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Biomedical subjects

T S Dharmarajan

Publications and source records attributed to T S Dharmarajan.

At least 19 recordsLinked to original sources
PubMed2006

Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients.

OBJECTIVE: The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. PARTICIPANTS: Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. RESULTS: Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P < .00005), lower Hct (P < .00005) and were more likely to be anemic (56% vs 38%, P = .001) than controls. A logistic regression model examined the effect of Hb level and anemia on falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P < .0005) and an overall 1.9-fold increased risk of falls in anemic patients (P < .001). Patient age, gender, and place of residence were not related to the risk of falls during hospitalization. CONCLUSIONS: These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.

Academic Medical Centers↗
PubMed2006

Renal tubular defects from antidepressant use in an older adult: An uncommon but reversible adverse drug effect.

Adverse drug reactions are common and contribute to significant mortality and morbidity. We report a case study of an elderly woman who manifested with uncommon reversible renal tubular defects following the use of escitalopram. She was initially seen for worsening symptoms of depression and started on escitalopram in addition to her regular medications, which included donepezil, hydrochlorothiazide and mirtazapine. Three weeks later, she became increasingly confused and manifested recurrent falls. Laboratory evaluation showed hyponatraemia and evidence of renal tubular absorption defects. The patient's symptoms and laboratory abnormalities improved upon discontinuation of escitalopram as well as of mirtazapine and hydrochlorthiazide. This case illustrates the possibility of rare but reversible renal tubular defects associated with the use of antidepressant medications.

Aged↗
PubMed2005

To anticoagulate or not to anticoagulate? A common dilemma for the provider: physicians' opinion poll based on a case study of an older long-term care facility resident with dementia and atrial fibrillation.

OBJECTIVE: Anticoagulation therapy is an acceptable strategy for the prevention of thromboembolic events in the presence of atrial fibrillation. However, this strategy is controversial in older subjects particularly in the presence of dementia. We conducted an opinion poll regarding the decision to anticoagulate or not among physicians in practice and in various levels of training (residents and fellows) that was based on a specific, yet not unusual, case scenario in the nursing home. SETTING: A university teaching hospital in the Bronx, NY. METHODS: A survey questionnaire was distributed to physicians to solicit opinions on the decision to anticoagulate based on an actual case from a LTCF and the results were analyzed. RESULTS: One hundred seven completed surveys were returned from 49 residents, 20 fellows, and 38 attending physicians. The majority (85%) felt that long-term anticoagulation therapy was not indicated in the case patient. However, most (88%) felt they would provide an antiplatelet agent, with the choice being 78% aspirin, 20% clopridogel, and 2% aspirin-dipyridamole. The most cited reasons for not providing anticoagulation were risk of falls (98%), dementia (40%), and short life expectancy (32%). However, 92% of respondents felt that the patient was a candidate for short-term anticoagulation therapy. Interestingly, the choices (yes, no, uncertain) to the questions were similar for all physicians irrespective of their level of training or years in practice (or faculty) after training. CONCLUSIONS: Although long-term anticoagulation for thromboembolic events in atrial fibrillation is considered beneficial, recent reports suggest that warfarin is underused in older adults, especially in the long-term care setting. Our physician poll, based on a specific case scenario, is consistent with this opinion as reflected by both trainees and practicing physicians. While there are absolute and relative contraindications to the use of long-term warfarin, decisions should be individualized and based on risks, benefits, and quality of life of the resident.

Accidental Falls↗
PubMed2005

Life-threatening, preventable hyperkalemia in a nursing home resident: case report and literature review.

A 70-year-old male nursing home resident, hospitalized for weakness and lethargy, was found to have life-threatening hyperkalemia. Concomitant use of potassium chloride, spironolactone, and propranolol appeared the likely offending agents. Hyperkalemia is common in the elderly, resulting from a combination of potassium homeostasis disorders, disease processes and certain medications. In particular, older adults in the nursing home on spironolactone and potassium replacement preparations should have serum potassium monitored frequently, particularly in the presence of renal insufficiency and diabetes. Also included is a review of literature illustrating alterations in potassium regulation in older adults and a suggested approach to potassium-related disorders in the nursing home setting.

Aged↗
PubMed2005

Vitamin D deficiency in community older adults with falls of gait imbalance: an under-recognized problem in the inner city.

INTRODUCTION: Recent reports suggest that vitamin D deficiency is both under-recognized and undertreated in the geriatric population. In particular, older adults with unexplained pain, falls, and gait disorders often may have osteomalacia from vitamin D deficiency. Currently, older adults are not screened for vitamin D status even when clinical skin suggest deficiency. Our pilot study determined the vitamin D status in older, inner city community adults with features suggestive of vitamin D deficiency. METHODS: The study was prospective and observational. Community-dwelling adults (> 60 years) from our ambulatory clinic or in-patient geriatric program, with features compatible with vitamin D deficiency (history of falls, gait imbalance, unexplained musculoskeletal pain, and/or fractures), were enrolled. IRB approval and signed informed consents were obtained. Following a history and physical exam, blood samples for vitamin D assay and routine chemistries were obtained. Additional information was collected on age, gender, race, dairy product intake, calcium and/or vitamin D supplement use, weekly sunlight exposure, season of exam (May-October vs. November-April), prior falls and fractures, musculoskeletal pain, and gait disturbances. RESULTS: Data were obtained from 48 patients (32F and 16M), mean age of 79 +/- 9 (SD) years (range 60-95). Seventy-seven percent of enrollees had gait disturbances, 77% had a history of falls, 29% had previous fractures and 6% had unexplained pain; 79% consumed milk daily, 25% took calcium supplements and 21% used vitamin D supplements (in a multivitamin or calcium supplement). Self-reported weekly exposure to sunlight ranged from 0 to 42 hours (clothing amount was highly variable). Fifty-four percent of this sample had sub-normal vitamin D status (serum vitamin D < 20 ng/mL). Patient age (P = 0.2287), gender (P=0.9270), exposure to sunlight (P=0.3493), season (P=0.573), and dairy intake (P = 0.735) were not associated with vitamin D status. However, 80% of vitamin D supplement users versus 37% of non-users had normal vitamin D status (P = 0.029) and 75% of calcium supplement users versus 36% of non-users had normal vitamin D status (P = 0.042). A logistic regression model determined that the use of vitamin D or calcium supplements decreased the risk of low vitamin D status by 94% and 93% (P = 0.009 and P = 0.010, respectively). CONCLUSION: In this pilot study of older adults with gait imbalance and falls, vitamin D deficiency (< 20 ng/mL) was observed in 54% of patients tested and previously unrecognized. Higher serum vitamin D levels appeared related to the use of vitamin D (in multivitamin or calcium supplements) suggesting that deficiency may be preventable and easily treated. As vitamin D deficiency is associated with substantial disability, the need for increased awareness to screen and prevent this disorder is evident.

