Geriatric Update Apr 28, 2025

The CDC reports 884 confirmed measles cases in 25 states, up from 800 last week. In Ohio, the Dept of Health website has not been updated from the 20 cases reported in March.

In patients with spontaneous intracerebral hemorrhage (ICH), randomized to intensive systolic BP target of less than 140 mm Hg within 6 hours of onset, compared with those with a target of less than 180 mm Hg, did not lead to more ischemic lesions detected with diffusion-weighted magnetic resonance imaging at 48 hours.

Obesity, particularly severe obesity, was strongly associated with the incidence of 16 common health outcomes: hypertension, type 2 diabetes mellitus, hyperlipidemia/dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, metabolic dysfunction–associated steatotic liver disease, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis, ranging from 14.0% (osteoarthritis) to 51.5% (obstructive sleep apnea) in this population of 270,657 participants, avg age 52, 62% women.

Metformin, 2000 mg/d, reduced knee pain measured on a 0- to 100-mm visual analog scale (score of 100 = worst): −31.3 mm in the group randomized to metformin and −18.9 mm in the placebo group (between-group difference, −11.4 mm; P = .01), corresponding to an effect size of 0.43 (95% CI, 0.02-0.83). 

Sodium-glucose co-transporter-2 inhibitors (SGLT2) were associated with lower risk of new-onset AF in patients with T2DM compared to those receiving glucagon-like peptide-1 agonists (GLP-1) (RR = 0.76, 95% CI: 0.65 to 0.89) in a systematic review of 6 observational studies. There was no statistically significant difference in the risk of stroke between SGLT2 and GLP-1 (RR = 1.09, 95% CI = 0.98 to 1.21).

Patients who were started on adrenergic blockers (AB), beta blockers except propranolol, prior to onset of Parkinson's disease (PD) symptoms showed the largest average delay of PD onset (at 72.3 ± 10.1 years), followed by statins, each almost 10 years later as compared with those not on AB (62.7 ± 10.7 years) (63.0 ± 10.6 years). NSAIDs delayed onset by 8.6 years, but these meds are risky and should be avoided in older adults. ACE-inhibitors/angiotensin II receptor blockers delayed onset by about 6 years, diuretics by 7.2 years, and calcium channel blockers by 8.4 years. All those who started taking AB after onset of symptoms had delayed disease but not as much as starting meds before symptom onset. After multiple regression analysis, ACE-I/ARBs, CCBs, diuretics, anti-diabetic medications, beta-agonists, and FH were not strong onset predictors.

In physically inactive older adults, protein supplementation had no statistically significant effect on total lean body mass (p> 0.05), muscle strength, and secondary muscle mass parameters showed negligible intervention benefits, whereas physical performance (stairs, transfer and get-up and go) showed heterogeneous outcomes.

Smokers interested in quitting, who were randomized to cytisinicline for 6 weeks had an almost 3 fold higher success rate (odds ratio [OR], 2.9; 95% CI, 1.5-5.6). Those with 12-weeks of treatment, over four-fold (OR, 4.4; 95% CI, 2.6-7.3; P < .001).

Smokeless tobacco use cessation interventions, evaluated in a Cochrane review, found increased quit rates from counselling, behavioral interventions (e.g. cessation counselling and brief advice) compared with minimal support (RR 1.76, 95% CI 1.44 to 2.16) and pharmacotherapies (e.g. nicotine replacement therapy (NRT) (RR 1.18, 95% CI 1.05 to 1.33) varenicline compared with placebo (RR 1.35, 95% CI 1.08 to 1.68). Bupropion did not show benefit compared with placebo (RR 0.89, 95% CI 0.54 to 1.44). I have had success with bupropion and found that many studies did not allow several weeks after medication start before stopping, to allow sufficient increase of bupropion blood levels in the brain. 

NarxCare is an on-line tool to  calculate the likelihood a patient is to misuse, abuse, or overdose on opioid analgesics and other controlled substances. Around 20 states use the product, according to the company. Based on only one study that validated the scores in pharmacies owned by a single company that compared scores to the results of more than 1400 surveys of patients on their experiences with opioids. The study did not involve physician prescribing, and found 17.2% of patients were classified as false positives. Caveat emptor!

Quercetin, a bioactive flavonoid present in red wine, can impair alcohol metabolism via the effect on mitochondrial aldehyde dehydrogenase (ALDH2). Red wine is notorious for inducing headaches and does so roughly 3-fold more frequently than other alcoholic beverages, often within 30 minutes and after only a single glass.

Patients, age ≥70 at dementia diagnosis using antihypertensives, diuretics, lipid-lowering drugs, and oral anticoagulants had statistically significantly fewer dementia diagnoses (odds ratio [OR] 0.75–0.91) than non-users. Antiplatelets use was associated with more dementia diagnoses (OR 1.13–1.25).  

Among 13,719 cancer patients treated with a first dose of IV cisplatin between 2006 and 2022, receipt of 2 g IV magnesium was associated with less acute kidney injury or death, 104 of 3893 patients (2.7%) who received IV magnesium, vs. 520 of 9826 (5.3%) who did not (adjusted odds ratio, 0.80; 95% CI, 0.66-0.97) also in multiple sensitivity and secondary analyses.