Geriatric Update Feb 2, 2026
In October I wrote about a acupuncture for chronic low back pain (CLBP), in a randomized clinical trial of 800 older adults, age 73, (both a standard course and additional maintenance sessions) improved pain-related disability with CLBP at 6 months and 12 months, with no statistically discernible benefit of additional maintenance sessions.
Now, another study of standard acupuncture (SA) for 12-weeks improved chronic low back pain (CLBP) related disability by 39.1% or SA plus maintenance (enhanced acupuncture [EA]) by 43.8% relative to usual medical care (UMC) at 3, 6, and 12 months, and results in sustained benefit for over 9 months 39.1%, in 800 individuals who were randomized to 3 groups, age, 73.6 years. It seems to be worth a try.
The Osher Center for Integrative Medicine compiled these Tips to fuel your well-being, previous postings:
Mindfulness and meditation as medicine
Food as Medicine
Spend 20 min a day in Nature
Art as Medicine
Movement as Medicine
Music as Medicine
Social Connection
Sleep as Medicine
CULTIVAMENTE is based on information posters, brochures and web info with 8 lifestyle recommendations to prevent dementia: diet, sleep, hearing, smoking, alcohol, physical activity, BP <140mm/Hg, positive attitude. The posters were displayed in 3 intervention senior centers but not in 4 control centers in Chile. Of 211 participants with cognitive impairment but no dementia (mean age 74.8 ± 7.0 years; 80.5% women), after 6 months, the intervention group (n = 101) demonstrated greater improvement in cognitive healthy behaviors compared to control (SD difference = 0.15; 95% CI = 0.02-0.28; p = 0.021; 95.4% greater increase than control). Cognitive scores improved significantly in the intervention group (memory = 0.24; 95% CI = 0.07-0.41; memory-executive functioning = 0.21; 95% CI = 0.08-0.33), and mild-to-moderate cognitive impairment cases declined in the intervention group (from 70 to 67) compared to the control group (from 71 to 75; p < 0.001).
In people with type 2 diabetes and peripheral artery disease (PAD), GLP-1s improved functional walking distance (HR = 1.10, 95% CI 1.05-1.15) and halved the risk of major adverse limb events (MALE) or lower extremity amputation (LEA) (RR = 0.53, 95% CI 0.39-0.73).
Depression was associated with higher major adverse cardiac events (MACE) risk (hazard ratio, 1.24 [95% CI, 1.14–1.34]; P<0.001), with stronger associations for concurrent anxiety plus depression (hazard ratio, 1.35 [1.23–1.49]; P<0.001) and remained significant after adjustment for demographics, lifestyle, cardiovascular, and socioeconomic factors, in 3078 (3.6%) participants, who developed MACE, of 85,551 Mass General Brigham Biobank (2010–2020) subjects, over 3.4 years. The mechanism is through increased amygdala-to-cortex activity on brain imaging, a sign of stress-related neural activity. They also had reduced heart rate variability and higher blood levels of C-reactive protein (CRP), indicators of increased autonomic activity and systemic inflammation. An earlier study showed that depression or anxiety accelerates the development of cardiovascular risk factors, namely hypertension, hyperlipidemia, and type 2 diabetes, especially in young women. Exercise and Mediterranean diet have been shown to improve depression and anxiety, as well as MACE.
Home hazards put older adults with visual impairment at increased risk of falling. No grab bars showed the lowest increase (DVA: OR, 1.14; 95% CI, 1.02-1.27; CS: OR, 0.91; 95% CI, 0.84-1.00), tripping hazards (DVA: OR, 1.29; 95% CI, 1.11-1.49), and broken flooring the highest risk(DVA: OR, 1.47; 95% CI, 1.26-1.70).
Vitamin D 1600 IU/day, and 3200 IU/day showed a similar fall risk as placebo over 5 years of follow-up in 2495 healthy Finns, age 68 who were not vitamin D deficient.
