Geriatric Update Jan 5, 2026

One of the most impactful articles of 2025 was on diet and longevity. Over 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01–2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Healthy diets were linked not only to overall healthy aging but also to its individual domains, including cognitive, physical, and mental health, the author noted. 

According to the new obesity definition of waist circumference, waist-to-hip ratio and waist-to-height ratio, it is estimated that 75.2% of US adults have obesity, which measures excess body fat and risk of adverse outcomes. Even 38.5% (95% CI, 36.4%-40.6%) with BMI less than 25.

In patients with isolated diastolic hypertension (IDH), defined as systolic BP < 130 mmHg and diastolic BP ≥ 80 mmHg, a 5 mmHg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with or without IDH over 4.2 years. The Data were pooled from 51 randomized controlled trials of 358,325 participants, 15,845 (4.4%) had IDH, and did not differ by cardiovascular disease (CVD) history, age, prior medication use, and BP measurement methods. Diastolic hypertension is less common in older adults due to decreased venous return because of inelasticity of veins.

People with cardiovascular disease using low-dose colchicine as secondary prevention for >6 months showed reduced rates of myocardial infarction and stroke, without an increase in serious adverse events, but did not decrease mortality, based on the Cochrane review of 12 studies involving 22,983 randomized participants.

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome is beneficial for the first 30 days, ischemic outcome occurred in 3.3% of patients receiving monotherapy vs 1.8% with DAPT. After 30 days ischemic outcome rates were similar between study groups (3.8% each), while bleeding remained less frequent with monotherapy (1.3% vs 3.5%).

In patients with basal artery occlusion, endovascular thrombectomy led to better functional outcomes and reduced mortality compared with medical management (adjusted risk ratio, 2.05; 95% CI, 1.35-3.11). This difference disappeared in patients over age 70. In a randomized controlled trial of 307 patients, avg age 68, over 3 years.

Stroke is the 4th most common cause of death, and  is significantly higher in Black individuals, but 80% of cerebrovascular events are attributable to modifiable risk factors. The brain care score (BCS) addresses 12 modifiable risk factors across three domains: physical (blood pressure, blood sugar, cholesterol, and BMI); lifestyle (nutrition, alcohol consumption, smoking, physical activity, and sleep); and social-emotional (stress, social relationships, and meaning in life). Based on 10,861 adults, age 63, revealed a 5-point improvement in BCS was associated with a 53% lower risk of stroke in Black individuals compared to a 25% lower risk in White individuals over 16 years.

Women with chronic severe coronary artery disease (CAD), coronary artery bypass grafting (CABG) was associated with significantly lower long-term rates of major adverse cardiovascular and cerebrovascular events, all-cause mortality, and cardiovascular readmissions compared with percutaneous coronary intervention (PCI), 22% vs 37%, and 30% lower risk of death over 5 years. 

Financial strain ages the heart as much as classic risk factors for heart disease, (HR, 1.6) and other social determinants of health, such as housing instability and food insecurity were the strongest determinants.

Methotrexate (MTX) is recommended in guidelines as glucocorticoid (GC)-sparing agent for patients with polymyalgia rheumatica (PMR) prone to relapses or prolonged GC use. Low doses of MTX (7.5-10 mg/wk) have shown conflicting results, so higher doses (25 mg/wk) were used within 8 weeks of GC start and showed GC-free remission at 52 weeks in 80% of patients vs 46% in the placebo group, and the median time to remission was shorter in the MTX group than in the placebo group (28 weeks vs 39 weeks; P = .013). The MTX group experienced fewer relapses through week 52 (31 vs 45), but the cumulative GC dose was similar in the 64 Dutch patients. Despite randomization, patients assigned to placebo had a higher median age than the MTX group (68 years vs 63 years) and a higher BMI (28 vs 25).

The transcriptional repressor B cell lymphoma 6 (BCL6) has been studied in immune cells, but also has key roles in metabolic tissue to maintain muscle mass. The mechanism is through sustaining growth hormone (GH). This could open avenues for targeted therapeutic strategies to combat muscle-wasting conditions, such as sarcopenia. I would like to see older adults included in further studies as GH declines with age, and usually there is a reason. When longevity clinics injected GH in older adults, it did not prolong life and increased diabetes rates.

Thank you Joe Powell for sending this article on Statin use in type 2 diabetes for primary prevention was associated with reductions in all-cause mortality and major CVD across the full spectrum of predicted cardiovascular risk, over 10 years in a cohort study using target trial emulation. In patients with muscle aches from statins, I have had success with vitamin D supplementation and retrial after 3 months, to give enough time to bring vitamin D stores up in muscles.

In this Peter Attia podcast with James Clear on building and changing habits, he describes his “Four Laws of Behavioral Change:”

• Why nearly half of your daily behavior runs on autopilot and how this quietly shapes your choices throughout the day

• Why modern environments reward short-term comfort even when long-term goals matter more

• Why bad habits repeat despite knowing the consequences and why good habits struggle to stick

• Why focusing on goals alone rarely leads to lasting change compared to focusing on daily behaviors 

In nursing home residents, protection against COVID-19 began to decline as early as 90 days following their last vaccination. The risk of mortality more than doubled (OR 2.4; 95% CI 1.8-3.2) when comparing individuals vaccinated over a year ago to those vaccinated within the last 90 days.

In patients with long COVID, 3 months coached resistance training improved Shuttle Walk Test distance at compared with baseline to 83 m in the intervention group and 47 m in the control group. Health-related quality of life, anxiety, depression, and grip strength also improved significantly more in the intervention group, in this randomized clinical trial of 233 patients.

The CDC reports 2,041, confirmed measles cases in 44 states, up from 1,988 in 44 states 1 week ago. For flu activity, the CDC reports 14.8% positive for influenza and for respiratory illnesses this week, 13 hospitalizations per 100,000 population.

The Ohio reported hospitalizations for: flu 1,465 (last week: 722); COVID 603 (453); RSV 233 (164).  the first child died of flu in Ohio, unvaccinated.