Geriatric Update Feb 23, 2026

Starting a Glucagon-like peptide-1 receptor agonists (GLP-1) led to a positive shift from ultraprocessed to unprocessed goods, slightly more protein and slightly less carbohydrates, sugar, saturated fats, calories and nutrient dense foods.

Muscle loss is a concern with weight loss from GLP-1 meds. While some studies quoted it as 40-60%, others showed <15%. Studies that included MRI imaging showed decreased muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function. And in patients with peripheral artery disease, GLP-1 meds improved walking speed and distance.

Intensive blood pressure (BP) control of 110-130 mmHg vs 130-150 mmHg for 12 months, at which point all patients moved to intensive BP control, led to fewer composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death resulting from cardiovascular causes over 6 years in this randomized trial of 8511 patients, age 66. I usually start with BP meds at the same time I encourage lifestyle changes, to then stop meds if we can, and I explain that I don’t want my patient to have a stroke until we get the BP controlled.

About 5% of tanning bed users were diagnosed with melanoma compared with 2% of nonusers.  After adjusting for age, sex, sunburn history, and family history, tanning bed use remained associated with a nearly 3-fold increased risk, and the more tanning sessions, the higher the risk, based on 2925 tanning bed users matched with nonusers.

FDA approved a vagus nerve stimulator for rheumatoid arthritis (RA). In patients with RA uncontrolled with Disease modifying drugs (DMARD). The implantable device that stimulates the vagus nerve for 1 minute per day showed a 35.2% (43/122) response vs. control 24.2% (29/120) (p-value=0.0209, 95% CI 0.6 to 23.1) on the American College of Rheumatology 20% response (ACR20) at Week 12 and improved further to 51.5% in treatment and 53.1% in control, after crossover, by Week 24.

Artificial intelligence (AI) scribe adoption increased RVUs by 1.81 per week, with no evidence of increased denials, which translates to $3044 annually per physician, using 2025 Medicare reimbursement. The study was done in one academic Health Center with almost 2 million patient encounters and 698 Physicians adopting AI vs 867 nonadopters.

AI was as effective as a human coach–led Diabetes Prevention Program of lifestyle intervention, 31.7% vs 31.9% of the 368 participants, age 58, achieved the primary composite outcome (5% weight loss, 4% weight loss plus 150 minutes of physical activity per week, or an absolute hemoglobin A1c reduction of ≥0.2 percentage points with hemoglobin A1c maintained at <6.5% throughout the study duration) at 12 months.

AI will likely increase health care spending by $300-$500 a month for AI, increasing coding levels without increasing value to the patient, picking up more diagnoses, and referring for preventive services. Studies on return on investment are needed to see if patients follow up on prevention and reduce overall cost and outcome.

AI detected breast cancer earlier, so that fewer interval cancers that were invasive (75 vs 89), T2+ (38 vs 48), or non-luminal A (43 vs 59) in the intervention than the control group, in 105,934 women, age 54. Sensitivity was higher in the intervention group (80.5% [95% CI 76.4-84.2]) than the control group (73.8% [68.9-78.3]; p=0.031), an effect consistent across age and breast density, and for invasive cancer but not for in-situ cancer. Specificity was 98.5% (95% CI 98.4-98.6) for both groups (p=0.88).

Eric Topol wrote an excellent summary of the current evidence for AI and mammography, found benefits for patients and cost savings to the health care systems of many countries.

The AI-stethoscope (TRICORDER) was used to detect point-of-care heart failure (ejection fraction, EF <40%), atrial fibrillation, and valvular heart disease (VHD), across 972 clinical users in the British NHSof nearly 13,000 stethoscope exams, avg patient age 44. In per-protocol analyses, adjusting for patient exposure to the AI-stethoscope, detection of heart failure (IRR 2·33 [95% CI 1·28–4·26]), atrial fibrillation (IRR 3·45 [2·24–5·32]), and VHD (IRR 1·92 [1·09–3·40]) was significantly increased in the intervention group, however, intention-to-treat analysis found detection of all 3 diagnoses did not differ from routine care (IRR 0.94 [95% CI 0.86-1.02]); with no difference in community-based or hospital-based diagnoses (p>0.05).

Virtual reality (VR) interventions significantly improved several test results: Trail Making Test (TMT)-A, TMT-B, attention, and memory in older adults with mild cognitive impairment (MCI), but did not improve instrumental activities of daily living (IADL) (SMD, 1.01; 95% CI, −0.27 to 2.29). As previous studies of mind games, it trains for the test but has no effect on patient-oriented outcomes. 

Statin drugs do not cause most of the side effects attributed to them on package inserts, based on a meta-analysis of 23 clinical trials with 154,664 participants. Only liver function tests were statistically significant: statin vs placebo RR 1.34 [95% CI 1.23–1.45], absolute annual excess 0.13%, but not any patients oriented liver outcomes.

