Geriatric Update Apr 13, 2026
Itching is most commonly caused by dry skin, but elevated bilirubin levels in liver disease and elevated phosphorus levels in kidney disease can cause itching. Lynavoy (linerixibat) was approved for patients with primary biliary cholangitis, or PBC. The twice-daily oral pill reduced itch severity and itch related sleep disruption in PBC patients when compared with placebo over 24 weeks.
Hydration did not reduce symptomatic kidney stone recurrence, defined as stone passage or procedural intervention for stone(s), during a 2-year follow-up period. Hydration was encouraged by use of a smart water bottle and measured by urine volume. Looking at the urine volume curve, the control group also increased volume, and the difference between groups, while statistically significantly different, was small. Additionally, the intervention group's urine volume at 2 years was lower than the control group volume at 6-18 months. Therefore, I don’t discount the benefit of hydration based on this study of 1658 participants, median age 44.
Hormone Therapy for postmenopausal women overall was associated with several types of hormone-sensitive and non-hormone-sensitive cancers. While HT offered some cardiovascular benefit when started at age 50-65, it also raised stroke (HR: 16.692, 95% CI: 15.571-17.893), cancer risk (HR: 8.490, 95% CI: 7.281-9.900), and ischemic heart disease/myocardial infarction (HR: 9.169, 95% CI: 8.321–10.102). HT initiated in those aged 65 years or older also significantly raised the risk for both any cancer (hazard ratio [HR]: 2.216, 95% confidence interval [CI]: 1.833-2.677) and cerebrovascular accident (HR: 2.695, 95% CI: 2.358-3.079). This observational study had a 22-year follow-up but did not differentiate between progesterone users, though progesterone has been established to be the main culprit.
Several heart societies have released new cholesterol guidelines:
Treat young adults with low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or a strong family history of premature atherosclerotic cardiovascular disease (ASCVD).
Use the Predicting Risk of cardiovascular disease EVENTs (PREVENT™) calculator.
Therapy can be considered in adults for primary prevention of ASCVD with a 10-year PREVENT-ASCVD risk estimate of 3% to <5% (borderline risk) and should be considered for those at 5% to <10% (intermediate risk) 10-year risk.
Lipoprotein(a) (Lp(a) levels ≥125 nmol/L (50 mg/dL), which is associated with about a 1.4-fold increased ASCVD risk, and values ≥250 nmol/L (100 mg/dL) are associated with ≥2-fold higher estimated risk, should be measured once.
Coronary artery calcium (CAC) scoring in men at least 40 years of age and women at least 45 years of age can improve risk assessment and guide goals.
In persistently elevated triglyceride (TG), statin therapy remains the foundation of pharmacotherapy as an adjunct to lifestyle intervention.
Among patients with atherosclerotic cardiovascular disease, targeting an LDL-C level of less than 55 mg per deciliter resulted in a lower risk of cardiovascular events at 3 years when compared with targeting a level of less than 70 mg per deciliter (hazard ratio, 0.67; 95% confidence interval, 0.52 to 0.86).
Lowering LDL-C level to 52 mg/dL with PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab led to fewer major cardiovascular events (MACE) and fewer deaths at 48 weeks in 83 patients, age 65 (5-year Kaplan-Meier estimate, 5.0%) compared with 117 patients (5-year Kaplan-Meier estimate, 7.1%) in the placebo group (hazard ratio [HR], 0.69 [95% CI, 0.52-0.91] with LDL-C level 111 mg/dL (P < .001). There were 136 deaths (5-year Kaplan-Meier estimate, 7.8%) in the evolocumab group compared with 172 deaths (5-year Kaplan-Meier estimate, 7.8% vs 10.1%) in the placebo group (HR, 0.76 [95% CI, 0.61-0.95]).
Among 25,820 individuals with hypertension, average age 60.6 years, adherence to a healthy lifestyle was associated with 51% lower risk of cardiovascular disease (CVD) aHR 0.49 (95% CI, 0.39-0.61) and 79% lower risk of type 2 diabetes (T2D) aHR 0.21 (95% CI, 0.14-0.30) for those in the highest lifestyle category compared with the least healthy category over 24 years. Individuals with the highest post-diagnosis healthy lifestyle score (HLS) had a gain in life expectancy of 8.2 years at age 40 after adjusting for other major cardiovascular and diabetes risk factors and antihypertensive medication use. Those whose lifestyle worsened increased their risk of CVDs (AHR, 1.14; 95% CI, 1.00-1.30) and T2D (AHR, 1.75; 95% CI, 1.45-2.10) compared with those who consistently maintained a higher HLS.
However, 513 older adults (aged 60-85, average 68.7 years) without dementia and with hypertension, with family history of dementia, and/or with self-reported subjective cognitive decline showed no difference in cognitive testing at 24 months compared with placebo when randomized to increasing aerobic exercise to 65% to 85% of maximal heart rate 160 minutes/week, systolic BP <130 and cholesterol (LDL-C) <70 mg/dL. My concerns with this study are: small sample size, only 15% of screened participants were enrolled, short follow-up of 24 months, similar BP control in intervention and control group, and high risk for early dementia. Optimally these interventions should occur in midlife.
Blood chemistry shifts appear to mirror the rise of atmospheric carbon dioxide. The average blood bicarbonate levels have increased by 7% since 1999, closely tracking the rise of in atmospheric carbon dioxide over the same period. If these trends continue, bicarbonate in human blood could reach unhealthy levels within the next 50 years.
