Geriatric Update Aug 18, 2025
The CDC has not updated its measles cases since Aug 5th, and still reports 1356 in 41 states.
The US Food and Drug Administration (FDA) put a pause on the chikungunya vaccine in May 2025, due to postmarketing reports of serious adverse events in older adults, including neurologic and cardiac complications. Now it has cleared the vaccine, requiring a completed benefit assessment of travel to high risk regions and adverse reactions of serious chikungunya-like illness, cardiac and neurological reactions in older adults >65 with >1 medical problem.
Even mild cases of COVID cause increased coagulation, and this study showed that the spike protein activates fibrinogen, leading to leakage into the brain, but thrombin also converts fibrinogen to fibrin, forming a clot. The spike protein also activates macrophages, leading to inflammation and fibrosis in the lungs, and activating microglia, the brain’s macrophages, causing inflammation and brain fog. Using peptide array mapping, the researchers were able to identify not only the binding, but exactly the domains on fibrin that spike binds to, and two key domains, one the inflammatory domain and the other the plasmin binding site, which is important for fibrin degradation.
The vast majority 80% of cancer deaths averted, have come from prevention and screening efforts: the Pap smear, HPV screening and now HPV vaccines almost completely averted cervical cancer deaths, 25% of breast cancer deaths were averted due to screening; 56% from prostate cancer; 79% of deaths from colorectal cancer; and, 98% of the impacts on cancer deaths has resulted from a reduction in smoking. The next frontiers are obesity and alcohol.
A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and longer overall survival (hazard ratio for death, 0.63; 95% CI, 0.43 to 0.94) in 889 patients followed for 7.9 years. The exercise group had a 10 MET per week increase from baseline activity, with brisk walking for 1 hour equal to 4 MET.
Inverse relationship between overall daily physical activity and cancer risk, vigorous 26% lower, moderate 13% and light activity levels 6% over sedentary behavior significantly reduced the risk of 13 cancers in 85,394 UK biobank participants (age 63).
This TED talk addressed weight lifting in women to fight sarcopenia, metabolic syndrome and prolong healthy lifespan. The presenter encouraged us to lift heavy weights wherever we can, and addressed 3 myths:
Lifting weights makes us big and bulky- it is hard to bulk up this much.
Weight lifting is for boys and aerobics is for girls.
Weightlifting is too hard for women. In reality, estrogen makes women fatigue less fast and recover faster, and able to handle more weight at training without overtraining.
A computer program observed the walking patterns of patients with knee osteoarthritis and calculated the maximum stress they were placing on their knees, and generated computer models of four new foot positions angled inward or outward by 5 or 10 degrees and estimated which would best reduce stress on each person’s knees. This resulted in reduced maximum loading in their knees by 4%, while those who kept their normal stride increased loading by more than 3%. Further, those taught the new foot position experienced a 2.5-point reduction on a 10-point pain scale, equivalent to the effect of over-the-counter painkillers like NSAIDs and acetaminophen.
Of 6 Running Myths addressed in a NYT article, two stood out:
Post-exercise soreness is not related to such metabolic stresses, such as lactic acid or free hydrogen ions, but is caused by the microscopic damage that happens when you put unusually high demands on your muscles.
Rest is not always the best way to heal an injury. Fractures need rest but ligament and tendon strains need blood flow to heal. Stopping all movement can slow down the recovery process.
Cagrilintide is a long-acting analogue of amylin, a peptide hormone that is co-secreted with insulin from the pancreatic β-cells at 1/100th of insulin. Amylin plays a role in glycemic regulation by slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels. The combination with semaglutide led to glycated hemoglobin (HbA1c) level of <6.5% in 73.5% of the cagrilintide–semaglutide group and 15.9% in the placebo group. Gastrointestinal adverse events were reported by 72.5% of the patients in the cagrilintide–semaglutide group and 34.4% in the placebo group, most of which were transient and mild or moderate in severity.
In patients with atrial fibrillation taking apixaban, who carried the APOE ε4 allele, was associated with a 3-fold increased risk of intracerebral hemorrhage (hazard ratio, 3.07; 95% CI, 1.42-6.65).
