Geriatric Update Aug 31, 2026
The American Heart Association offers updated guidance on heart-healthy dietary patterns to reduce the risk of cardiovascular disease:
Adjust energy intake and expenditure to achieve and maintain a healthy body weight.
Eat plenty of vegetables and fruits and choose a wide variety and color.
Choose foods made mostly with whole grains rather than refined grains, such as brown rice instead of white rice.
Choose healthy sources of protein, shift from meat to plant-based sources such as legumes including beans, peas and lentils, along with nuts and seeds.
Choose sources of unsaturated fats in place of sources of saturated fat.
Choose minimally processed foods instead of ultraprocessed foods.
Minimize intake of added sugars in beverages and foods.
Choose foods low in sodium and prepare foods with minimal or no salt. Choose herbs, spices or lemon instead of salt.
If alcohol is not consumed, do not start; if alcohol is consumed, limit intake.
In 101 primary care offices in the Netherlands, men aged ≥40 and women ≥45 years without known CAD, with possible cardiac or non-cardiac chest pain, were cluster randomized to coronary artery calcium score (CACS) or usual standard of care (SOC). The CACS group showed 47.1% relative reduction in cardiologist referrals compared with SOC (42.5% vs 80.3%) and increased enrollment in cardiovascular risk management from 17.0% to 36.3%. Patients with CACS 0 or 1 to 10 accounted for 47% of all scans, and during 19.5 months of follow-up, none of the referred patients in these groups were diagnosed with obstructive coronary artery disease, and none of the 3 MACEs occurred in patients managed conservatively.
In persons aged 75 years or older receiving statins for primary prevention with no previous history of ASCVD, discontinuation of statins was non-inferior to continuation in terms of all-cause mortality or adverse events over 3 years. I would like to see follow-up of >10 years to also monitor dementia incidence, function, cancer and other outcomes.
Statin initiation was associated with reduction in pneumonia (hazard ratio (HR)= 0.86, 95%CI: 0.78, 0.94) and general acute respiratory infections (HR=0.83, 95%CI: 0.76, 0.89) diagnosed in hospital, but not for influenza (HR=0.63, 95%CI 0.21, 1.93), in 213,372 UK patients >65 years old.
GLP-1 (0.87, 0.83-0.92), SGLT-2 inhibitors (0.82, 0.75-0.90), metformin (OR 0.69, 95% CI 0.53-0.89) and tirzepatide (0.82, 0.72-0.93) were associated with a significant reduction in Major Adverse Cardiovascular Events (MACE) and sulfonylureas with increased MACE. The meds showed similar reduction in mortality but no effect was observed for insulin, DPP4 inhibitors (DPP4i), pioglitazone or sulfonylureas in a pairwise network meta-analysis including 93 randomized controlled trials with a duration of at least 40 weeks.
GLP-1s may not be in the gut, but in the brain. This TED talk discusses the development of GLP-1s and how they could quiet the relentless noise of craving.
Patients’ confidence in their own ability to manage their weight was the strongest psychosocial marker of GLP-1 treatment success, distinguishing groups more reliably than motivation, cravings, stress or self-monitoring.
Switching to a vegan diet for even a short time can reduce inflammation and slow aging on a cellular level. After just one month changes were seen in genetic expression that promoted lower inflammation associated with reduced cancer risk and decelerated biological aging was seen compared to those eating a meat-rich diet.
Eating 200 g (7 oz) of raw tomatoes and 50 g (2 oz) of tomato sauce daily reduced liver fat on FibroScan in 79 adults, age 58 years with metabolic dysfunction-associated steatotic liver disease (MASLD) and a BMI ≤30 vs the control group.
The dirty dozen are vegetables that have a lot of pesticide residue that is hard to wash off, and should be bought as organic. Here are 10 lower-residue picks, foods that have thick skin or are harvested quickly and are more protected from pesticide residue. The Environmental Working Group (EWG) calls these its “Clean Fifteen,” the nonorganic produce carrying the lowest pesticide residue, where we can save money:
Pineapple
Sweet Corn
Avocado
Onion
Sweet Peas
Asparagus
Cabbage
Cauliflower
Bananas
Mushrooms
People who consumed less sugar in utero and before age 2, the 1st 1,000 days of life, had a quarter lower risk of developing dementia later in life based on 40,963 participants exposed to sugar rationing during fetal and/or early-childhood life, and 23,774 unexposed from the U.K. Biobank, with hazards of all-cause dementia (HR, 0.79; 95% CI 0.66–0.94) and AD (HR, 0.77; 95% CI 0.59–1.00).
