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Dr K K Aggarwal

Even the elderly should exercise

By Dr K K Aggarwal
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Research has found that older runners live longer and suffer fewer disabilities than healthy non–runners. This observation applies to a variety of aerobic exercises, including walking.

A study by authors, from Stanford University School of Medicine, published in the Archives of Internal Medicine has shown that being active reduces disability and increases survival.

There are benefits of vigorous activity late in life. Earlier many experts believed that vigorous exercise would actually harm older individuals. And running, in particular, would result in an epidemic of joint and bone injuries. But this new study proves otherwise.

Two hundred and eighty–four runners and 156 healthy “controls,” or non–runners, in California completed annual questionnaires over a 21–year period. The participants were 50 years old or over at the beginning of the study and ran an average of about four hours a week. By the end of the study period, the participants were in their 70s or 80s or older and ran about 76 minutes a week. At 19 years, just 15 percent of the runners had died, compared with 34 percent of the non–runners.

In the study, running delayed the onset of disability by an average of 16 years. It’s so important to be physically active your whole life, not just in your 20s or 40s, but forever.

Exercise is like the most potent drug. Exercise is by far the best thing you can do.

One should take lessons from Yudhishthir in Mahabharata who walked till his death. However a word of caution, if an elderly person is walking or entering into an exercise program, he or she should have a cardiac evaluation done to rule out underlying heart blockages.

Treatment for constipation in the elderly

By Dr K K Aggarwal
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In patients over of 70 years being treated with enemas for constipation, water enemas should be used rather than sodium phosphate enemas

The commonly used treatment for constipation is sodium phosphate enemas. There is evidence that the use of sodium phosphate enemas may be associated with serious adverse events.

In a retrospective series, the use of sodium phosphate enemas in older adults for constipation was associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo–or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval).

Use painkillers with caution in the elderly

By Dr K K Aggarwal
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Painkillers can cause stroke via irregular heart rhythm. Non selective non–steroidal anti–inflammatory drugs (NSAIDs) and new generation selective COX–2 inhibitors commonly used to treat inflammation are now linked to an increased risk of irregular heart rhythm called atrial fibrillation (AF), as per a Danish Research of 32602 patients led by Professor Henrik Toft Sørensen at Aarhus University Hospital in Denmark.

These drugs are already linked to increased risk of heart attacks and strokes. And now through AF, the risk gets intensified for stroke and new risk added of heart failure and death.

In the study compared with non users, new users (first drug within 60 days of diagnosis) showed 40% increased risk of AF with non–selective NSAIDS and 70% increased risk with COX–2 inhibitors. This means four extra cases of AF per year per 1000 new users of non–selective NSAIDS and seven extra cases of AF per 1000 new users of COX–2 inhibitors.

The risk was highest in the elderly, patients with chronic kidney disease or rheumatoid arthritis especially on COX–2 inhibitors. NSAIDs should be used very cautiously in older patients with a history of hypertension or heart failure.

Sodium phosphate enemas in the elderly should be avoided

By Dr K K Aggarwal
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Sodium phosphate enemas are used in the treatment of constipation and for preparation for flexible sigmoidoscopy. Sodium phosphate enema use in older adults (mean age 80 years, range 61 to 89 years) is associated with hypotension, volume depletion, hyperphosphatemia, hypo– or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval). In patients over the age of 70 years use warm water enemas rather than sodium phosphate enemas.

Vaccination for elderly

By Dr K K Aggarwal
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The best gift to your grandparents is to get them vaccinated if they have not been vaccinated earlier.

  • Annual influenza or flu vaccine is recommended for all persons aged 6 months and older.
  • Pneumonia vaccine should be given to all adults aged 65 years and older.
  • Tetanus Toxoid should be given to all irrespective of age after every 10 years.
  • A single dose of herpes zoster vaccine is recommended for adults aged 60 years and older regardless whether they have had a previous episode of herpes zoster. The vaccination begins at 60 years of age.
  • Hepatitis B vaccine should be given to all if they have not been vaccinated earlier.
  • All diabetics aged 60 years or older should be vaccinated for hepatitis B. This recommendation is based on increased need for associated blood glucose monitoring in long term care facilities.
  • All patients with chronic liver diseases should also be given the Hepatitis B vaccine.

Elderly Beware of Commonly Prescribed Group of Drugs

By Dr K K Aggarwal
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Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to “slow down” in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs – used to treat acid reflux, Parkinson’s disease and urinary incontinence –– may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anti-cholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately acting anticholinergic medication, or two or more mildly acting anticholinergic medications, their function is similar to that of someone 3 to 4 years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drug.

Vaccination for elderly

By Dr K K Aggarwal
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The best gift to your grandparents is to get them vaccinated if they have not been vaccinated earlier.

  • Annual influenza or flu vaccine is recommended for all persons aged 6 months and older.
  • Pneumonia vaccine should be given to all adults aged 65 years and older.
  • Tetanus Toxoid should be given to all irrespective of age after every 10 years.
  • A single dose of herpes zoster vaccine is recommended for adults aged 60 years and older regardless whether they have had a previous episode of herpes zoster. The vaccination begins at 60 years of age.
  • Hepatitis B vaccine should be given to all if they have not been vaccinated earlier.
  • All diabetics aged 60 years or older should be vaccinated for hepatitis B. This recommendation is based on increased need for associated blood glucose monitoring in long term care facilities.
  • All patients with chronic liver diseases should also be given the Hepatitis B vaccine.

Elderly Beware of Commonly Prescribed Group of Drugs

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Elderly Beware of Commonly Prescribed Group of Drugs

Anti–cholinergics, a commonly prescribed group of drugs, may cause elderly people to “slow down” in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anti–cholinergic drugs – Used to treat acid reflux, Parkinson’s disease and urinary incontinence –– may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anti–cholinergic drugs work by blocking acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anti–cholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.

Vaccination for elderly

By
Filed Under Wellness | Tagged With: , , | | Comments Off on Vaccination for elderly

The best gift to your grandparents is to get them vaccinated if they have not been vaccinated earlier.

  • Annual influenza or flu vaccine is recommended for all persons aged 6 months and older.
  • Pneumonia vaccine should be given to all adults aged 65 years and older.
  • Tetanus Toxoid should be given to all irrespective of age after every 10 years.
  • A single dose of herpes zoster vaccine is recommended for adults aged 60 years and older regardless whether they have had a previous episode of herpes zoster. The vaccination begins at 60 years of age.
  • Hepatitis B vaccine should be given to all if they have not been vaccinated earlier.
  • All diabetics aged 60 years or older should be vaccinated for hepatitis B. This recommendation is based on increased need for associated blood glucose monitoring in long term care facilities.
  • All patients with chronic liver diseases should also be given the Hepatitis B vaccine.