Geriatric Update Aug 3, 2026

The PAM gene encodes the sole enzyme responsible for activating (amidating) bioactive hormones including GLP-1, leading to lower intracellular GLP-1. 10% of the population has this gene, making these meds less effective.

Lifestyle intervention, consisting of weight management plus exercise training, preserved bone quality in older adults with obesity during weight loss in 120 older adults (aged 65–85 years, mean age 71.4) with obesity (BMI ≥30 kg/m2) over 12 months vs healthy lifestyle, consisting of educational sessions on healthy diets. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity. 

Structured multidomain lifestyle arm (supervised exercise, dietary counseling, cognitive and social engagement, and health coaching) vs self-guided education significantly reduced white matter hyperintensity indicating small-vessel disease-related injury on MRI among participants younger than 70 years, but not among those 70 years or older. White matter hyperintensities contribute to dementia later in life. 

A 2-year systematic lifestyle intervention (SLI) adapted to South America improved global cognitive composite scores over 2 years in both randomized groups, with a mean annual change of 0.31 SD (95% CI 0.28-0.34) per year in the SLI group and 0.20 SD (0.17-0.23) per year in the control group receiving health information (mean between-group difference of 0.11 SD per year [0.06-0.15; p<0.0001]). 

Autonomic dysfunction, (e.g. blood pressure instability) can be an early marker of synucleinopathies such as Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and pure autonomic failure (PAF).

Of 638 young Australians, men who ate more legumes – such as beans, lentils and peas – were significantly less likely to show early warning signs of heart disease including high blood pressure, increased waist circumference, unhealthy cholesterol and elevated blood sugar (OR = 0.278, 95%CI = 0.088–0.883, p = 0.030). Young women saw the biggest benefit from cruciferous vegetables like broccoli, cauliflower and cabbage for fewer early warning signs of heart disease and type 2 diabetes (OR = 0.151, 95%CI = 0.023–0.999, p = 0.049). A single serving a day of the right vegetables was linked to a much lower health risk – even in people in their early 20s. Both classes of vegetables add benefits in both sexes and it’s worth starting at any age.

Of 479,607 adults without diabetes enrolled in the UK Biobank, low handgrip strength, low skeletal muscle mass relative to body weight, and high body fat percentage were associated with incident type 2 diabetes in 32,948 participants over 14.2 years. Sarcopenic obesity was associated with the greatest risk of incident diabetes (hazard ratio = 3.54), exceeding the risk associated with obesity (HR = 2.97) or sarcopenia (HR = 1.85) alone.

(Ultra-)short-acting insulin analogues may result in little to no difference in glycemic control, non-severe hypoglycemia and treatment adherence at short-term follow-up. A reason for older adults to not use the very short analogs is the delayed absorption of food and the slower and lower release of insulin from the pancreas as we age. I have seen patients get hypoglycemic with these agents before they even got to the dining room table. Watch my diabetes presentation for explanation of the reason and evidence of this. 

Gut health is based on five core pillars — dietary regulation and hydration, adhering to routine timing, physical activity, mind-body practices and behavioral toileting habits to improve gut motility, stool consistency, microbial diversity, and stress resilience. 

Among 64,717 respondents who identified as Black, 88.3% were born in the United States, 8.0% were born in the Caribbean, South, and Central America [CSCA] and 3.7% were born in Africa. Foreign-born individuals had lower odds of stroke (adjusted OR 0.44, 0.34–0.57 for CSCA and 0.39, 0.23–0.63 for Africa), and the odds of stroke were lowest for those who had recently immigrated at the time of the survey (adjusted OR < 15 years 0.27, 95% CI 0.15–0.47). 

An updated universal definition of heart failure (HF) by 4 US and international cardiology societies makes cutoffs for left ventricular ejection fraction (LVEF) more flexible and adds the causes of heart failure. Classification now includes 16 causes, such as amyloidosis, Takotsubo cardiomyopathy, plus idiopathic/other, and adds stage B or pre-HF to identify individuals at risk of developing HF.

In 2023, there were an estimated 473,000 ischemic heart disease (IHD) deaths in the US, a decrease of 58.7% in age-standardized rate since 1990. Between 2010 and 2023, there was a 19.0% decrease for males and a 24.5% decrease for females. High systolic blood pressure (SBP) contributed 47.2%, dietary risks 38.6%, and high low-density lipoprotein cholesterol (LDL-C) 28.5%. Increased exposure to several risk factors substantially increased their attributable burden for IHD deaths in 2023, with high fasting plasma glucose (FPG) increasing 38.8% (95% UI, 11.5%-81.1%) and high body mass index (BMI) increasing 54.5% (95% UI, 41.8%-66.3%) since 1990. Smoking at 33.3% and particulate matter pollution at 74.9% had the greatest decrease in attributable IHD mortality since 1990.

