Geriatric Update Jan 19, 2026

Guideline recommended exercise of 150 min moderate-to-vigorous physical activity (MVPA) per week reduced coronary heart disease (CHD) by 22% in female individuals and 17% in men. To reduce CHD risk by 30% (hazard ratio (HR) = 0.70) women needed to exercise 250 min per week of MVPA, whereas men required 530 min per week for comparable benefits over 7.8 years.

A 12-week unsupervised online Tai Chi program with a mobile app to encourage adherence and online osteoarthritis (OA) educational information improved participants’ knee pain on walking (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and physical function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007) at 12 weeks more than online OA educational information alone. The number needed to treat (NNT) for achieving the knee pain improvement was 4 (95% CI, 3 to 9), and for physical function, the NNT was 6 (95% CI, 4 to 20).

Older adults  ≥ 65 years, seen in Emergency Departments (EDs) for minor injuries were randomized to multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate- and high-risk patients, 3×/week for 12 weeks, at home or in community groups or usual ED care. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12% [95% CI: 8%–17%] vs. 25% [95% CI: 18%–34%], RR: 0.48 [0.26, 0.90] but disappeared at 6 months. In high-risk participants, between-group differences in functional status were not significant.

A previous study has shown that dance as an intervention in older adults, >75, maintained cognition over 5 years. A review showed a 76% reduction of dementia with twice weekly dancing compared to less or none, avg age 73.

Some studies rely on patient report, but this systematic review and meta-analysis documented fitness by maximal or VO2peak exercise test, and BMI reported and directly measured, and demonstrated that unfit individuals had 2–3-fold greater mortality risks. Normal weight-unfit (CVD: 2.04 (1.32–3.14), all-cause: 1.92 (1.43–2.57)), overweight-unfit (CVD: 2.58 (1.48–4.52), all-cause: 1.82 (1.47–2.24)) and obese-unfit (CVD: 3.35 (1.17–9.61), all-cause: 2.04 (1.54–2.71)) 

Vigorous intermittent lifestyle physical activity of 3 length-standardized bouts per day (lasting 1 or 2 min each), as measured by wearable devices, was associated with a 38%–40% reduction in all-cause and cancer mortality risk, a 48%–49% reduction in CVD mortality risk. A total of  4.4 min per day was associated with a 26%–30% reduction in all-cause and cancer mortality risk and a 32%–34% reduction in CVD mortality risk, particularly in women who may not have time or opportunity to exercise regularly.

Two bouts of “exercise snacking” per day, once in the morning and once in the evening consisting of five exercises, each for one minute with as many repetitions as possible in that minute, and eating 150 g of yogurt with breakfast, improved 60 second sit-to-stand (STS) score by 31%. Between each exercise, the randomized 10 participants, age 70, rested for one minute. The exercises were STS from a chair, seated knee extensions of alternating legs, standing knee bends of alternating legs, marching on the spot, and standing calf raises, with advice to hold onto a chair for stability if needed. Leg pressing power increased by 6% and thigh muscle cross-sectional area increased by 2%.

Physical activity (PA) levels are typically reduced in patients with chronic obstructive pulmonary disease (COPD). While both light and intensive coaching interventions yielded comparable, modest improvements at the 6-month mark, these gains diminished to only marginal increases by 12 months.

For patients with degenerative meniscal tear and knee pain, physical therapy (PT) is routinely recommended. Adding PT text messages to encourage adherence to home exercises was not superior in reducing pain to a home-exercise program alone.

Total physical activity, light, moderate and vigorous intensity physical activity and step counts, based on accelerometers for 7 days,  were inversely associated with incident cancer. Compared with individuals in the lowest quintile of total physical activity (<21.6 milligravity units), those in the highest (34.3+) had a 26% lower cancer risk (HR=0.74 (95% CI 0.65 to 0.84)), based on 85,394 UK biobank participants, median age 63, followed for cancer incidence for 5.8 years.

This podcast by Eric Topol with Dan Buettner is about the Blue Zones, where people get about 12,000 steps a day moving naturally.

The life's simple 7 (LS7) include not smoking, eating healthy, being physically active, managing weight, controlling blood pressure, managing cholesterol, and controlling blood sugar, developed for cardiovascular health, is associated with lower all-cause and cancer mortality in cancer survivors, potentially through shared biological mechanisms. Cancer survivors in the ideal cardiovascular health category had a 38% lower risk of all-cause mortality compared to those with poor cardiovascular health [hazard ratio (HR) 62; 95% confidence interval (CI) .41-.94]. Similarly, one third mortality reduction in cancer-free participants (HR .68; 95% CI .59-.78). Each 1-unit increase in LS7 metric (0-14 points) was linked to 10% lower cancer mortality (HR .90; 95% CI .82-.98).

The American Cancer Society (ACS) guideline for cancer survivors of nonmetastatic prostate cancer recommends avoiding obesity, engaging in regular physical activity, and following a healthy diet. Higher adherence to ACS guidelines led to lower all cause mortality (HR, 0.77; 95% CI, 0.69-0.85; per 1-point increase: HR, 0.94; 95% CI, 0.91-0.96; P < .001) and cardiovascular disease mortality (HR, 0.75; 95% CI, 0.63-0.91; per 1-point increase: HR, 0.93; 95% CI, 0.89-0.97; P = .001), while results for prostate cancer specific mortality were not statistically significant. Possibly because prostate cancer is a slow growing cancer in older adults, and other causes, especially CVD are more prevalent in this cohort of 4232 non-metastatic prostate cancer survivors with a median age at diagnosis of 69 years, followed for a median of 14.1 years. 

