Geriatric Update Dec 1, 2025

A year ago I wrote about arsenic in US drinking water contributing to cardiovascular and ischemic heart disease. This Bangladeshi study showed reduction in drinking water arsenic decreased urinary arsenic and each quartile reduction was associated with 22% lower chronic disease mortality 20% lower cancer mortality. In those whose levels decreased below the median, cancer, heart disease and chronic disease mortality each decreased by more than half over 20 years of follow up. Cincinnati’s level is 0.117 ppb, well below the 10 ppb level recommended by the US and WHO.

Nitrogen dioxide (NO2) is a risk factor for ovarian cancer and may increase the risk, accelerating the onset and progression of the disease. NO2  in air pollution was associated with ovarian cancer, OR of 2.618 (95% CI: 1.066–6.432, P = .0358), controlling for reverse causality. As a strong oxidant, NO2 may influence cancer development through pathways such as inducing oxidative stress, inflammatory responses, and DNA damage. 

USPSTF criteria for lung cancer screening states: Adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Of 997 patients with lung cancer, only 35.1% met USPSTF criteria; screening noneligible patients led to better survival. Expanding criteria to ages 40 to 85 years and 10 or more pack-years increased the detection rate to 62.1%, whereas universal age-based screening (40-85 years) including non-smokers, detected 93.9% of cancers, preventing at least 26,124 deaths annually at $101,000 per life saved vs $890,000 for breast and $920 000 for colorectal screening.

Lung cancer screening is most appropriate for older adults at high risk of lung cancer with a life expectancy greater than 3.4 years, based on preventing 1 death when screening 1000 patients.

mRNA vaccines targeting SARS-CoV-2 also sensitize tumors to immune checkpoint inhibitors (ICIs). In preclinical models, SARS-CoV-2 mRNA vaccines led to a substantial increase in type I interferon, enabling innate immune cells to prime CD8+ T cells that target tumor-associated antigens. Concomitant ICI treatment is required for maximal efficacy in immunologically cold tumors, which respond by increasing PD-L1 expression, which is a protein that can be found on cancer cells and healthy cells, which helps the immune system regulate itself.

Childbirth and breastfeeding protect against triple-negative breast cancer (TNBC) may be due to long-lived “resident” T cells being left behind in the breast and body, reducing the risk for cancer and boosting defenses. 

In women with early breast cancer treated with mastectomy and contemporary adjuvant systemic therapy, chest-wall irradiation did not result in higher overall survival than no chest-wall irradiation among patients with intermediate-risk. 

The USPSTF states that the current evidence is insufficient to assess the benefits and harms of screening mammography in women >75 years. A study of women aged ≥80 years with a history of breast cancer, who were screened with mammogram showed a 55% lower risk of their cancer returning and a 74% lower risk of dying over 55 months, compared with women who were not screened. These results persisted even after adjusting for age, tumor subtype, and surgical intervention, but are limited that medical records only included women who were ultimately diagnosed with breast cancer, and doesn’t capture potential downsides of screening, such as false positives, extra tests, or the emotional and financial stress on patients and their families. As we are living longer and healthier, larger studies are needed to confirm the benefits of mammograms for older women and to guide clearer screening recommendations.

While many cancers are more indolent (less aggressive) in old age, survival outcomes with acute myeloid leukemia (AML) declined steadily with age, even among patients classified as having favorable genetic risk. For example, patients aged 18 to 24 years with favorable-risk AML had a 5-year overall survival (OS) rate of 73%, while those aged ≥75 years had a OS rate of just 21%. This trend was consistent across all risk categories.

In patients with obstructive sleep apnea, the seizure medicine Sultiame at 200 mg and 300 mg, not approved in the US, decreased breathing disturbances by 35% at 15 weeks. However, given that adverse events (AEs) increased dose-dependently, investigators said the 200 mg dose offered the most favorable balance of benefits and side-effects, which include ataxia, paraesthesia of face and limbs, hyperpnoea, dyspnoea, and decreased appetite. 

Learning a second language could provide you 3 more years of healthy aging and later onset of dementia, more languages even longer life, or alternatively, speaking only your mother’s tongue was linked to a loss of 5 years of healthspan. 

Mild or greater hearing loss was associated with smaller brain volume, greater white matter abnormalities, and declines in executive function over time. Any hearing loss was associated with a 71% increased risk of developing dementia, in 2178 Framingham Heart Study participants, age 60 in 1995, especially in persons with at least 1 apolipoprotein E ε4 allele. Hearing aid use mitigated these risks.

