Geriatric Update Dec 22, 2025
Although tirzepatide’s dual action of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors lead to greater weight loss than GLP-1 meds alone, among patients with type 2 diabetes and atherosclerotic cardiovascular disease, tirzepatide was noninferior to the GLP-1 only med dulaglutide with respect to a composite of death from cardiovascular causes, myocardial infarction, or stroke.
The editors of JAMA selected 9 research studies from their journal that showed the greatest impact in 2025:
Patients initiating semaglutide or tirzepatide had a more than 40% lower risk of hospitalization for heart failure or all-cause mortality compared with sitagliptin (a DPP-4 med with no effect on heart failure end points). In a head-to-head comparison, tirzepatide showed no meaningful benefit over semaglutide.
Shingles vaccination could reduce the risk of dementia in an observational study over 7 years involving >100 000 people in Australia.
Large language model (LLM) applications in medicine have exploded in recent years, but are fragmented and insufficient, with only 5% using real patient data.
Genome sequencing can identify hundreds of disorders, particularly genetic conditions lacking the blood biomarkers required by standard screening methods, which currently is possible to test newborns for 60, and has been shown to improve outcomes.
Finland’s FINGER, and now the US has POINTER—both clinical trials encouraged to increase their physical and cognitive activity, social engagement, and cardiovascular health monitoring and to eat a more healthful diet. The POINTER trial included a more racially and ethnically diverse population, who is usually at higher risk of developing dementia and had no control group, but follow up was only 2 years, too short to show a difference in cognition.
The Transfusion Strategies in Acute Brain Injured Patients (TRAIN) randomized clinical trial showed better outcomes when transfusion is initiated at 9 g/dL hemoglobin vs 7 g/dL.
In patients with ductal carcinoma in situ (DCIS) the COMET trial showed noninferiority of active monitoring with guideline-concordant treatment typically surgery. After 2 years, the cumulative rate of ipsilateral invasive cancer was 4.2% in the active monitoring group, compared with 5.9% in the guideline-concordant care group, and mastectomy was 2% and 10%, respectively.
People with immunocompromising conditions such as HIV may not mount an adequate immune response to the conventional vaccine for hepatitis B virus (HBV). The BEe-HIVe trial showed that 2 doses of the HBV vaccine with a cytosine phosphoguanine adjuvant (HepB-CpG vaccine) generated protective antibody levels against the virus in 93% and 3 doses in 99% of patients vs. 81% of people receiving 3 doses of the conventional HBV vaccine with an aluminum hydroxide adjuvant (HepB-alum).
In treatment resistant hypertension, aldosterone synthase inhibitor lorundrostat reduced systolic blood pressure by a clinically meaningful 16.9 mm Hg compared with 7.9 mm Hg in the placebo group at 6 weeks.
The Frailty Trigger (FT) consists of 2 questions:
Is there difficulty with walking/washing/dressing/toileting/cooking (impaired ADLs)?
Is there difficulty with memory or thinking (impaired cognition).
The FT had excellent diagnostic accuracy for frailty, Area Under the Curve (AUC) of 0.822, similar to the Variable Indicator of Placement (VIP) (AUC 0.820), although significantly lower than the 7 question PRISMA-7 (AUC 0.896) and 9 question Clinical Frailty Scale (CFS) (AUC 0.946), however, time to administer FT was on avg only 25.5 seconds. Scoring positive on the Frailty Trigger was associated with increased length of stay (LOS), median 6.4 versus 2.3 days (p < 0.001). After adjustment for age, sex, and co-morbidity, a positive score was associated with reduced survival at 1 year (Hazard Ratio 2.2; 95% CI 1.15-4.33, p = 0.017). Half (51%) of the 313 adults aged ≥ 70 years were frail based on the comprehensive geriatric assessment, median age 78 years.
The New York Times article by longevity expert, Dr. Eric Topol, describes 5 Tips for Aging Well:
Strength training
Schedule sleep at the same time
Bolster mental health by spending time outdoors
Use tests and trackers sparingly
Be wary of influencers that hawk supplements or diets
To manage age-related sarcopenia, whole-body high frequency vibration, and combined exercise (that included resistance, balance, flexibility, and aerobic training) were equally or more effective than resistance training (RT) in improving muscle mass, strength, and function. These findings challenge the conventional wisdom that RT is the best option for sarcopenia prevention.
