Geriatric Update July 14, 2025
The CDC reports 1288, confirmed measles cases in 39 states, up from 1227 in 37 states last week.
Shingrix vaccine is a suspension for intramuscular injection consisting of a lyophilized recombinant varicella zoster virus glycoprotein E antigen that is reconstituted with AS01B suspension at the time of use as an immunological adjuvant. This AS01B adjuvant is also in the new RSV vaccine, and is possibly the reason why these 2 vaccines reduce dementia.
Bedtime dosing of blood pressure medications led to better blood pressure control and circadian rhythm than morning dosing among 720 patients, age 55. Nighttime diastolic blood pressure was only −1.4 mm Hg between-group difference, (95% CI, −2.8 to −0.1 mm Hg; P = .04), more patients had better nocturnal systolic blood pressure control (79.0% [244 of 309] vs 69.8% [208 of 298]; P = .01) and improved circadian rhythm. The incidence of nocturnal hypotension did not differ. We need to discuss the best time to take the medication with our patients, if morning is preferred, I feel the small BP difference is not worth the change.
The SPRINT trial used a systolic blood pressure (BP) of <120 mmHg. When simulating preferences for participants who view the benefits of intensive BP lowering (reduction in death, stroke, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (e.g., acute kidney injury and syncope), 100% had a positive net benefit. When simulating intermediate importance, 85% had a positive net benefit. Importantly, participants with polypharmacy, advanced age and frailty had greater net benefits from intensive BP lowering despite experiencing more harm in both simulations. This is a shift from previous studies that used gait speed of 0.8 m/s to determine frailty in older adults age >65 years, and 0.5 m/s in patients age >80 years, as the cut-off for tighter BP control benefit vs. harm.
Patients with atrial fibrillation (AF) who had catheter ablation were more likely to be free of AF at 12 months (73.0%) than patients using lifestyle modification directed weight loss and physical exercise in combination with antiarrhythmic drugs (LFM) (34.6%). Weight loss (-6.4 ± 7.9 kg vs -0.35 ± 4.8 kg; P < 0.001) and HbA1c reduction were better in the LFM group.
Older individuals age 75, undergoing major noncardiac surgery (n= >5.5 million), who experienced postoperative delirium had 2.8-fold higher odds of death, 3.5-fold higher odds of death or major complications, and 4.0-fold higher odds of nonhome discharge. The odds of postoperative delirium were 1.5-fold higher for patients undergoing surgery in hospitals with a higher rate of postoperative delirium compared with hospitals with lower rates of postoperative delirium.
Last month I wrote about subclinical hyperthyroidism significantly increasing hip fractures. An NHANES and Chinese database review found, using age-, sex-, and race-specific reference intervals reclassified 48.5% of persons with subclinical hypothyroidism as normal, especially women and White participants, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal, especially women, Black participants, and Hispanic participants, with similar findings across US and Chinese populations.
Thank you to Joe for sending this article on glymphatic clearance of brain waste, which occurs mostly during non-REM, theta wave sleep. Sleeping on the (right > left) side is optimal, but also alcohol intake, exercise, omega-3 consumption, intermittent fasting and chronic stress all modulate glymphatic clearance.
Higher intake of sugar-sweetened beverages or artificially sweetened beverages in later life was not associated with the risk for all-cause dementia, pooled data from six large prospective cohort studies of 10,974 participants, age: 73.2 [6.8] years over 116 ,067 person-years of follow-up showed. However, more research in younger cohorts is warranted.
Brain aging was determined by the thickness of the cerebral cortex and the volume of grey matter from a single MRI, augmented by artificial intelligence (AI), was validated in multiple datasets and linked with risk of dementia, cognition, chronic diseases and mortality. Accelerated brain aging was seen in countries with more pollution and greater income inequality.
In the elderly cohort, gabapentin prescription was associated with increased incidence of both dementia and mild cognitive impairment (MCI) (RR 1.28 and 1.53, respectively). Similarly, dementia and MCI were more commonly diagnosed in nonelderly gabapentin users than nonusers (RR 2.10 and 2.50, respectively), there was no significant difference in younger patients, 18-34 years old. I would have expected a stronger association in older adults, but most physicians probably avoid prescribing it in older adults because of the Beers Criteria recommendation against its use.