Accidental Falls↗
PubMed2005

Does anemia matter? Anemia, morbidity, and mortality in older adults: need for greater recognition.

Anemia is common and under recognized in older adults and associated with increased morbidity and mortality. Estimates of prevalence of anemia in older adults vary considerably based on the setting, gender, age and definition used and likely to increase further based on aging trends. Rather than simply a consequence of aging, anemia is a marker of underlying disease, requiring investigation for an etiology. A cause is discernible in at least two-thirds of cases; management involves addressing the underlying disease process, replacement of deficient nutrients or the use of erythropoietic factors.

Adaptation, Physiological↗
PubMed2004

Tube feeding in the elderly. The technique, complications, and outcome.

Tube feeding is an art and a science that is increasingly used in our aging society as more people become physically incapacitated or have dementia. Properly used, tube feeding can be helpful. However, patients should be monitored for tolerance and complications and assessed for a possible return to oral feeding. The joy of eating, one of the pleasures in life, should not be denied if at all possible.

Aged↗
PubMed2003

The growing problem of pressure ulcers. Evaluation and management for an aging population.

Pressure ulcers, an important concern in older adults with restricted mobility, promise to become an even bigger issue as the US population ages. These ulcers can lead to devastating complications and place demands on an already stressed healthcare system. They also can be a quality indicator of the preventive measures taken in healthcare facilities. In this article, Drs Dharmarajan and Ahmed present guidelines for the prevention and treatment of pressure ulcers.

Aged↗
PubMed2003

Vitamin B12 deficiency. Recognizing subtle symptoms in older adults.

Vitamin B12 deficiency is a common but under-recognized, yet easily treatable disorder in older adults. Although several causes exist, food-cobalamin malabsorption is now believed to be the most common etiology. Complications of vitamin B12 deficiency are myriad, ranging from lethargy and weight loss to dementia. Causes of deficiency include failure to separate vitamin B12 from food protein, inadequate ingestion, absorption, utilization, and storage as well as drug-food interactions leading to malabsorption and metabolic inactivation. The roles of B12 deficiency, elevated homocysteine and elevated methylmalonic acid in various disease states are still evolving. Timely screening and replacement of vitamin B12 will help prevent many complications.

Aged↗
PubMed2002

Geriatric medicine programs in India: has the time arrived?

Aging trends in India and the world over are burdening society with the health care and economic problems resulting from an older population. With this in mind, countries are preparing themselves to face the challenges of meeting this burden. India with its huge population and improving life-expectancy should be no exception. The task involves preparation in healthcare to take care of the elderly and train a new generation of physicians in geriatric medicine. The review attempts to address some of these issues and makes pertinent recommendations, based on the author's own experiences in developing a large geriatric program with all necessary components in the last decade.

Aged↗
PubMed2001

Percutaneous endoscopic gastrostomy and outcome in dementia.

The use of percutaneous endoscopic gastrostomy for the administration of food and medications in patients with dementia has been on an increase. Many studies have failed to demonstrate the positive outcome expected of this feeding modality for the indications that required tube placement. Hence, the concept of feeding through gastrostomy tubes has become the subject of much discussion and controversy in recent times. We have reviewed the literature with regard to outcome in older patients with dementia and percutaneous endoscopic gastrostomy with respect to nutritional parameters, quality of life, and survival. A brief discussion on ethical and legal aspects is included. Much of the data do not suggest that outcome in dementia is favorably improved after percutaneous gastrostomy.

Aged↗
PubMed2001

Approaches to vitamin B12 deficiency. Early treatment may prevent devastating complications.

Vitamin B12 deficiency is a common problem that affects the general population and the elderly in particular. Persons with the deficiency may be asymptomatic or may have hematologic or neuropsychiatric signs and symptoms. If the disorder is untreated, complications may cause significant morbidity. In this article, Drs Dharmarajan and Norkus discuss approaches to screening and diagnosis as well as the nontoxic, low-cost treatments now available.

Age Distribution↗
PubMed1999

Acute post streptococcal interstitial nephritis in an adult and review of the literature.

While glomerular lesions are a recognized sequel to infection with group A beta haemolytic streptococci, literature on primary tubular lesions, as remote effects of streptococcal infection, is scanty. A case of interstitial nephritis in a 29-year-old woman following streptococcal sore throat is described. This adult admitted with tonsillitis developed acute renal failure from acute interstitial nephritis and subsequently had full recovery of renal function. Acute interstitial nephritis should be included in the differential diagnosis of patients with streptococcal infections who develop acute renal failure.

Adult↗