What's Your Age Again? Can We Trust Our Medical Calculations?
I come from a mixed-marriage family, with my mother immigrating to this country out of the refugee camps in Thailand after escaping from the Khmer Rouge in Cambodia. When they were sponsored over, they had to know each other birthdays, in order to prove they were family and not trying to sneak over someone not related. Interestingly, most of the family do not know their birth dates. My mother for instances, celebrates two, which makes it confusing at times. Overall, they most likely got the years right, but not the dates or month.
That being the case, one of the largest issues is that my grandmother (the matriarch of the family) probably is the biggest unknown. She could be a decade older for all we know than what she thinks she is, just based on her accounts of her childhood and the events going on in French Indochina at the time.
Medical Calculations and Age
So this is the rub, I spend alot of time talking about medical calculations with students, especially in regards to risk calculations for heart disease or other events. But as a pharmacist, the biggest calculation I rely on is Cockcroft-Gault, which estimates renal function based on serum creatinine, age, weight, and gender.
Many drugs need to be dose adjusted based on renal function, whether due to a direct contraindication or for increased risk of adverse events or side effects.
In that regards, what does this mean for my grandmother? Factoring in the age component, she could be overestimating or underestimating renal function which could put her at risk for under treatment (e.g. infection treated with IV antibiotics) or at greater risk for medication misadventures (e.g. dosing of DVT prophylaxis).
What does this mean over all?
Recently, my thoughts have turned to the amount of immigrants that come in this country and rising geriatric patients. With our reliance on such calculations, are we factoring in other social issues that my actually fluctuate our demographic data for patients? Could this be an issue with making therapeutic decisions overall?
This is something that I think would actually make a really interesting research project, but not quite sure how the best to go about, especially factoring in what could occur.
Perhaps, this is an item that should be discussed with students and new clinicians in their education to factor in as well.