Geriatric Update July 13, 2026

‍Light exposure plays a crucial role in regulating circadian rhythms, which influence cognitive function. Daytime light exposure above 1000 lux was associated with reduced dementia risk (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.71–0.99, p = 0.039) and outperformed 6 established dementia predictors: obesity, alcohol consumption, traumatic brain injury, vitamin D supplementation, air pollution, and hearing loss. The mechanism may be to keep the brain stimulated, similar to hearing aids attenuating the decline of function.

A systematic review and meta-analysis found that two brands of commercially available nasal dilators (Breathe Right Strips and NoZovent) didn’t improve snoring, oxygen saturation at night, or measures of obstructive sleep apnea like the apnea-hypopnea index (AHI), with 0.36 events per hour (ranging from -2.05 to 2.77).

Women showed elevated plasma p-tau217 levels at higher aggregated amyloid-β (Aβ) than men. For a given level of p-tau217, women also showed greater cross-sectional and longitudinal tau accumulation relative to men across multiple brain regions, as well as faster cognitive decline than men when p-tau levels were high. 

People with an elevated risk were less likely to develop dementia if they followed a healthy diet, particularly a less inflammatory diet. Of 1,865 Swedish adults >60 (avg age 70) followed for up to 15 years (avg 8.4 years), 240 developed dementia. Those with a high dementia biomarker p-tau217 who followed a low-inflammation diet, the reversed Empirical Dietary Inflammatory Index (rEDII), had a 29% lower risk of dementia than those who had different eating patterns, 0.71 (95% CI, 0.58-0.88). The Alternate Mediterranean Diet (AMED) lowered dementia risk 0.79 (95% CI, 0.66-0.95) and Alternative Healthy Eating Index (AHEI) lowered dementia risk 0.73 (95% CI, 0.60-0.89) in lower risk patients but not in high risk ones. Diet also tracked high glial fibrillary acidic protein (GFAP), which is a measure of neuroinflammation, and high neurofilament light chain (NfL), a marker of nerve cell injury.

Both cognitive training group (CTG) and physical training group (PTG) received interventions for 30 min/session, 3 sessions/wk for 8 weeks and showed potential cognitive benefits over the control group (CG), who received health education. Each group had 20 participants, with only PTG exceeding the minimal clinically important difference on the ADAS-Cog. 

Of 1.8 million older adults, age 77 years, 13.2% filled a sedative prescription (benzodiazepines, antipsychotics, and other sedative medication) after hospital discharge. In the 31.0% naive before hospital admission, outcomes increased: falls: 1.20, 95% confidence interval [CI] 1.13 to 1.26; ED visits: 1.20, 95% CI 1.19 to 1.22; hospital readmission: 1.20, 95% CI 1.17 to 1.22; and death: 1.78, 95% CI 1.73 to 1.83.

In patients with gout, a treat-to-target strategy to reach a serum urate concentration of less than 0.36 mmol/L (6.0 mg/dL) improved long-term disease control compared with symptom-driven care (39.4% [57 of 145 participants] vs 24.0% [39 of 163]; absolute difference 15.4 percentage points [95% CI 6.4-24.4]; p=0.024) in this RCT, without evidence of increased adverse events.

Beta-blocker use in heart failure with preserved ejection fraction (HFpEF) was associated with a lower risk of all-cause mortality (HR 0.81, 95% CI 0.73-0.90, p < 0.001), cardiovascular death (HR 0.76, 95% CI 0.64-0.90, p < 0.01), and HF hospitalization (HR 0.88, 95% CI 0.78-1.00, p = 0.05). This meta-analysis of 13 observational studies with 442,543 patients, mean age 76, requires confirmation in adequately powered randomized trials. 

In 7,631 (6.8%) veterans age 74.1 with a diagnosis of major depressive disorder, bipolar disorder, or schizophrenia but no dementia, exposure to sodium-glucose cotransporter 2 (SGLT2) inhibitors for >3 months reduced odds of all-cause dementia by about 40% in the intention to treat analysis (odds ratio [OR], 0.61; 95% CI, 0.52-0.73) and (OR, 0.54; 95% CI, 0.40-0.73) in the per protocol analysis. Hospitalization and visits varied by analysis and are therefore not reliable in this cohort study, however the large number of participants and the reduction of dementia to almost half warrants further evaluation with a randomized controlled trial.

Proton pump inhibitor (PPI) use was associated with an increased dementia risk in a dose-dependent manner (HR 1.66; 95% CI, 1.64–1.69 for the high-exposure category). The strongest associations were observed in the younger cohort: individuals aged < 65 years with high exposure exhibited a significantly higher risk (HR 1.97; 95% CI, 1.89–2.06) compared to older groups. This is possibly because PPIs lead to vitamin B12 deficiency within 9 months; for more information watch my vitamin B-12 presentation.

