Geriatric Update Apr 6, 2026
Urinary incontinence (UI) is one of the hidden illnesses that patients are afraid to bring up. Asking a screening question for UI before their visit increased the rate of diagnosis and treatment referrals to 9% among 72,009 women seeking routine care in 43 primary care clinics. UI diagnoses increased by 0.51 (95% CI, 0.12-0.91) per 100 encounters, referral for pelvic floor physical therapy referrals increased by 0.38 (95% CI, 0.23-0.53) and subspecialty services by 0.5 per 100 encounters. However, the rate of new prescriptions of UI medication did not change, good because almost all are antimuscarinic/anticholinergic and contribute to dementia over time.
Antimuscarinic medication used for the treatment of overactive bladder in women showed increased risk of cognitive decline or dementia in a systematic review and meta-analysis of 10 cohort studies over 7.5 years, with a pooled odds ratio (OR) of 1.33 (95% CI 1.10-1.61) and a hazard ratio (HR) of 1.24 (95% CI 1.19-1.30). Two studies reported increased cardiovascular risk (OR 1.13; 95% CI 1.01-1.25) and three studies reported increased mortality (OR 1.26; 95% CI 1.17-1.36). All studies demonstrated concerns regarding risk of bias. But short term, a meta-analysis of 8 RCTs (n = 675 participants) found no significant cognitive effects at mean follow-up of 19.5 days [standardized mean difference -0.23; 95% confidence interval (CI) -0.61 to 0.15, I2 75%].
Even a single round of antibiotics was linked to decreases in bacterial diversity 4-8 years later, with worst effects seen in the first year. Clindamycin, fluoroquinolones and flucloxacillin had the most lasting negative effects on gut health. On the other hand, penicillin V and some extended-spectrum penicillins were found to be much friendlier to the gut. Individual-level data from the Swedish Prescribed Drug Register was matched with fecal metagenomes of 14,979 adults for these findings.
This podcast discusses the major problems of groupthink, cognitive dissonance in the medical community and "blind spots." At 33:45 minutes, Peter Attia discusses with Marty Makary the routine overuse of (surgical) antibiotics. Other topics in this podcast episode are the slow change of practice due to groupthink in: peanut allergy, c-sections, non-operative treatment of appendicitis, and cancer of: breast, pancreas and ovaries.
Stroke risk was associated with cannabis (OR = 1.37, 95% CI = 1.14–1.65), cocaine (OR = 1.96; 95% CI = 1.27–3.01), and amphetamines (OR = 2.22, 95% CI = 1.40–3.53) in a meta-analysis of 32 studies with >100 million total participants.
Among frail individuals, greater time spent with systolic blood pressure (SBP) between 110 and 140 mm Hg was associated with lower major adverse cardiovascular event risk (hazard ratios per 10% increase in TTR, 0.92–0.94), whereas among robust individuals, greater time spent below 130 mm Hg was associated with lower risk (hazard ratios per 10% increase in TTR, 0.89–0.98). Age demonstrated limited discrimination in this pooled analysis of 19,230 participants, age >65, from SPRINT and ACCORD trials. Two previous studies have shown that frailty affected outcomes with SBP control and determined the threshold of walking speed of >0.8 meters/second in community living, age >65, and >0.5 m/s in very old, 90-year-old facility residents, when lower SBP control improved outcomes. In my experience, adequate hydration of 2 quarts a day allows me to safely bring down SBP, even to <120, in all patients, reducing risk of stroke, MI and dementia; however, dehydration is often a challenge in patients with frailty and dementia.
Using longitudinal plasma %p-tau217 (the ratio of phosphorylated to non-phosphorylated tau at position 217) from two independent cohorts (n = 258 and n = 345), clock models were used to estimate the age at plasma %p-tau217 positivity. The estimated age at plasma %p-tau217 positivity was associated with the age at onset of Alzheimer's disease symptoms (adjusted R2 of 0.337−0.612) with a median absolute error of 3.0−3.7 years. However, the time from %p-tau217 positivity to onset of AD symptoms was markedly shorter in older individuals.
In a cohort study of 2766 women, avg age 70, associations of p-tau217 with incident dementia were larger in magnitude among women assigned to estrogen plus progestin vs placebo (HR, 4.18; 95% CI, 3.41-5.13) vs placebo (HR, 3.07; 95% CI, 2.41-3.91) but did not vary for estrogen alone vs placebo (p-0.4). Every 1-SD increase in log2-transformed p-tau217 was associated with incident MCI or dementia (HR, 2.43; 95% CI, 2.18-2.71). P-tau217 associations with MCI or dementia were larger in magnitude for women >70 years, for APOE ε4 carriers, and for White compared with Black women.
Falls are associated with faster progression to Alzheimer’s disease (AD) dementia. Of 125 cognitively intact older adults, age 74 at start, followed for 10 years, dementia was assessed with the clinical dementia rating scale (CDR) 0-3. Those who had a fall in the first year progressed as fast as participants with amyloid on positron emission tomography (PET) scan within the first 2 years. Those who had a fall and amyloid on PET progressed the fastest, while those negative for both progressed the slowest, reflecting motor and gait dysfunction intrinsic to disease progression.
Just one 15-minute session of aerobic exercise floods the brain with brain-derived neurotrophic factor (BDNF), a protein I wrote about 3 weeks ago, known to support the development of new brain cells and the health of existing brain cells.
