Geriatric Update Dec 8, 2025

Obesity, defined as BMI >30 and/or waist circumference >88cm or >35 inches was associated with a graded increase in all-cause, cardiovascular and cancer mortality compared to no obesity. With the traditional BMI-based classification, overweight was associated with cardiovascular and cancer mortality but not all-cause mortality. Obesity had a hazard ratio of 1.36 (95% CI, 1.31-1.42) compared to normal weight.

Weight-reducing treatments regardless of the kind that led to >5% weight loss, were associated with a beneficial effect on quality of life, functional health status and a reduced risk of depression, without any safety signal for psychiatric adverse events. 

Only 60.1% of glucagon-like peptide-1 receptor agonists (GLP-1) prescriptions were filled, with Black and Hispanic patients were less likely to fill their orders than white patients, and patients with both diabetes and obesity more likely to fill their orders than those with diabetes only or obesity only. The reason is mainly out of pocket costs.

After stopping tirzepatide, 18% regained <25% of the weight lost and saw minimal cardiometabolic changes, the 57% participants who regained ≥50% experienced substantial increases in waist circumference, systolic blood pressure, non-high-density lipoprotein cholesterol, Hb A1C, and insulin levels. By 1 year, most of the 308 participants, age 47, had regained at least 25% of their lost weight. 

In addition to glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonists, more G-protein–coupled receptor targets are being studied, including glucagon, amylin, oxyntomodulin, and peptide YY receptors that appear to affect the regulation of body-fat mass and energy homeostasis. Retatrutide is a triple agonist of the GIP, GLP-1, and glucagon receptors. Over 48 weeks, weight loss was −24.2% in the highest, 12-mg group. Side effects were mild to moderate, dose dependent and mitigated by dose titration. Tachycardia was an additional side effect of the glucagon agonist portion and peaked at 24 weeks. I am concerned that raising the metabolic rate with the glucagon agonist will accelerate aging and over the long-term increase cancer by increasing free radical burden. 

While observational studies have shown benefit, the results of the evoke randomized trial,  presented at the 18th Clinical Trials on Alzheimer’s Disease (CTAD) Conference, showed no benefit from semaglutide 14 mg po daily on Alzheimer’s disease over 156 weeks, 3 years, on cognitive testing. It statistically reduced inflammation markers of c-reactive protein by 24%, and AD-relevant cerebrospinal fluid biomarkers by about 10%, of pTau181, pTau217, npTau181, and npTau205, as well as in the neuroinflammation marker YKL-40 and two neurodegeneration markers (total tau and neurogranin). A 30% reduction is considered needed to be clinically effective at improving cognition.

GLP-1 meds lower major acute coronary events and all-cause mortality in patients with type 2 diabetes and peripheral artery disease but do not show benefit in limb-specific outcomes, weight, cardiovascular mortality, myocardial infarction, or stroke. I wonder if patients had lost weight, limb and other outcomes were better, which is saw in my clinical experience. 

In a double-blind randomized clinical trial of 202 participants with peripheral artery disease (PAD) and without diabetes randomized to metformin or placebo, change in 6-minute walk distance at 6-month follow-up was not significantly different between participants: −5.4 m; placebo: −5.3 m).

Cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for chronic insomnia and at 3 months was better than Tai Chi, reduction of 6.67 on Insomnia Severity Index score, a 28 point scale, while the CBT-I group had a reduction of 11.19. At month 15, the reduction for tai chi was 9.51 and CBT-I was 10.18, which was not statistically significantly different. .

A 12-week unsupervised multimodal online tai chi intervention improved knee pain and physical function in 178 people with knee osteoarthritis (OA), age 61.

The prevalence of hearing loss in people with type 2 diabetes was 4 fold higher than that in control individuals (odds ratio [OR], 4.19). The mechanism is through hyperglycemia that results in damage to micro- and macrovasculature that affect the cochlea, the ultrastructure of the inner ear capillaries, potentially leading to thickening of the basilar membrane and atrophy of the stria vascularis. 

Artificial intelligence (AI)-led lifestyle intervention based on the Diabetes Prevention Program (DPP) is noninferior to referral to a human-led DPP in achieving recommended thresholds for weight loss, hemoglobin A1c (HbA1c) reduction, and weekly physical activity among adults with prediabetes and overweight or obesity.

Children exposed to recommended levels of fluoride in drinking water exhibit modestly better cognition in secondary school, an advantage that is smaller and no longer statistically significant at age ~60. This contradicts possible dangers of fluoride in water voiced by some, leading some to advocate to stop recommending fluoride in drinking water.

Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine cancer, that grows and spreads rapidly with a high mortality rate. Following malignant transformation, SCLC cells seem to hijack synaptic signaling to enable SCLC cells to form synaptic glutamate structures with neurons in vitro and in vivo and promote tumor growth. In mouse models, very early but not late targeting of this system stopped tumor growth.

In patients with prosthetic heart valve thrombosis, a single bolus of tenecteplase showed more and faster thrombolytic success than alteplase infusion (risk ratio, 1.18; 95% CI, 1.03-1.39; P = .02 for noninferiority). Additionally, patients treated with tenecteplase had higher rates of complete success with the first administered dose and a shorter duration of hospital stay (median [IQR], 4.1 [3.2-5.1] days vs 6.5 [4.3-9.2] days; P < .001). The rates of major and minor adverse events were similar.

The Therapeutic Hub provides nurses and other staff hospital space to utilize the 4Ms of an Age-Friendly Health System framework to offer multisensory stimulation and comfort to older patients, with the aim of preventing cognitive and functional decline, agitation, and delirium.

The current influenza vaccine includes an H1N1 virus, an H3N2 virus, and a B/Victoria lineage virus. A new subclade K has emerged that is not a perfect match for the H3N2 subclade J included in this year's vaccine. However, it will still prevent severe disease, hospitalization, death and post-infection sequelae such as heart attacks, and last year being the deadliest flu season this century was due to low vaccination rates. 

Adult vaccinations, particularly against herpes zoster, influenza, pneumococcus and tetanus, diphtheria and pertussis (Tdap), are associated with a lower risk of dementia in a review of 21 studies, including >104 million participants.

Compared with standard vaccines, high-dose vaccines reduced laboratory-confirmed influenza in adults aged 65 years or older but increased the risk for fever. Recombinant vaccines reduced laboratory-confirmed influenza in all adults and those younger than 65 years compared with standard vaccines, (all high certainty of evidence). Based on review of 35 randomized controlled trials (RCTs) and nonrandomized studies of interventions (NRSIs) by the European Centre for Disease Prevention and Control (ECDC). 

Vaccine effectiveness against documented Respiratory syncytial virus (RSV) infections declined from 83% at 0 to 1 month to 59% at 0 to 18 months in the overall cohort and 75% to 40% among immunocompromised veterans.

Severe adverse events after hospitalization for COVID-19 were monitored for 1 year. Veterans, avg age 63, who needed intensive care had 14 fold higher major adverse cardiovascular events (MACE), 12 times the rate of stroke, 14 times the rate of heart failure and 3 times death, mostly within 3 months, than veterans admitted for COVID to a medical bed. This stresses the importance of COVID vaccination to prevent severe disease.

Colchicine for long COVID, showed no statistically significant difference in functional capacity, respiratory function, mental states, constitutional symptoms, or inflammatory markers at 52 weeks among 346 participants, age 46, in a randomized trial. 

Half of the worldwide population is at risk for dengue but no treatment is available. A phase 2a, double-blind, randomized trial, showed that prophylaxis with 600 mg mosnodenvir loading dose and 200 mg once daily, significantly reduced DENV-3 RNA load and prevented DENV-3 infection in 60% (6 of 10), vs 0% with placebo or low dose mosnodenvir, and 17% (1 of 6) with the medium loading dose of 200 mg followed by 50 mg daily. No major adverse effects were found in the  young healthy volunteers.

The federal vaccine advisory committee voted on Friday to end the recommendation that all U.S. babies get the hepatitis B vaccine on the day they’re born, recommending it only for babies whose mothers test positive, and in cases where the mom wasn’t tested. For other babies, it will be up to the parents and their doctors to decide if a birth dose is appropriate.  Since 1991, the birth hepatitis vaccine has significantly decreased liver cancers. Moms may test negative for several reasons, recent infection, immune compromise, lab error, and still pass the infection on to their babies with devastating consequences.

A 3rd whooping cough infant death occurred in Kentucky and 2 in Louisiana, amid low vaccination rates.

The CDC reports 1,804, confirmed measles cases in 43 states, up from 1,775 in 43 states 1 week ago.

The CDC COCA call on Thursday, December 11, 2025 at 2:00– 3:00 PM ET is on 2025 - 2026 Clinical Recommendations for Seasonal Influenza Prevention and Control. Recordings of prior calls are archived under that link as well. 

The OMDA call on Thu Dec 11th at 8 am is: MAID (Medical Aid in Dying), Jason Chen, PhD, HEC-C

Happiness? That’s nothing more than good health and a poor memory. Albert Schweitzer