Geriatric Update Aug 17, 2026
These are 6 myths about dementia:
It starts in old age, when it actually starts 20 years before symptoms appear.
It starts with memory, when actually it starts with not being able to do certain tasks.
My parents have dementia I will get it, when actually lifestyle is more important than genes.
Symptoms are the same for men and women when actually women have longer preserved language function for example.
Hormones protect from dementia, actually there is no good evidence of it.
Heart and brain health are separate when they're actually closely linked. What's good for the heart is good for the brain.
Those who had hypertension, diabetes and smoked at age 55 had dementia-free survival of only 17.5 years vs 30.1 years for those who didn’t. Participants with all three risk factors had a higher incidence of dementia (HR 2.69, 95% CI 1.94-3.73) and a higher incidence of dying before a dementia diagnosis (HR 5.61, 95% CI 4.67-6.74) compared with those who had no risk factors.
Home-based comprehensive geriatric assessment (CGA) resulted in improved functional status over various time frames of the 36 months follow up (standardized mean difference [SMD] 0.17, 95% confidence interval [CI] 0.09–0.25), including an increased health-related quality of life (HRQoL), a reduction in mortality, a reduction in hospitalizations and improved patient satisfaction with care. Home-based CGA resulted in little or no difference in nursing home admission, emergency department presentation, or adverse events. Intervention characteristics and multidisciplinary team composition varied across trials.
Another NYT article described 9 things that we should do in midlife to increase longevity:
Cardio-respiratory fitness is one of the best predictors of longevity and being able to be active and mobile in the later years
Run errands with a friend emphasizes the importance of social relationships
Eat fermented food to support the gut microbiome, and I would add fiber from legumes, nuts/ seeds, and green vegetables.
Lift weights
Include a little protein in every meal, not more, the average man exceeds their protein need by >55% and the average woman by >35%.
Take the stairs
Get the shingles vaccine
Make a list of your parents’ chronic health conditions
Go to bed at the same time every night
This NYT article described regular sleep times as more important than sleep duration for health.
Those with the most irregular sleep schedules were more than twice as likely to develop cardiovascular disease than those with more regular sleep patterns.
Those with the most irregular sleep schedules, were about 50 percent more likely to develop dementia than those who scored in the middle of the sleep regularity range.
A group of sleep scientists concluded that there was enough evidence to recommend maintaining a regular sleep schedule to help protect metabolic, mental and cardiovascular health.
Antihypertensive meds (AHMs) that increase angiotensin-II formation (angiotensin II receptor blockers [ARBs], thiazides, and dihydropyridine calcium channel blockers [DHP-CCB]) decreased dementia risk with combined statin more than angiotensin-II-suppressing AHMs (angiotensin-converting enzyme inhibitors [ACEIs], beta-blockers and non-DHP CCBs) though it was not statistically large enough for an observational study to change my management (HR, 0.88; 95% CI, 0.79–0.98); there was 13% lower all-cause mortality (HR, 0.87; 95% CI, 0.82–0.93). The differences between rosuvastatin, atorvastatin vs pravastatin were larger (HR, 0.43; 95% CI, 0.36–0.50 and HR, 0.74; 95% CI, 0.64–0.84, respectively) in the 34,610 propensity matched Australians, avg age 66, but I would want to see a randomized controlled trial.
Statin initiation was associated with a 24% lower risk of developing frailty or death compared with non-initiation (hazard ratio = 0.76; 95% confidence interval, 0.75-0.76), with similar protection among veterans who were pre-frail at baseline. 987,301 statin-naïve US Veterans aged ≥67 years (avg 72) propensity matched with veterans not on statins.
In 109 patients discharged after hip fracture, oral nutritional supplementation increased protein intake but did not improve physical functional performance.
Traditional Chines exercises (TCEs) are effective in improving cognitive function in older adults, particularly in domains such as global cognition, executive function, working memory, processing speed and memory function. All of the tests improved; I am reporting only the Montreal Cognitive Assessment [mean differences (MD) = 1.67; 95% confidence interval (CI): (1.20, 2.14)]. Given the methodological limitations and heterogeneity of the 28 RCTs with a total of 2297 participants of the included studies, these findings require confirmation in further large-scale, high-quality RCTs.
Simultaneous initiation with finerenone and an SGLT2i reduced urine albumin creatinine ratio (UACR), a measure of kidney function, compared with monotherapy and was well-tolerated irrespective of HbA1c levels −52% (−56 to −46) for the combination and −32% (−39 to −24) for finerenone alone. In addition to this drug company (finerenone) sponsored study, I would like to see a comparison trial between generic spironolactone, another mineralocorticoid, and finerenone because of the difference in cost, $10 vs. $700 a month.