Cervical epidural spinal cord stimulation (SCS), as a neuroprosthetic approach for chronic post-stroke upper limb paralysis/hemiparesis, improved motor function immediately, regardless of impairment severity (average +32% strength and +5.6 points on Fugl-Meyer Assessment). Notably, 3 of 7 participants with residual corticospinal connectivity to finger muscles improved hand/finger movement with SCS.
A soft, fingertip-mounted wearable continuously and noninvasively monitors L-dopa. Parkinson’s low motor symptom scores aligned with peak L-dopa levels, and real time monitoring enables at-home dosage adjustments and paves the way for future autonomous closed-loop L-dopa therapeutic system development.
In 214 patients with chronic constipation, age 50, elobixibat 10 mg daily, which increases the delivery of bile acids to the colon and boosts secretion and motility, compared to prucalopride 2 mg daily, which stimulates colonic motility, improved complete spontaneous bowel movement within 24 hours (44.8% vs 23.58%), and median time to the first bowel movement was shorter (7 hours 20 minutes vs 13 hours 30 minutes; P < .01 for both). At 8 weeks, recipients of elobixibat had a higher mean weekly CSBM frequency than recipients of prucalopride (3.5 vs 2.8; P = .011), with a greater increase in frequency from baseline (2.5 vs 1.8; P = .004).
In this article, Dr. Eber, the President of the Society of Post-acute and Long-term Care Medicine (PALTC) describes 8 tips helpful in welcoming new clinicians and in helping them thrive in PALTC.
This NYT article and video addresses “The Fake Influencers Selling Wellness on Your Feed.” The takeaway points:
Protein needs plateau once requirements are met, which is: RDA 0.8 g/kg/day.
Resistance training >1.6 g/kg/day shows no extra muscle gain.
Detox diets/colon cleansing lack evidence; can cause electrolyte imbalance, infection and bowel injury.
Food-specific IgG tests do not equal allergy/intolerance and may prompt unnecessary restriction.
BMI alone poorly reflects health; waist circumference is better, but focus on BP, glycemia, lipids, fitness, and function, especially for older adults.
Students who followed social media influencers with product lines reported using 30% more products in the previous 24 hours, and students who watched hair or beauty tutorials used 40% more, raising risks of overexposure to phthalates, parabens and phenols, which have been linked to hormone disruption and cancer risk.
This podcast addresses “The Wellness-Industrial Complex” and social influencers; excellent!
Under the One Big Beautiful Bill Act, Obamacare was cut, making healthcare unaffordable to 5 million Americans. Medicaid cuts will go into effect after the midterm elections in November and in addition to the Obamacare cuts, will cause 16 million Americans to lose health insurance and hundreds of hospitals to close, mostly in rural areas. This comes at a time when hospitalizations are up for vaccine-preventable infections and foodborne illnesses due to the cuts in surveillance.
Older adults in rural communities compared with urbanites, experience barriers to support at the end of life: they are more likely to die in nursing homes, less likely to receive paid caregiving support at home, less access to hospice and higher reliance on unpaid family caregivers.
The FDA has approved this year's COVID vaccine and it should be available soon for adults >65 years old, and 30 - 60% of Americans who have a qualifying condition, FDA officials estimated last year. Aside from age, a long list of factors can increase the risk of severe illness. They include asthma, diabetes, obesity, physical inactivity and pregnancy, as well as cancer, immune deficiency, some mental illnesses and various heart and lung diseases. Additionally, the vaccine can be administered off label. Insurance covers it but prescription is required in 3 states: Utah, Oregon and Arizona.
The CDC reports 2,887 confirmed measles cases in 47 states vs 2,761 cases in 47 states last week.
The Hamilton County Health Department has detected West Nile virus in a pool of standing water in Green Township on routine testing. So far no human infection has been documented here, last year there was one.
As we are entering September, National Suicide Prevention Awareness Month, Dr. Doug Lane shared on the AGS forum this handout from the E-4 Center at Rush University School of Medicine (Center of Excellence for Behavioral Health Disparities in Aging), summarizing many good resources in support of suicide prevention and older adults.
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