What is it about?
Based on my 38years of clinical treatment of the patient, who was an Atomic Bomb survivor and suffered from refractory anemia( one of myelodysplastic syndome), valvular heart disease(aortic stenosis) , frequent cereblar circulation insufficiency and gait disturbance with verteblar fracture, I tried to apply the diuretic therapy (NY-mode diuretic therapy, NY=derived from patinet' name),namely mineral-corticoid receptor inhibitor spironolactone 12.5mg/day on alternate days, in an Atomic Bomb survivors nursing home(Kosuke Okada was only one medical doctor of the home).
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Why is it important?
Adequte hydration is important for healthy life, especially for older adults. This is one of 7 pillars of fall prevetion described In the book (Medical Encyclopedia for Fall Prevention) published by Japan Mdical Fall Prevention Society. In the textbook of gerontology (the 3rd Eddition) ,which was published by Japanese Society of Geriatric Medicine, the specialist of geriatic medicine described that we shoud use small dose of diuretics on alternate days for edema of older adults. However, to the best of my knowledge there are very few physician use this kind of diuretic therapy, dispite the healthy life (not mean life) of the female older adults in our Hiroshima prefecture is the bottom in Japan now. It is wll known that the main factors of inhibiting the prolongation of healthy life is cereblovasculer desease, dementia and falls. On the medication of falls and fall-related fractures, drugs for sleep disturbance or psycological probelems are noticed and diuretica are not so noticed to prevent falls and fall-related fractures. In a 730 beds large hospital of Hiroshima city , doctors tried to change drugs for sleep disturbance to decrease the incidence of falls , but falls of every day are not ipmroved at all. In our special geriatric nursing home we could improve falls and fall related proximal femoral fractures. We carried out analysis of muscle and water volumes.
Perspectives
In japan the specialist of chronic cardiac failure descibed that the 1st choice of diuretics is loop diuretics furosemide or azosemide every day and then the combination of loop diuretics with mineral corticoid inhibitor such as spironolactone every day when these drugs are required. However, I have never use spironolactone every day ,because it is well known that the half life of spironolactone is long ,so the prescription of daily pottasium sparing diuretics spironolactone is unreasonable. We need the case control study of the standard diuretic therapy of guidelines and NY-mode diuretic therapy for older adults from the view point of fall-fracture prevention.
Dr Kosuke Okada
Hiroshima Atomic Bomb Survivors Nursing Home Kandayama Yasuragien Clinic
Read the Original
This page is a summary of: Reduction of diuretics and analysis of water and muscle volumes to prevent falls and fall-related fractures in older adults, Geriatrics and Gerontology International, February 2016, Wiley,
DOI: 10.1111/ggi.12719.
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