CNN has reported on research that has shown that following a dozen or more lifestyle interventions, when practiced >60% of the time, can improve cognitive function, especially in women. It was investigating the impact on cognition of such lifestyle changes as a healthy plant-based diet, stress reduction, strength training, aerobic exercise and quality sleep habits — outlined in this recent review published in Nature.
The MIND diet emphasizes eating more of these to reduce the risk of dementia: berries, beans, leafy green vegetables, fish, poultry, whole grains, olive oil and nuts. The diet also emphasizes eating extremely limited saturated fats such as cheese, butter, red meat and fried foods. Greater adherence was equivalent to 2.5 years of reduced brain aging during the 12.3-year follow-up.
However, among individuals with APOE34/44 genotypes, approximately one-quarter of the global population, higher meat consumption was associated with better cognitive trajectories and lower dementia risk (sHR, 0.45; 95% CI, 0.21 to 0.95; P = .04). Among 2,157 older Swedish adults without dementia (mean age 71.2), 569 participants (26.4%) had APOE34/44 genotypes. Red meat consumption stood out to improve the cognitive trajectories and dementia risk, while processed red meat did not, and the effect was greater in women. We evolved as herbivores, but recent addition of meat led to selection for “meat‐adaptive” gene resistance to disease risks associated with meat eating, and also increased life expectancy. Post-hoc analysis showed that in participants with APOE34/44 genotypes, Vitamin B-12 absorption was greater with higher meat consumption, while the opposite pattern was observed for APOE2 carriers and no difference in APOE33. Yet APOE4 still carries the highest risk for Alzheimer’s and APOE2 the least. It might be better to get our vitamin B-12 from a senior multivitamin and not eat red meat.
A daily senior multivitamin showed a 4-month delay in aging over 2 years on five DNA methylation measures of biological aging (PCHannum, PCHorvath, PCPhenoAge, PCGrimAge and DunedinPACE) among 958 participants, age 70, but 500 mg cocoa flavanols per day did not show the delay in aging.
These simple tests indicate if we are aging well:
Sitting-rising test: go from standing to sitting on the floor, and back up again, using the least amount of support possible.
Walking speed: slower gait, <1.2 meters/second, or 2.7 miles an hour, or 1 mile in 22 minutes, could indicate that there’s a problem in cardiovascular, musculoskeletal, vestibular (balance), sensory, brain processing and nervous systems.
Grip strength: a 45-year-old man should be able to carry two 60-pound dumbbells, a 65-year-old two 40-pound dumbbells and an 85-year-old two 25-pounders. For a woman at those ages, goal weights are 40 pounds, 25 pounds and 15 pounds in each hand.
Single leg stand for balance: start by holding on with one hand and over time reduce the number of fingers required for balance.
Maintaining or improving a healthy lifestyle after a hypertension diagnosis halved cardiovascular disease (CVD) aHR 0.49 (95% CI, 0.39-0.61) and reduced type 2 diabetes by 79%, aHR 0.21 (95% CI, 0.14-0.30).
In an attempt to decrease inflammation, the interleukin-1ß blocker diacerein 50 mg was given twice daily, but did not improve knee pain over 24 weeks (-19.9 mm [diacerein] vs -18.6 mm [placebo]; between-group mean difference, -1.3 mm; 95% CI, -9.8 to 7.3). The adverse events of gastrointestinal symptoms, diarrhea and dark urine occurred 1/3 more often in the diacerein group than the placebo group.
Statin treatment improves clinical outcomes even in patients >80 years of age. Of 15,745 Israeli patients (mean age 84.5 years) 8,413 were statin users. Statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34–0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68–0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80.
Direct-to-consumer gut microbiome tests produced markedly different results when 21 samples of the same stool were sent to 7 different labs, even when the same lab analyzed it using kits produced by the same company. Until quality control improves validity, our time and resources are better used increasing intake of cruciferous vegetables and legumes by replacing rice with riced cauliflower and meat with lentil loaf to improve our gut biome.
Over 155,000 unrecognized additional COVID-19 deaths occurred in 2020-2021 outside of hospitals. That would mean about 16% of deaths went uncounted in those years. They were more likely Hispanic and other people of color, died in the first few months of the pandemic, and were in certain states in the Southwest and South – including Alabama, Oklahoma and South Carolina.
The high-dose inactivated influenza vaccine (HD-IIV) has demonstrated superior protection against a range of hospitalization end points versus standard-dose inactivated influenza vaccine (SD-IIV), and its effect in those with or without pre-existing cardiovascular disease (CVD) is statistically significant in lowering hospitalization for any CVD (HD-IIV, 1.15%, versus SD-IIV, 1.24%; relative vaccine effectiveness, 6.6% [95% CI, 1.6-11.4]; P=0.010), for any respiratory disease (HD-IIV, 0.92%, versus SD-IIV, 0.98%; relative vaccine effectiveness, 6.5% [95% CI, 0.7-11.9]; P=0.027), and for heart failure (HD-IIV, 0.11%, versus SD-IIV, 0.15%; relative vaccine effectiveness, 21.3% [95% CI, 7.6-33.0]; P=0.003).
The CDC reports 1,661 confirmed measles cases in 33 states vs 1,566 cases in 32 states last week.
Ohio’s respiratory dashboard showed 60 flu hospitalizations (217 last week), 31 COVID hospitalizations (136), and 100 RSV (316). As respiratory illnesses have waned, I will stop reporting them until a resurgence occurs.
The OMDA call on Thu April 9 is an: Institute for Healthcare Improvement (IHI) Update for Michigan and Ohio, by Alice Bonner
Take care of your body. It's the only place you have to live. (Jim Rohn)