Melatonin and ramelteon did not significantly reduce delirium incidence, whereas dual orexin receptor antagonist sleep meds showed a possible benefit (RR 0.55; 95% CI 0.35-0.87), but the meta-regression did not demonstrate a reliable between-class difference (p = 0.14). This systematic review and meta-analysis points to the need for adequately powered randomized trials.

Pre-emergency department functional decline is independently associated with identifiable clinical risk factors: malnutrition based on the mini nutritional assessment [adjusted odds ratio (aOR), 2.83], frailty (aOR, 2.17), peptic ulcer disease (aOR, 1.70), and age (aOR, 1.02, CI 1.002–1.039) and linked to increased hospital admission rates (69.0% vs 55.4%) and longer median lengths of stay (9 vs 5 days; both P < .001).

The enhanced transtheoretical model intervention (ETMI) for low back pain is a self-management approach focused on reassurance, addressing unhelpful beliefs, and encouraging recreational physical activity for managing pain independently, helping patients avoid future reliance on medical services, medication, or imaging when pain recurs. In 4193 patients, age, 56.3 years, ETMI was associated with greater improvement in function, fear-avoidance, with no differences observed for pain scores, and required fewer therapy sessions. 

In 171 ovarian cancer patients with fatigue, self-acupressure achieved a clinically normal fatigue level at the end of 6 weeks of treatment in 58% for true self-acupressure with a device, 51% for sham self-acupressure, and 18% for usual care. Participants applied daily self-acupressure on 5 specific acupoints (yin tang, anmian, heart 7, spleen 6, and liver 3) for 3 minutes per point for 27 minutes daily. 

Thank you, Irene, for sharing this Guide for older adults and their caregivers preparing for surgery.

The Mediterranean diet had a lower risk of all types of strokes, 18% less likely to have any type of stroke, with a 16% lower risk of ischemic stroke and a 25% lower risk of hemorrhagic stroke. The prospective cohort study followed 133,477 California women school teachers over 20 years.

Higher caffeinated coffee intake was associated with lower dementia risk (141 vs 330 cases per 100 000 person-years comparing the fourth [highest] quartile of consumption with the first [lowest] quartile; hazard ratio, 0.82 [95% CI, 0.76 to 0.89]) and lower prevalence of subjective cognitive decline (7.8% vs 9.5%, respectively; prevalence ratio, 0.85 [95% CI, 0.78 to 0.93]) in 131,821 participants over 43 years of follow up with every 2-4 years questionnaire-based assessments. The optimal amount of coffee was 2-4 cups and tea 1-2 cups a day. While it is statistically significant, the difference is not large for an observational study, I would want to see a ratio of 0.5, however, we should enjoy our coffee or tea in moderation.

The artificial sweetener, sucralose (Splenda), modifies microbiome composition, restricts T-cell metabolism and function, and limits immunotherapy response in preclinical models of cancer and patients with advanced cancer treated with anti–PD-1–based immune checkpoint inhibitors.

Patients hospitalized for respiratory syncytial virus (RSV) had higher rates of

• myocardial infarction (MI), Incidence rate ratios (IRRs) were 8.7 (95% CI, 6.7-11.2) during days 1 to 7, decreasing to 5.2 (95% CI, 3.7-7.2) during days 8 to 14 and 2.6 (95% CI, 1.6-4.3) during days 15 to 21 in 11,887 patients, age 69.4 years.

• stroke, the IRRs were 7.4 (95% CI, 5.5-10.1), 5.9 (95% CI, 4.2-8.3), and 3.7 (95% CI, 2.3-5.9) during the first 3 weeks with a similar pattern for

• Congestive heart failure (CHF) exacerbation (12.5 [95% CI, 10.5-14.8], 4.1 [95% CI, 3.1-5.5], and 2.4 [95% CI, 1.6-3.6], respectively)

• Chronic obstructive pulmonary disease (COPD) exacerbation 23.1 (95% CI, 20.2-26.5) through day 7 to 1.3 (95% CI, 0.8-2.4) during days 15 to 21

• Arrhythmia from 16.5 (95% CI, 14.5-18.7) to 1.6 (95% CI, 1.1-2.5), respectively.

RSV vaccines significantly decrease hospitalization for RSV.

COVID vaccine effectiveness against virus-associated hospitalization reached 40% (95% CI 27-51) among immunocompetent adults and 45% (95% CI 31-56) among seniors. Protection against invasive mechanical ventilation or death reached 79% among immunocompetent adults overall and 73% for those 65 and up (95% CI 41-90).

The CDC reports, 975 confirmed measles cases in 26 states vs 904, cases in 24 states last week.

Ohio’s respiratory dashboard showed 462 flu hospitalizations (616 last week), 342 COVID hospitalizations (441), and 286 RSV (288).