In a new guideline, the Canadian Task Force on Preventive Health Care (CTFPHC) strongly recommended against screening all adults with a standardized tool for depression, instead clinicians should ask patients about their well-being and be vigilant for symptoms. 

Short-term cardiovascular and metabolic side effects of antidepressants vary widely by medication but are relatively mild in those commonly prescribed in the United States.

From 2002 to 2015, gabapentinoid use (γ-aminobutyric acid analogue drugs that include gabapentin and pregabalin) more than tripled, and between 2010 and 2024 almost tripled, from 5.7 million to over 15.5 million. Gabapentin is the 5th most dispensed medication nationwide in 2024, and despite safety concerns putting it on the Beers list, patients aged 65 years or older were prescribed gabapentin at more than twice the rate of younger adults in 2024.

The risk of schizophrenia at 10 years was significantly lower in adolescent psychiatric patients treated with doxycycline (low cumulative dose: 1.4%, risk ratio=0.70, 95% CI=0.48, 0.85). The mechanism is thought to be due doxycycline crossing the blood brain barrier and causes pruning of weaker brain connections. While this observational study does not meet the 2.0 RR, it should stimulate a randomized trial to control for confounders. 

In patients with traumatic brain injury, presentation characteristics at 90 minutes, associated with persistent 30-day symptoms included female sex (odds ratio [OR], 2.09); mechanism of injury, including fall (OR, 2.87), vehicular crash (OR, 3.79), and abuse (OR, 3.67); a prior diagnosis of headaches or migraines (OR, 2.76), depression (OR, 2.25), or anxiety (OR, 2.52;); and the presence of focal neurological deficits (OR, 1.52), headache (OR, 2.08), or multiple computed tomography scans (OR, 2.22) at intake.

In a survey of 1178 menopausal US women aged 40-65 years, those who used masturbation, 21% cited noticeable benefits, including enhanced mood (43%), better sleep (13%), improved vaginal lubrication (11%), and reduced pain or hot flashes (10%). It ranked among the most effective options, alongside partnered sex and lubricants.

High triglycerides can cause pancreatitis, both were cut in half with olezarsen vs placebo over 6 months. The incidence of any adverse events appeared to be similar across trial groups. Elevations in liver-enzyme levels and thrombocytopenia (platelet count, <100,000 per microliter) and increase in the hepatic fat fraction were more common with the 80-mg SC monthly dose of olezarsen, monthly cost $60,552. Olezarsen is an antisense oligonucleotide targeting apolipoprotein C-III messenger RNA.

Dietary Approaches to Stop Hypertension (DASH)-style groceries were delivered to residents of food deserts led to reduced blood pressure by 5.7 mm Hg systolic and 2.3 mm Hg diastolic, but this effect did not continue after the program ended. The control group was randomized to receive 3 $500 stipends every 4 weeks intended for self-directed grocery shopping. Additionally, the DASH group also had reductions in urine sodium level and low-density lipoprotein (LDL) cholesterol by 8.0 mg/dL.

Replacing red and processed meat (80 g/wk) with legumes was associated with a lower rate of gallbladder disease (HR: 0.97, 95% CI 0.95; 0.98). No difference was seen with the switch from chicken or fish to legumes. While the difference is small, the pain on an individual basis might add to our armamentarium to prompt some of our patients to change their diet.

Thank you, Joe for sending this article: In patients with new diagnosis of glioblastoma, the use of proton pump inhibitors that are potent activators of aldehyde dehydrogenase 1 A1, was associated with inferior survival outcomes, independently of MGMT promoter methylation status and steroid use. No such association was observed with other antacid medications.

Among US hospitals, a 10% increase in favorable care environments, nurse staffing adequacy, clinical care environment, and physician and nurse teamwork, was associated with lower odds of physicians intending to leave (odds ratio [OR], 0.78; 95% CI, 0.68-0.90), not recommending their hospital (OR, 0.75; 95% CI, 0.61-0.92), experiencing high burnout (OR, 0.90; 95% CI, 0.83-0.98), and having job dissatisfaction (OR, 0.81; 95% CI, 0.69-0.95). The numbers were similar for European physicians.

The CDC reports 1,775, confirmed measles cases in 43 states, up from 1,730 in 43 states 1 week ago.

Listen to your patient, he is telling you the diagnosis. Sir William Osler