title: Reduction of diuretics and analysis of water and muscle volumes to prevent falls and fall-related fractures in older adults.
abstract: OBJECTIVE
  In an attempt to decrease the incidence of falls and fall-related fractures at a special geriatric nursing home, we endeavored to reduce diuretic doses, and examined the relationship between the effectiveness of this approach with the body compositions and activities of daily living of the study cohort.
  
  
  METHODS
  We enrolled 93 participants living in the community, 60 residents of an intermediate geriatric nursing home and 50 residents of the 100-bed Kandayama Yasuragien special geriatric nursing home. We recorded body composition using a multifrequency bioelectrical impedance analyzer. Daily loop diuretic and other diuretic regimens of those in the special geriatric nursing home were reduced or replaced with "NY-mode" diuretic therapy, namely, spironolactone 12.5 mg orally once on alternate days.
  
  
  RESULTS
  The incidence of falls fell from 53 in 2011 to 29 in 2012, and there were no fall-related proximal femoral fractures for 3 years after the introduction of NY-mode diuretic therapy. We also found statistically significant differences in muscle and intracellular water volumes in our elderly participants: those with higher care requirements or lower levels of independence had lower muscle or water volumes.
  
  
  CONCLUSIONS
  We found that reducing or replacing daily diuretics with NY-mode therapy appeared to reduce the incidence of falls and fall-related proximal femoral fracture, likely by preserving intracellular and extracellular body water volumes. Low-dose spironolactone (12.5 mg on alternate days) appears to be an effective means of treating elderly individuals with chronic heart failure or other edematous states, while preventing falls and fall-related fractures. Geriatr Gerontol Int 2017; 17: 262-269.
authors: Hiroshima Atomic Bomb Survivors Nursing Home Kandayama Yasuragien, Hiroshima, Japan.
authors: Kosuke
authors: http://orcid.org/0000-0001-5161-8431
authors: K
authors: Okada
authors: Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, Hiroshima, Japan.
authors: Masahiro
authors: M
authors: Okada
authors: Hiroshima Atomic Bomb Survivors Relief Foundation, Hiroshima, Japan.
authors: Nanao
authors: N
authors: Kamada
authors: Hiroshima Atomic Bomb Survivors Nursing Home Kurakake Nozomien, Hiroshima, Japan.
authors: Yumiko
authors: Y
authors: Yamaguchi
authors: Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Masayuki
authors: M
authors: Kakehashi
authors: Faculty of Nursing, Hiroshima Bunka Gakuen University, Kure, Japan.
authors: Hidemi
authors: H
authors: Sasaki
authors: Faculty of Nursing, Hiroshima Bunka Gakuen University, Kure, Japan.
authors: Shigeko
authors: S
authors: Katoh
authors: Faculty of Nursing, Hiroshima Bunka Gakuen University, Kure, Japan.
authors: Katsuya
authors: K
authors: Morita
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D001834:Body Water; D015331:Cohort Studies; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D057187:Independent Living; D008297:Male; D009735:Nursing Homes
chemical_list: D004232:Diuretics
keywords: body water; diuretic; elderly; fall fracture; muscle