Geriatric Update Feb 16, 2026

Patients with dysarthria, speech difficulty from stroke, ALS or Parkinson’s disease are helped with an AI-driven intelligent throat (IT) system that integrates throat muscle vibrations and carotid pulse signal sensors with large language model (LLM) processing to enable fluent, emotionally expressive communication. IT’s LLM agents intelligently corrected token errors and enriched sentence-level emotional and logical coherence, achieving low error rates (4.2% word error rate, 2.9% sentence error rate) and a 55% increase in user satisfaction.

Mobile smoking cessation with a supportive chatbot via a messaging app for 3 months, in addition to routine smoking cessation treatment by a live counselor improved biochemically validated tobacco abstinence at 6 months after randomization, defined by an exhaled carbon monoxide level of less than 5 ppm or a negative salivary cotinine test result. (45.9% [135 of 294] vs 35.5% [105 of 296]; relative risk [RR], 1.29; 95% CI, 1.06-1.58; P = .01), longer abstinence and lower relapse rate vs routine live counselor care. 

The prevalence of cognitive disability among younger adults aged 18–39 years nearly doubled, increasing from 5.1% (95% CI 4.8%–5.3%) to 9.7% (95% CI 9.2%–10.2%), more than the overall cognitive disability prevalence in the United States, 5.3% (95% CI 5.1%–5.4%) in 2013 to 7.4% (95% CI 7.2%–7.6%) in 2023. This has potential long-term implications for population health, workforce productivity, and the health care systems. The article’s discussion section describes potential reasons, including education, disparities, technology, etc.

Wearables, such as smartwatches, Improved detection of atrial fibrillation in 437 randomized patients (219 intervention, 218 control); age 75 years, CHA2DS2-VASc score was 3.0. New onset AF occurred in 21 (9.6%) patients of the intervention group and 5 (2.3%) patients of the control group (risk difference: 7.3%; HR: 4.40; 95% CI: 1.66-11.66), .

Night owls had overall worse cardiovascular health based on Life's Essential 8 (LE8): physically active; avoiding tobacco; getting enough sleep, a healthy diet, and controlling blood pressure, cholesterol, blood sugar and weight. Unhealthy behaviors, particularly: smoking, insufficient sleep and poor diet, are the main reasons for the elevated risk. In 322,777 UK Biobank participants aged 39-74 years, a definite evening chronotype was associated with 79% higher prevalence of an overall poor LE8 score, and over 13.8 years higher risk of stroke and myocardial infarction hazard ratio (HR) 1.16 (95% CI, 1.10–1.22) than definite morning type and HR, 1.11 [95% CI, 1.09–1.13]) compared to intermediate type.

4 global cardiology societies—the American College of Cardiology, the American Heart Association, the European Society of Cardiology (ESC), and the World Heart Federation—called for action to address the environmental risk factors for CVD: air, soil and water pollution, chemical pollution, extreme heat, and excessive noise have been steadily raising the risk of cardiovascular disease (CVD) for years.

At the same time greenhouse gas rules are removed as EPA’s Zeldin signs ‘single largest deregulatory action’ in history. Richard Nixon’s administration warned of dangers of climate change, the First George Bush signed the international climate treaty, and subsequent presidents have supported it. As I have written extensively about the evidence of pollution increasing dementia, stroke, autism, cancer and CVD, I don’t understand this move. 

In patients with glaucoma, elevating their heads up on two stacked pillows – with an elevation ranging from 20° to 35° – compared to when they were sleeping in a supine position, increased intraocular pressure (17.42 vs 16.62 mm Hg, P<0.001), 2/3 of patients had increased IOP. Ocular perfusion pressure was also worse with the high-pillow position (54.57 vs 58.71 mm Hg for the flat position, P<0.001).

The FDA approved carbachol–brimonidine eye drop for presbyopia. The mechanism is by constricting the pupil size to 2 mm, optimal for distance, low light and near vision. Side effects were similar to control and no retinal or vitreous detachment was reported.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) has been associated with increased risk of ischemic optic neuropathy (ION), but 20 randomized controlled trials showed no elevated risk of ION (OR 1.20, 95% CI 0.73-1.97, I2 = 0%) and vision loss/disturbance events (OR 1.08, 95% CI 0.60-1.94) in 83,288 participants over 3 years.

Metformin was associated with 37% reduced incidence of intermediate AMD over 5 years in patients with diabetes after adjusting for confounders (complete record OR 0.63, 95%CI 0.43 to 0.92, p=0.02). I hope this will be replicated in a randomized trial.

Transcranial photobiomodulation (PBM) decreased inflammation from repetitive head acceleration events (RHAE) in 13 college football players over 1 season and improved  neuroinflammation and axonal remodeling on restricted diffusion imaging (RDI) and quantitative anisotropy (QA), diffusion magnetic resonance imaging markers, respectively, compared to the 13 players in the randomly assigned sham PBM group. PBM (810 nm) was self-administered 3 days a week under supervision in the athletic training room with a transcranial plus intranasal device throughout the preseason practice period and regular season (16 weeks). I would like to see it tested in older adults who have fallen, striking their head.