High-dose supplementation of 2 g/day omega 3, docosahexaenoic acid (DHA) in 739 APOE ε4 carriers without dementia and with low baseline omega-3 intake, age 66.4 years, showed no differences in cognition or brain structure over 24 months vs placebo.

nicular artery embolization using gelatin microspheres reduced knee pain on the numeric rating scale score (range, 0–10) from 7 (IQR, 6–8) to 3 (IQR, 2–5) at 12 months (95% CI: 3.5–4.0) by cutting off abnormal blood flow to the joint. The 194 randomized participants, age 69 years, showed improved symptoms, pain and quality of life from 19 (IQR, 13–31) to 40 (IQR, 26–59; P < .001).

Six brief 30-minute sessions of cognitive behavioral therapy (CBT) for chronic pain in 184 primary care veterans with moderate to severe chronic musculoskeletal pain, age 59 years, improved pain interference, physical quality of life and sleep quality at 6 weeks with continued improvement at 12-week treatment completion and 3-month follow-up among the behavioral treatment group (but not the usual pain care group).

Prucalopride, a selective serotonin 4 (5-HT4) receptor agonist approved for chronic constipation improved emotionality scores faster and more significantly than the antidepressant fluoxetine, reversing corticosteroid-induced behavioral changes within 7 days. Gut microbiota analysis revealed corticosteroid-induced depletion of Ruminococcus was restored. Prucalopride improved performance on multiple objective cognitive measures in individuals with remitted depression. I would like to see it tested in older adults with dementia and/or delirium.

Non-pharmacological multi-component interventions reduce delirium occurrence and are first line. Dexmedetomidine showed benefit in non-cardiac surgical populations (RR = 0.49; 95% CI 0.43-0.57). In the meta-analysis of 87 trials (19,289 randomized patients) it was administered by IV in ICU but is available as sublingual strip.

Creatine supplementation has been used for muscle building, but 0.2 g/kg was associated with up to 12% reduced deterioration in cognitive performance during sleep deprivation in 29 sleep-deprived but otherwise healthy adults, age 27. For a 150-lb adult, this dosage would be about 14 g of creatine per day. Before recommending it, I would like to see a randomized trial including older adults, monitoring inflammation and comparing it with vigorous exercise, which mobilizes muscle creatine.

In 61 adults, age 55 with obesity and without diabetes, a 10-hour daily eating window and standard dietary counseling focusing on a heart-healthy Mediterranean diet showed more weight loss from baseline than the control group (-4.59 kg vs -1.68 kg) who received dietary counseling alone. RNA sequencing and gene analysis showed downregulated expression of genes involved in proinflammatory pathways, including TNF-alpha signaling, interferon-gamma response, interleukin-6-JAK-signal transducer and activator of transcription-3 signaling, interferon-alpha response, and general inflammatory response.

There is a lack of robust evaluation of repositioning regimens for pressure injury prevention, and studies are small with low or very low evidence, resulting in uncertainty about the review findings.

Thank you, Joe, for this study on human papillomavirus (HPV) vaccination in England with coverage of 88–90% at age 12–13 years, which resulted in no cervical cancer deaths, compared with 23.1 expected deaths based on historical rates in women aged 20–24 years between 2020 and 2024. Up until the end of 2024, HPV vaccination in all of England was associated with a reduction of around 199.6 cervical cancer deaths.

Comprehensive smoke-free laws were associated with a mean reduction of 12 cardiovascular disease (CVD) deaths per 100,000 population annually, with larger reductions observed among adults >65 years, 84/100,000, and among male and White individuals.

The OMDA call on Thu July 16 - Medication Update, Alan Fox, RPh, BCGP

On July 9th the CDC reported 145 cases of Cyclosporiasis in 17 states, caused by several species of the microscopic parasite Cyclospora, which causes explosive diarrhea, often requiring IV fluids and hospitalization. The same day the AMA reported 1,251 total cases of cyclosporiasis in Michigan, a 26% jump from the previous day, mainly in the southeastern part of the state, and >360 cases in Ohio. The next day, on July 10, the latest update at the time of my update send out, the CDC posted an update that they are aware of >1500 cases that require further analysis. Today’s Cincinnati newspaper reported 7 cases in the region.

The CDC reports 2,218 confirmed measles cases in 42 states vs 2,158 cases in 41 states last week.

Drugs are not always necessary. Belief in recovery always is. (Norman Cousins)