In over a million people, for every 10% increase in ultraprocessed food consumption, there was a 10% higher risk of age-adjusted all-cause mortality.
The new dietary guidelines are summarized in this article and include several positive recommendations:
Whole grains
Avoid processed foods
Avoid sweetened beverages
Avoid salty or sweetened foods
Saturated fat should not exceed 10% of calories
Consume a variety of protein from animal and plant sources
Of concern is the new focus on full fat dairy, red meat, and higher protein 1.2 to 1.6 g/kg of body weight per day because they have all shown to increase cardiovascular mortality, the main cause of death in the developed world. Two-thirds of the reviewers had financial or other ties to the beef, dairy or pork industries, and one who owns the meat-focused Atkins diet brand.
Later breakfast timing is associated with increased mortality, with 10-year survival rates of 86.7% in the late eating group compared to 89.5% in the early eating group. Longer meal preparation times, difficulty preparing meals, and worse sleep quality was associated with a later breakfast. This observational study could not assess if poor quality late night snacks contribute to later morning hunger and poor health outcomes. Many people don't count snacks in their food questionnaire reports.
Preservatives increased the potential risk of cancer in 105,260 people. In another study of 108,723 patients, 12 of the 17 preservatives examined and considered generally recognized as safe, or GRAS in food by the FDA were linked with nearly a 50% higher risk of developing type 2 diabetes in people who consumed the highest levels. Preservatives are widely used to extend the shelf life of industrially processed foods, but previous research has suggested that some of these additives may have adverse metabolic effects. They included potassium sorbate, potassium metabisulfite, sodium nitrite, acetic, citric and phosphoric acids, sodium acetates, calcium propionate, sodium ascorbate, alpha-tocopherol, sodium erythorbate, and rosemary extracts.
Dementia risk was 50% higher in prefrail individuals (hazard ratio [HR], 1.50; 95% CI, 1.44-1.57) and nearly threefold higher in frail individuals (HR, 2.82; 95% CI, 2.61-3.04) compared with nonfrail peers, after adjustment, over 13.6 years and 8900 dementia cases. Dementia risk rose with increasing frailty scores of 1 through 5, with HRs of 1.37 (95% CI, 1.31-1.44), 1.91 (1.80-2.04), 2.78 (2.56-3.02), 3.06 (2.67-3.50), and 4.36 (3.23-5.89). Each frailty component was independently associated with an increased risk of dementia, with highest 1.82 (1.71-1.93) for slow walking speed.
Even though our population is aging, medical school education in geriatrics is declining. Between 2005 and 2021, the percentage of schools requiring geriatrics clerkships fell from 23% to 10%, whereas those requiring geriatrics embedded into another clerkship declined from 48% to 38% and those offering elective geriatrics clerkships dropped from 89% to 71%, while the percentage of >65 yo has increased from 13.1% to 16.9%. (p 53-54) The movement is to prepare all physicians for geriatric care. I tell my students that even pediatricians need to know how to identify dementia in their patients’ caregivers, if the child does not gain weight.
The inflammation–oxidation-promoting diet doubled the risk of skin cancer (OR 2.19, 95% CI 1.29 to 3.72, p = 0.004) compared to the inflammation–oxidation-reducing diet, after adjusting for all covariates, in the National Health and Nutrition Examination Survey (NHANES) database. The mechanism is through accelerated aging.
Worsening renal function (WRF) was strongly associated with cardiometabolic index (CMI): [Triglycerides / HDL] × [Waist Circumference (WC) / Height], after multiple adjustments for eGFR, age, fasting plasma glucose, urinary albumin, and urinary creatinine. Participants in the highest CMI tertile had a 16% higher risk of WRF compared with those in the lowest tertile (adjusted HR: 1.16; 95% CI: 1.09-1.24) in 10,094 Chinese participants from the Action to Control Cardiovascular Risk in Diabetes trial over 5 years.