Of 2760 randomized patients, age 58, with pulmonary embolism (PE) or proximal deep-vein thrombosis (DVT), apixaban 10 mg twice daily for 7 days followed by 5 mg twice daily caused half of the bleeding of rivaroxaban 15 mg twice daily for 21 days, followed by 20 mg daily (relative risk, 0.46; 95% confidence interval [CI], 0.33 to 0.65). Recurrent PE or DVT and death were no different. Since 2015, the Beers criteria include a recommendation against rivaroxaban due to greater risk of bleeding, particularly GI bleeding, in older adults.
Among 138 patients who agreed to make their own warfarin dosing decisions based on home monitoring, 87% successfully transitioned to patient self-management (PSM). At 6 months of follow-up, time in therapeutic range improved from 77.1% to 81.3% during PSM, with 83% of warfarin dosing decisions made independently by patients and rarely requiring intervention from clinicians.
To support long term effects of GLP-1 weight loss, 8 microsteps, along with two 2-minute videos, increased behavioral expectations, hope and happiness, and reduced sugary drinks intake. Microsteps were evidence-based behavioral nudges for lifestyle changes related to improved food choices (switch sugary drinks for water, eat protein throughout the day), exercise (stretch, schedule time on calendar, integrate movement into daily activities), adequate sleep (avoid caffeine after 2pm, set an alarm 30 minutes before bedtime), and stress management (inhale twice and exhale slowly through the mouth, go outside for 5 minutes). The storytelling video was slightly better than the animated didactic video.
In the treatment of fibromyalgia, duloxetine 120 mg provided greater quality-adjusted life years and lower lifetime costs vs. amitriptyline and pregabalin 450 mg. Although amitriptyline is cheaper, when societal costs, including fatigue and sleep scale were considered, duloxetine came out ahead. This study did not consider the long-term side effect costs, which for amitriptyline include dementia from long-term exposure to the anticholinergic effect.
Patients whose antidepressants were selected using the PETRUSHKAtool, a decision-support system, were 38% less likely to stop taking their medication within the first 8 weeks of treatment compared with those who received usual care. This is another tool that I have used for years and found helpful.
Mild loneliness in combination with social isolation more than doubled perimenopausal women’s risk of cognitive decline OR 2.66 (1.44-4.91). Moderate to severe loneliness in combination with social isolation increased the risk more than sevenfold OR 7.52 (2.40-23.53).
Of nonorganic fruits and vegetables grown in California, 37% contain traces of 17 pesticides that are also PFAS, or "forever chemicals."
65 patients with mild-to-moderate Crohn’s disease (CD) were randomized to follow a plant-based, calorie-restricted, fasting-mimicking diet (FMD) for 5 consecutive days per month over 3 months, consuming 1090 calories on day 1 and 725 calories on days 2-5 before resuming their usual diet for the remainder of each month. 32 patients in the control group made no dietary changes and continued standard medical care. 45 patients in the FMD group (69.2%) and 14 patients in the control group (43.8%) had a clinical response (P = 0.03). Similarly, 42 patients in the FMD group (64.6%) and 12 patients in the control group (37.5%) achieved clinical remission (P = 0.02). There was also a decline from baseline in several inflammatory markers in the FMD group compared with the control group (−22.0% versus 8.0%, P = 0.03).
A high intake of fruits, vegetables, legumes, and potatoes was associated with a lower risk of developing Crohn’s over 13.4 years (4th versus 1st quartile adjusted hazard ratio (aHR), 0.44 (CI: 0.26–0.76). However, no significant association was seen for ulcerative colitis (aHR, 1.07).
Women with high adherence to MED and MIND diets had a 24% (hazard ratio [HR], 0.76; 95% CI, 0.58-1.00) and 25% (HR, 0.75; 95% CI, 0.58-0.97) lower incidence, respectively, of Parkinson's disease (PD) before 71 years of age than those with low or medium adherence. Of 71,542 women, avg age 53 at onset, over 20 years, 845 developed PD. No association was found in those >70 years old. Those who ate more than an ounce of legumes a day had a 1/3 lower risk, HR 0.64 (0.46-0.88), based on a 208-item semi-quantitative dietary questionnaire.
Although the US Environmental Protection Agency (EPA) has acknowledged that exposure to mercury, lead, and other heavy metals can cause a variety of health problems, the EPA has removed limits on hazardous air pollutants includingmercury and other heavy metals emitted from power plants, stating: “the regulatory rollbacks will ensure public health and the environment are protected without compromising America’s energy or economic prosperity.” Yet, the Clean Air Act reduced emissions by 90% and has shown a benefit to cost ratio of more than 30 to 1 by reducing cancers, stroke, CVD, dementia, etc. I don’t understand why politicians don’t want clean air.
At minute 8:20 this BBC Happy Pod reports how bacteria convert the plastic polyethylene terephthalate, used in food containers, into levodopa for Parkinson's disease at room temperature within 24 hours. Genetically engineered E.coli is used to turn the same plastic into acetaminophen.
The CDC reports 1,704 confirmed measles cases in 33 states vs 1,661 cases in 33 states last week.
The OMDA call on Thu April 16 is on: Do Not Intubate (DNI), by Joshua da Silva, DO, FACEP
I will be giving a presentation on: Normal Aging Changes and Geriatric Syndromes, on Wednesday at 9:30 am and 7:30 pm EDT.
To want something with sufficient fervor is to want it beyond the possibility of ever getting enough of it. (From “All Things Are Too Small” by Becca Rothfeld)