Olezarsen is an antisense oligonucleotide targeting apolipoprotein C-III messenger RNA, for patients with severe hypertriglyceridemia.  Monthly olezarsen 50mg injection led to a 63% greater reduction in the triglyceride level than placebo in one trial, and 49.2% in another. With olezarsen 80-mg, the reduction was 72% and 55% respectively. Acute pancreatitis, which is a common cause of high triglyceride levels, was lower with olezarsen than with placebo (mean rate ratio, 0.15; 95% confidence interval, 0.05 to 0.40; P<0.001). The incidence of any adverse events were similar but liver-enzyme level elevations, hepatic fat fraction and thrombocytopenia (platelet count, <100,000 per microliter) were more common with the 80-mg dose of olezarsen.

The Program of all inclusive care of the elderly (PACE) enrolls Medicaid and Medicare dually eligible patients as alternative to institutionalization. Among 63,741 PACE enrollees in 2021, age 77 years, 66.3% female 78.7% were served by nonprofit PACE, and 21.3% by for-profit PACE (14.9% with private equity (PE) and 6.4% without PE backing).  For-profit enrollees were younger and more likely male, White, have a greater number of ED visits, and disenroll from PACE. Compared with nonprofit PACE enrollees, a lower share of for-profit PACE enrollees were enrolled in only Medicaid, long-stay nursing home visit, and died. Among for-profit enrollees, those in PE-backed programs had more skilled and long-term nursing home stays. The study did not mention staffing differences. 

The American Thoracic Society Clinical Practice Guideline for diagnosis and management of Community-acquired Pneumonia recommends that lung ultrasound is an alternative to chest x-ray, 3-5 days of antibiotics without steroids in stable patients, while patients with severe pneumonia should receive antibiotics for 5 days or longer and steroids.

Benadryl or diphenhydramine is on the Beers list and should not be taken by older adults because of the anticholinergic effect, i.e. it depletes acetylcholine in the brain and in a dose dependent fashion leads to dementia, falls, confusion, etc. This article describes and I agree that patients would benefit and the health care system would save money on the expenditures to treat adverse events if oral diphenhydramine were removed from the over the counter market. It is for example in multiple PM products, advertised for sleep. Although requiring a prescription would limit patient choice for those who prefer diphenhydramine over second-generation antihistamines, the authors and I believe this impact is outweighed by the substantial public health benefits. There is a cumulative time and dose effect of anticholinergic drugs and dementia.

The new blood pressure guidelines recommend <120/80, yet in 2021-2023, about 79.1% (95% CI, 77.2%-81.1%) of US adults with hypertension had uncontrolled blood pressure (BP) when guidelines were <130/80. Of these 3216 adults, an estimated 61.3% (95% CI, 58.8%-63.9%) were not taking antihypertensive medication. The number is different in older adults: >65-<75 yo twice as many are taking 24.8% than not taking 12.4% their BP meds. In those >75 yo thrice as many are taking their meds 21.6% vs. 7.1%.

Dengue vaccine in adults in adults can be given at a lower, 500 IU dose and be as effective as the full standard dose (>13 000 IU), important because of the shortage of the Institut Pasteur de Dakar (Dakar, Senegal) 17D-204 yellow fever vaccine. But in children 9-12 months the full dose is required, co-administered with the measles-rubella vaccine.

4 studies showed that treating SARS-CoV-2 with 14 days of metformin reduced long COVID by 41% hazard ratio (HR) 0.59 (95% confidence interval [CI] .39–.89) and in those who started metformin within 3 days of symptom onset by 63% HR 0.37 (95% CI .15–.95), and reduced the time to an undetectable viral load to 3.3 days for metformin and 5.6 days for placebo.

In patients with bronchiectasis, dipeptidyl peptidase-1 (DPP-1) inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo in 2523 patients from four randomized controlled trials, of whom 1689 (66.9 %) received DPP-1.

Last week I mentioned CostPlus Drugs, this JAMA podcast talks with the owner, Mark Cuban about the role of pharmacy benefit managers, insurance formularies, and opaque pricing practices that shape how most Americans access prescription drugs, and why he thinks doctors are the good guys in a broken system. 

Illinois Medicaid induced a 12.2% increase in nurse staffing in nursing homes and showed improvements in patient health, ADLs and 4.1% lower hospitalizations. Yet, the Centers for Medicare & Medicaid Services (CMS) repealed the 2024 nurse staffing rule for nursing homes.

The FDA sent a letter to Moderna that the agency would not review its mRNA flu vaccine. This came as a surprise as the FDA has been involved in and in agreement with the trial design.

This article is about health influencers who operate outside mainstream, such as Peter Attia, whose $ million connection with David protein bars was severed when his name was released in the recent Epstein files. The article ended that "We should be skeptical of any people who sell themselves as singularly capable of giving health advice on the internet and should always follow the money and connections where they lead."

The CDC reports, 904 confirmed measles cases in 24 states vs 727, cases in 20 states last week. For flu activity, the CDC has not updated the website since Dec.

Ohio’s respiratory dashboard showed 515 flu hospitalizations (616 last week), 441 COVID hospitalizations (489), and 288 RSV (306).

The OMDA call on Thu February 19 is on PACE Cincinnati, by Laura Trice, MD, FACP, AGSF; and Flu, RSV, COVID Update, David Hartley, PhD, MPH.

Wishing those who celebrate a blessed Ash Wednesday.