Physicians have been cautious about correcting hypernatremia too fast. This study matched 430 intensive care unit (ICU) patients and faster correction significantly reduced 30-day mortality (adjusted HR 0.49, 95 % CI 0.28–0.84, p = 0.01), improved 30-day hospital-free survival (adjusted HR 1.75, 95 % CI 1.40–2.18, p < 0.001), shorter ICU LOS (median 4 vs. 5 days, p = 0.002) and hospital LOS (8 vs. 11 days, p = 0.01). Hypernatremia is high salt levels in the blood, usually caused by insufficient fluid intake, probing why and coming up with strategies to assure sufficient intake is important to prevent recurrence.
Coronary computed tomography angiography (CCTA) upward reclassified 14.2% in those with cardiac events and incorrectly classified 1.6% into a higher-risk category of participants aged 50 to 64 years not experiencing an event. Over 7.8 years 304 coronary events occurred of 30,154 individuals who underwent CCTA and other cardiac assessments, improvement in net correct reclassification in the low-risk group with CCTA.
Dr. Rudolph Tanzi, neurologist advocates the acronym SHIELD: What’s good for your heart is good for your brain,
Sleep. Aim for 7-8 hours of high-quality sleep each night
Handling stress. Minimize chronic stress, which has been linked to accelerated cognitive decline
Interaction with friends
Exercise
Learning new things
Diet
He also describes the killer Ps:
Plastics
Pollution
Periodontal bacteria
Processed food
Cardiorespiratory fitness levels (V̇O2peak) improved twice as much in the high-intensity interval training (HIIT) group's as those of the moderate-intensity continuous training (MICT) group with 3 days per week of HIIT or MICT for 12 weeks, in a randomized controlled trial of 82 adults, age 65. HIIT repeated 1-minute bursts at 100% VO2 alternating with 1 minutes of 30% for 20 min on adaptive recumbent steppers, the control group exercised at 60%.
Hearing aid use in 2777 Australian participants, age 75, of the ASPirin in Reducing Events in the Elderly study, showed 7-year risk of dementia was 5.0% under hearing aid (HA) prescription and 7.5% under no HA prescription (risk ratio [RR] 0.67; 95% CI 0.37–0.97), and that of cognitive impairment was 36.1% under HA prescription and 42.4% under no HA prescription (RR 0.85; 95% CI 0.70–1.00). The risks of dementia and cognitive impairment were inversely associated with the frequency of HA use.
In a cross-sectional study of 132 older male veteran twins discordant for post-traumatic stress disorder (PTSD) undergoing in-laboratory polysomnography, current PTSD diagnosis and symptoms were associated independently with obstructive sleep apnea (OSA), even after controlling for demographics, behavioral factors, cardiovascular risk factors, and familial factors.
In patients with chronic diarrhea, gelatin tannate, that acts through a mechanical action on the gut wall, in combination with tyndallized acid lactic bacteria improved abdominal pain 79.1% vs 43.0% with baseline and placebo and significantly improved levels of most beneficial microbiota species assessed, including Faecalibacterium prausnitzii and Akkermansia muciniphila.
Our local TV channel reported that 4 vitamins and minerals may be affected by coffee intake:
Iron absorption was decreased by 54% compared to taking it with water, possibly due to tannins, and separating it by 2 hours will prevent interference.
Vitamin D absorption is decreased by reducing the expression of vitamin D receptors. Associated calcium absorption may also be reduced.
B vitamins are water soluble and coffee’s diuretic effect can lead to increased excretion before they are fully absorbed, and polyphenols in coffee may also impact B vitamin absorption.
Among 332,438 participants 65 years or older, high-dose inactivated influenza vaccine (HD-IIV) provided consistent benefit for cardiorespiratory, cardiovascular, and influenza hospitalizations compared with standard dose (SD-IIV), regardless of diabetes status. participants with diabetes duration longer than 5 years showed greater vaccine efficacy (rVE, 20.4%; 95% CI, 5.3%-33.1%) compared to those without diabetes, but not in those with shorter duration (rVE, -0.4%).