After 6 months of androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitors (ARPIs), 63 men with prostate cancer showed worsening lipid profiles and 21% had worsening of their CV risk based on general population tools, but not worse blood pressure. These findings highlight the unmet need to develop prostate cancer–specific CV risk assessment tools and to treat hyperlipidemia aggressively.

The cancer mortality rate continued to decline through 2023, largely because of smoking reductions, earlier detection, human papilloma virus vaccine, and improved treatment. These interventions are also evident in rising 5-year relative survival, which reached a milestone 70% for diagnoses during 2015–2021 overall, 69% for regional-stage disease, and 35% for distant-stage (metastatic) disease. At the same time, incidence (new cases) continues to rise for many common cancers, including breast, prostate, liver (female), melanoma (female), oral cavity, pancreas, and uterine corpus, even as mortality declines.

The Dipeptidyl Peptidase-4 (DPP-4) inhibitors Sitagliptin and Linagliptin reduced KRAS-mutated pancreatic ductal adenocarcinoma by inhibiting proliferation, migration, & colony formation, and inducing apoptosis (programmed cell death), confirmed by flow cytometry.

Glucagon-like peptide-1 receptor agonists (GLP-1) have shown benefit in observational studies, but in a review of 48  randomized placebo-controlled trials involving 94,245 participants showed little or no effect on risk for cancer outcomes: thyroid cancer odds ratio (OR) 1.37 (95% CI, 0.82 to 2.31), pancreatic cancer OR 0.84 (CI, 0.53 to 1.35), breast cancer OR, 0.95 (CI, 0.60 to 1.49), or kidney cancer OR, 1.12 (CI, 0.78 to 1.60), colorectal, gastric, esophageal, liver, gallbladder, , ovarian, or endometrial cancer; multiple myeloma; or meningioma.

Vegetarians showed lower risk for all cancers combined (HR 0.88; CI 0.83,0.93), as well as for medium-frequency cancers (HR 0.82; CI 0.76, 0.89)  as a group. Specific cancers with evidence of lower risk are breast, colorectal, prostate, stomach, and lymphoproliferative subtypes. Risk at some other sites, such as pancreas (HR 0.76) may also differ in vegetarians, but did not reach statistical significance due to low numbers. The study was based on the Adventist Health Study-2 North American cohort of 79,468 participants without cancer at start, over almost 8 years.

Lay health worker-led, telephone-based symptom assessments in 43 oncology clinics in California and Arizona, for 12 months, had 53% lower odds of emergency department use (61 [30.5%] vs 103 [47.7%] adjusted odds ratio [OR], 0.47; 95% CI, 0.32-0.71), 68% lower odds of hospitalization (37 [18.5%] vs 86 [39.8%], OR, 0.32; 95% CI, 0.20-0.51), 75% lower odds of acute care facility death (OR, 0.25; 95% CI, 0.08-0.77), and lower mean total costs by $12 000 per participant than control group participants.  The lay health workers reviewed the Edmonton Symptom Assessment System, with advanced practice practitioners who conducted interventions for symptoms rated 4 or greater or that increased by 2 points or more. 

Thank you Dr. Shomo for sharing info during our grand rounds on colon cancer screening: for rides for colonoscopies for people who need them. It's called Coalition for Health Justice: 513-404-3882.

Although potentially inappropriate prescriptions without clinical indications declined between 2013 and 2021, among the 16.2% of beneficiaries receiving potentially inappropriate CNS-active prescriptions in 2021, still 11.4% (70.4%) lacked clinical indications.

For scabies, ivermectin was less effective than 5% permethrin (76.6% v 91.5%; percentage point difference -14.9, 95% CI -23.6 to -6.2).

Among US skilled nursing facilities (SNF), the number of licensed SNF beds declined by 5% following the pandemic, and operating capacity by 15% between 2019 and 2024. This was worse in rural areas and associated with longer hospitalizations.

The CDC reports 171, confirmed measles cases in 9 states in 2026. For flu activity, the CDC has not updated the website since Dec 30.

Ohio has reported a measles outbreak with 3 unvaccinated children of the same household. Ohio’s respiratory dashboard showed 1383 flu hospitalizations (1938 last week), 771 COVID hospitalizations (845), and 289 RSV (314), all down after the holiday exposure surge.

For influenza, oseltamivir (OTV) and baloxavir (BLX) improve outcomes of mortality and hospitalization (0.37% OTV vs 0.15% BLX, risk ratio: 2.48, 95% confidence interval: 1.13–5.43). Thank you Dr. Fox for these studies that showed lower familial transmission with BLX treatment 9.57% vs OTV 19.35%, odds ratio 1.73 (1.68–1.77).  The one time dose of BLX compared to 5 twice daily dose of OTV reduces viral load 1 day after initiation and does not have to be adjusted in renal failure, but also showed higher development of resistance than OTV.

The OMDA call on Thu Jan 22nd at 8 am is: Legislative Update, by Monica Hueckel and Todd Baker, OSMA

Our new website: www.PG-65.com is up and running (please note the dash between PG and 65), which stands for Practical Geriatrician (or Parental Guidance-65...)  

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