Oral or enteral magnesium intake was slightly lower than intravenous (IV) infusion, at 24 hours, mean magnesium concentrations were 0.80 mmol/L in the enteral group vs 0.92 mmol/L in the IV group of the ICU patients, with a mean difference of -0.12 mmol/L (95% CI, -0.16 to -0.07 mmol/L). Although IV is slightly better absorbed than enteral/ oral, enteral replacement substantially decreased urine magnesium concentrations compared with IV replacement (median difference of area under the curve, -46.2 mmol·hr/L), cost (median difference, -6.48 Australian dollars), waste (median difference, -55 grams), CO2 footprint (median difference, -946 grams), and additional IV fluid administration (median, -100 mL; interquartile range).
Women with recurrent urinary tract infections (rUTIs) (n=100, age 73) received a sublingual Uromune® autovaccine prepared from inactivated strains isolated from each patient's urine culture (UC). Over 12 months rUTI episodes decreased from 4 (3-5) at baseline to 0 (0-2) at 3 months, 1 at 9 and 1 at 12 months (all P < .001). Approximately 40% were UTI-free in each follow-up interval. Urine cultures were negative: 50.7% at 3 months, 25.9% at 9 months, and 45.5% at 12 months. Vaccine-related adverse events were uncommon (6%) and mild.
Prostate-specific antigen (PSA) test for prostate cancer screening likely reduces prostate cancer-specific mortality and may reduce overall mortality in this Cochrane review of 6 randomized controlled trials with a total of 789,086 participants.
Rates of glaucoma, ocular hypertension, and open-angle glaucoma were significantly higher in men with a history of the PDE5 inhibitor tadalafil (Cialis) prescriptions for lower urinary tract symptoms. These patients also had a higher likelihood of initiating treatment for glaucoma as compared with men who did not use a PDE5 inhibitor.
Wyoming, Montana and Alaska are 3 states with the highest rates for suicide. The two biggest factors, experts say, are the isolation of living in a sparsely populated state and easy access to guns. Another one is a denial of mental health.
Navajo patients (n=206) with heart failure, age 65.8, were provided with 14 culturally and medically tailored meal (CMTM) per week for 60 days. Breakfast included items such as a blue corn mush plate with blueberries, bison sausage, and butternut squash. For dinner, patients had meals such as mutton rainbow stew with steamed corn, blue corn meal, and wild rice vs usual care comprising heart-healthy, home-prepared meals incorporating locally sourced foods in the control group. The meals included no added salt or sugar, and patients could eat whatever they wanted outside of the prescribed diet. Hospitalization and ED visits were significantly less frequent in the intervention group (43 [40.6%] vs 57 [57.0%]; relative risk, 0.72; 95% CI, 0.54-0.96; P = .02), which was driven mainly by reduced hospitalizations (13 [12.3%] vs 26 [26.0%]), especially a lower incidence of heart failure hospitalizations (4 [3.8%] vs 13 [13.0%]).
In 3698 stabilized patients after myocardial infarction (MI) with preserved ejection fraction, age 63.5 years, higher HR remains associated with adverse cardiovascular events and mortality. Interrupting ß-blockers substantially increases HR and is consistently linked with worse outcomes irrespective of baseline HR, supporting continuation of ß-blocker therapy. Higher HR was associated with increased risk of death, MI, or stroke (5.5% versus 6.4% versus 9.2%; adjusted hazard ratio 1.55; 95% CI, 1.14-2.12) and death, MI, stroke, or heart failure (6.5% versus 7.1% versus 10.4% adjusted hazard ratio 1.47; 95% CI, 1.11-1.97). Beta-blocker interruption did not seem to improve the patients' quality of life.
In this randomized clinical trial of 160 patients, age 62, a structured early Nephrology consult (ENC) triggered by a machine-learning AKI risk score, there was no difference in kidney function (ΔSCr). ENC recommendations followed by 41% of the ENC and 68% of the control group. This supports by an earlier study of an electronic alert system for acute kidney injury that did not improve clinical outcomes among 2,393 patients in hospital.
Higher abundance of oral human papilloma virus (HPV), Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) correlate with worse survival of head and neck squamous cell carcinoma (HNSCC). Cell culture studies showed 1000-fold higher Pg/Fn in their saliva and 100-fold higher in oral-rinse samples than non-cancer control participants. A single dose of bean gum + protegrin-1 (antimicrobial peptide) reduced Pg/Fn > 99% in saliva and oral-rinse samples (n = 42). Although protegrin was effective against anaerobic Pg/Fn, it did not kill capsule forming bacteria including Streptococci, providing selectivity and protection of oral commensal (good) bacteria.
The OMDA call on Thu August 20- Survey Readiness, by Barb Bull and RN, Lauren Fiser
The CDC reports 2,550 confirmed measles cases in 47 states vs 2,449 cases in 47 states last week.
Medicines cure diseases, but only doctors can cure patients. Dr. Carl Jung (1875-1961)