Air pollution leads to high BP, stroke and heart disease. Participants who had elevated systolic blood pressure (SBP) (>120 mm Hg) had a significant 2.8-mm Hg mean reduction in SBP after HEPA filtration (P = 0.03) and a 0.2-mm Hg mean increase in SBP after sham filtration (P = 0.85). There was no significant benefit on diastolic BP or for participants with normal SBP (<120 mm Hg).
Last week I mentioned that CPAP may not help patients with mild to moderate sleep apnea, this study describes what may help. Of 16 patients randomized to shankh blowing, a conch shell, for 15 minutes, 5 days per week, had greater improvement in sleepiness with 34% reduction in Epworth Sleepiness Scale (change, -5.0 points; 95% CI, (-8.06 to -1.93) compared to 16 patients in the deep breathing exercise for the same amount of time, over 6 months. Sleep quality (Pittsburgh quality of sleep index, PSQI) and apnea hypopnea index (AHI) were also significantly improved. Age 19-65 with BMI <35 kg/m². For my patients with dementia, who may not be able to follow instructions, I had success with a pillow in a backpack that prevents them from turning on their back at night.
In a mouse study, reducing endogenous cortical Lithium by approximately 50%, the deposition of amyloid-β and the accumulation of phospho-tau markedly increased, and led to pro-inflammatory microglial activation, the loss of synapses, axons and myelin, and accelerated cognitive decline through activation of the kinase GSK3β. Lithium deficiency gives rise to transcriptome changes in multiple brain cell types that overlap with transcriptome changes in Alzheimer’s disease (AD). Replacement therapy with lithium orotate, which is a Li salt with reduced amyloid binding, prevents pathological changes and memory loss in AD mouse models and ageing wild-type mice.
Lorazepam-based regimens, reduced persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting more than Haldol, which was not different from placebo. While I have found lorazepam helpful in patients with a history of alcoholism, but usually stay away from it because it contributes to depression by suppressing REM sleep via gamma-aminobutyric acid and monoaminergic function, and causing or worsening dementia over time.
Initiation of pregabalin was associated with a 48% higher risk for new-onset heart failure overall and an 85% higher risk in those with a history of CVD than initiation of gabapentin, in 246,237 propensity matched Medicare beneficiaries with noncancer chronic pain, median age of 73 years (65-89 years). Both meds are on the Beers list and if used should be at the lowest dose. The most common side effects in older adults are ataxia (imbalance), falls and confusion.
Taurine, a non-essential amino acid is in many energy drinks for boosting physical and mental performance has been suggested to extend life span, at least in mice and monkeys. But a recent study casts doubt on taurine’s longevity promise, and debunks taurine as biomarker of biological aging. They repeatedly measured taurine levels in participants over time and showed no consistent age-related decline, and in many cases, taurine concentrations increased with age. And taurine is a key driver of myeloid malignancies, such as leukemia. Taurine can be biosynthesized, in the human liver from cysteine and/or methionine, which is abundant in grains, such as bread, rice, pasta.
Heatwaves increase mortality, especially in older adults, and during compound heatwaves that offer no relief at night, Chinese patients were 86% more likely to die from a heart-related condition, compared to a 19% increased risk from daytime-only heatwaves and 16% from nighttime-only heatwave.
The amount of microplastics collected from carotid plaque of 304 patients who had undergone carotid endarterectomy for asymptomatic carotid artery disease, found microplastics in 150 plaques, and a 4.53 times higher risk for myocardial infarction, stroke, and all-cause mortality, among individuals with microplastics and nanoplastics in plaque compared with those without. It is not clear if patients who ate more ultraprocessed food in plastic packaging had higher amounts.
For patients with irritable bowel syndrome, 10 medications were assessed by adverse effects compared to placebo, and number needed to harm (NNH) calculated: Rifamixin, an antibiotic, was the only US approved medication that participants stopped least due to side effects less than placebo, for all other meds, the NNH was 14-58, and with tricyclic antidepressants the NNH was 24. In my experience, when I stop these meds, my patients’ symptoms do not worsen.
The OMDA conference on Thu Aug 21st at 8 am is: MAID (medical assistance in dying) Update, by Lisa Vigil Schattinger, MSN, RN, Ohio End of Life Options
Happy International Never Give Up Day.