Omega 3 fatty acid 2 g/d of daily in form of krill oil supplementation did not improve knee pain over 24 weeks compared with placebo.
In 142 patients with erosive hand osteoarthritis age 66.5 years, transcutaneous auricular vagus nerve stimulation using an electrode applied with gel to the left ear for 20 min daily, (using frequency of 25 Hz and a pulse duration of 100 μs and gradually increased intensity from 0 mA up to 8 mA, or until the patient experienced discomfort) versus sham stimulation showed no difference in hand pain on a visual analogue scale, compared to sham.
Primary care physicians performing large joint injections improve cost, access, and patient satisfaction with no compromise to outcomes, safety, and complication rates.
Thank you Joe, for this article: Calcium channel blocker (CCB) users having, on average, 39% higher odds of glaucoma, based on 33,175 CCB users (7.8%) of 427,480 adults in the UK biobank. The mechanism is through thinner macular ganglion cell-inner plexiform layer on optical coherence tomography (OCT) and macular retinal nerve fiber layer, but not increased intraocular pressure (IOP).
Vitamin D levels <25 nmol/L had an 11% higher risk of developing cataracts than those with levels of 50-74.9 nmol/L (aHR, 1.11; 95% CI, 1.07-1.15); the risk was even greater among people younger than 50 years (aHR, 1.27; 95% CI, 1.07-1.49), whereas those aged 60 years or older had a 9% increased risk (aHR, 1.09; 95% CI, 1.04-1.14), based on 427,923 participants (mean age, 56.2 years; 53.6% women) without cataracts at baseline, followed up for an average of 10.8 years.
Millions of Americans treat their pain, anxiety and sleep problems with cannabis, which is now legal in 40 states for medical use, and 27% of adults in the US and Canada report having ever used cannabis for medical purposes. High-potency cannabis compared with low-potency cannabis use is associated with increased risk of psychotic symptoms (12.4% vs 7.1%) and generalized anxiety disorder (19.1% vs 11.6%). Daily use increases coronary heart disease (2.0% vs 0.9%), myocardial infarction (1.7% vs 1.3%), and stroke (2.6% vs 1.0%). And 29% of individuals who used cannabis for medical purposes met criteria for cannabis use disorder.
Influenza immunization at midlife vs lack thereof was not associated with the risk of Parkinson’s disease overall (crude incidence rates per 1000 person-years, 0.16 vs 0.10; matched HR, 0.96; 95% CI, 0.76-1.22). Results varied over time, with the lowest point estimate approximately 8 years after vaccination (HR, 0.75; 95% CI, 0.52-1.08) in 1.2 million patients, age 44.
West Nile neuroinvasive disease (WNND) has been increasing and leads to high mortality (aHR, 2.49 for 30-day mortality), especially in older adults (aHR, 1.32 per decade), alcohol-related disorders (aHR, 1.54), multiple sclerosis (aHR, 2.34), chronic kidney disease (aHR, 2.08), and cerebrovascular disease (aHR, 2.00).
This German podcast addressed Long COVID and mentioned Ehlers Danlos patients most affected, using nicotine patches to help with vasoconstriction. I have also used 1-2 liters of water before activity as older adults drop 1-2 liters of blood in their lower extremities, and patients with Parkinson’s disease often have autonomic dysfunction. I also use nitroglycerine patches at night to increase vascular capacity, elevate the head of the bed to trap blood in the legs and prevent nighttime diuresis, and support stockings during the day.
An Assisted Living Accreditation program and Distinction in Assisted Living Outcomes designation will roll out nationally, the Accreditation Commission for Health Care announced, following a three-year, state-funded pilot in North Carolina. The pilot showed a trend for improved resident outcomes and care coordinated transitions, person-centered care, medication management and workforce, particularly medication management and workforce stability.
The CDC reports 1,934, confirmed measles cases in 44 states, up from 1,888 in 43 states 1 week ago.
Merry Christmas!
