new drug called Pradaxa (Dabigatran) will likely prove to be safer than Coumadin (warfarin).  2.2 million adults have atrial fibrillation and the median age is 75.  The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently.  Dabigatran will probably replace warfarin but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving.   As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.  I'm glad we are no longer bleeding people. 


Kathleen Summers, MD, PhD said...

Great poster at the end. Science is often one step forward, two steps back - but overall eventually there is progress.

This article at The Atlantic is a great read for docs - and everyone. It's entitled: Lies, Damn Lies and Medical Science.



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