Among 8,250 Chinese patients age 18-75 with multivessel coronary artery disease and in stable condition 12 months after implantation of a drug-eluting stent, extending DAPT with clopidogrel and aspirin for an additional 12 months led to a lower risk of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke (cumulative incidence, 5.8% vs. 6.8%; hazard ratio, 0.82; 95% confidence interval [CI], 0.69 to 0.98; P=0.03) when compared with continuing aspirin alone, without an increased risk of bleeding. For patients older than 75, not included in this study, bleeding risk increases and the risk shifts. 

Of 3,627 (29.6%) patients at high cardiovascular risk without prior myocardial infarction or stroke and LDL-C >90 mg/dL who had undergone prior percutaneous coronary intervention (PCI) within 4 years, the PCSK9 inhibitor evolocumab reduced LDL to 41.5 mg/dL versus 107.0 in the 8,628 randomized to placebo. Over 4. 8 years, evolocumab reduced cardiovascular death (2.6% versus 3.7%; HR, 0.66 [95% CI, 0.45-0.96]; P=0.030) and all-cause death (8.2% versus 10.2%; HR, 0.76 [95% CI, 0.60-0.95]; P=0.016), major adverse cardiovascular events (MACE) by 30% (5-year Kaplan-Meier rates 7.0% versus 9.5%; hazard ratio [HR], 0.70 [95% CI, 0.56-0.89]; P=0.004), MI by 50% (3.0% versus 6.1%; HR, 0.50 [95% CI, 0.36-0.70]; P<0.001), with the effect apparent as soon as 6 months after randomization. Cost is about $500 a month for the subcutaneous injection. 

The FDA approved the first oral PCSK9 inhibitor, enlicitide (Lipfendra) for high cholesterol not adequately controlled by statins.

The FDA also approved once-monthly Tryngolza (olezarsen), an injectable medication used alongside diet to treat adults with Familial Chylomicronemia Syndrome (FCS) and Severe Hypertriglyceridemia (sHTG) at risk of pancreatitis. The medicine cut in half triglyceride levels from an average 1,116 mg/dl (normal is <150 mg/dl). Olezarsen is an antisense oligonucleotide that inhibits the formation of apolipoprotein C3 (apoC-III), a protein that regulates both triglyceride metabolism and liver clearance.

The UK's National Institute of Health and Care excellence (NICE) has added finerenone to the guidelines for treating chronic heart failure with preserved or mildly reduced ejection fraction. The other drug class is SGLT-2. 

A longer time from atrial fibrillation diagnosis to ablation, 1-4 years vs <1 year, was associated with 48% higher atrial arrhythmia recurrence risk, and those treated >5 years after diagnosis had a 110% higher risk. 

Tamsulosin was stopped for 1 week in 31 men, age 69. One third, 11 (36.7%) had minimal or no tamsulosin effect, 11 (36.7%) had moderate effect, 4 (13.3%) had strong effect, and 4 (13.3%) did not tolerate stopping it for even 1 week. It is worth trying to deprescribe, given the complications of floppy iris syndrome with cataract surgery after exposure to alpha-blockers such as tamsulosin.

A smartwatch with a smartphone app identified heart failure by showing elevated heart rate up to 14 days vs 4 days with weight monitoring, before a rise in  B-type Natriuretic Peptide. The smartwatch was more sensitive (40.8% vs 7.2%; P = 0.01) and had higher positive predictive value (60.0% vs 37.5%; P = 0.05), negative predictive value (92.0% vs 69.9%; P < 0.001), and positive likelihood ratio (10.8 vs 1.4; P = 0.002) compared to weight-based monitoring, with better adherence (100% vs. 60.6%). Discriminative performance showed an area under the curve 0.865 vs 0.791 for weight gain. This device-company-sponsored trial was small, 124 patients, age 58, and needs to be followed up with patient outcomes data of hospital or mortality prevention. 

Regulatory T cells, or Tregs, may reset the immune system, triggering a long-term benefit without the need for continual immunosuppressive drugs for autoimmune diseases and possibly for transplants in the future. 

Immunocompromised adults, such as with auto-immune disease treatment, cancer chemotherapy or transplant, face higher risk of recurrent invasive pneumococcal disease (IPD) following a primary case of disease than the general population. In the first year alone, the incidence of recurrence was 1,468 cases per 100,000 person-years, a rate 152 times higher than the primary IPD rate in the general population. Only about a quarter of patients had the pneumonia vaccine that would have helped. 

Between 1999 and 2024, mean worker contributions toward family health insurance premiums increased by 308%, while total premiums increased by 342%. Over the same period, mean worker earnings increased by 119% and inflation by 64%. 

The CDC reports 2,355 confirmed measles cases in 45 states vs 2,302 cases in 44 states last week.

CDC has received reports of 6,707 laboratory-confirmed domestic cases of cyclosporiasis and is aware of more than 11,000 additional cases under investigation.