Anticholinergic medication use, mostly in over the counter sleeping meds and bladder and muscle relaxants, over 10 years, have shown to reduce gait speed at around 4 years, and grip strength at about 6 years, both markers of longevity. Anticholinergics also contribute to dementia and falls in a dose dependent exposure.
As I am preparing my Pain presentation for the Ohio Medical Directors Conference, I came across this study on extracorporeal shockwave therapy for knee osteoarthritis that improved pain (standard mean difference [SMD]-2.02, 95% CI -2.38 to -1.67, P < 0.00001) and function (SMD -2.71, 95% CI -3.50 to -1.92, P < 0.00001; I2 = 97%).
Patients with rheumatoid arthritis, who apply pneumatic cuffs to a limb while working out, experience reduced pain and improved strength and physical performance because blood flow-restricted resistance training forces muscles to work harder, even if a person is using lighter weights or less effort. Patients had high acceptability (100% “liked” the program), session adherence (81%), and elicited significant (p < 0.05) improvements in strength, functional lower extremity related physical performance, and pain. However, no improvements in quality of life were observed (p > 0.05).
Nonintensive grandchild caregiving was significantly associated with reduced odds of dementia in a cohort study of 10,058 older Chinese adults. This association was partially mediated by mobile telephone ownership (17.68% mediation), broadband internet access (17.36% mediation), and low loneliness (16.83% mediation).
Rates of cardiometabolic illnesses among American adults have reached 50%, and 45% of all deaths from cardiometabolic diseases are attributable to unhealthy eating. The American Heart Association (AHA) recently issued a scientific statement based on a systematic review of these programs in the US: the Cleveland Clinic tailored meals leading to fewer visits to the emergency department (ED) and inpatient hospital days, saving $12,046 per patient. Nutrition support led to 23% fewer hospitalizations and 13% fewer ED visits among adults on Medicaid, healthcare costs dropped by an average of $2502 per person.
The price of a cigarette: 20 minutes of life, strikingly calculated how much smoking shortens healthy lifespan, it does not shorten the disabled lifespan. The minutes were calculated upward from 11 minutes, likely because smokers now inhale more thoroughly and do not let a cigarette sit in the ash tray due to cost.
Patients with interstitial lung disease (ILD) over 30-year follow-up had higher risk of lung cancer (355.4 vs. 26.2 per 100 000 person-years) than those without ILD. After adjusting for sex, age, calendar period, educational attainment, and smoking-related diseases, hazard ratio (HR, 2.16; 95% CI, 1.89-2.46), sibling-controlled analyses (HR, 2.91; 95% CI, 1.98-4.27) and highest risk for small cell carcinoma (HR, 3.29; 95% CI, 2.32-4.68).
A smartphone app that alerts bystanders trained in cardiopulmonary resuscitation (CPR) to a nearby out-of-hospital cardiac arrest before EMS arrived. These volunteer responders improved survival to discharge by 37%, in 9196 out-of-hospital cardiac arrests in Victoria, Australia.
Postmenopausal women with regular sexual activity in the past three months had lower vulvar pain, dryness, and irritation than those with sexual activity in the past year but not in the past three months. With age, there was a significant decrease in sexual desire, arousal, and lubrication ability, while sexual pain increased, but no decline in orgasm and satisfaction with age. Use it or lose it.
Half of patients who say they always feel lonely (50%) have clinical depression, compared with just 10% of those who report never feeling lonely.
While regulations on sales and transfers, background checks and access to firearms, gun owner accountability and restricting firearms in public places correlated with decreased firearm homicide, sociodemographic factors, such as unemployment, poverty, and insurance status, correlated with larger changes, suggesting policies that address root causes of violence through economic mobility and access to robust social, health, and educational services may be associated with a greater reduction in homicides.
This Medscape article is a nice summary of kratom, available at Walmart or gas stations, made of the tropical plant mitragyna speciosa, a native to Thailand, Indonesia, and Malaysia. The leaves contain several active alkaloids, primarily mitragynine and 7-hydroxymitragynine, which act as partial agonists at mu opioid receptors, thus the addictive potential, and influence adrenergic and serotonergic pathways. At low doses, kratom enhances alertness and performance and induces mild euphoria in humans. At higher doses, it produces sedative and analgesic effects similar to those of opioids. While used in western nations for chronic pain, anxiety disorders, and opioid withdrawal management, it can cause nausea, vomiting, constipation, dizziness, drowsiness, and, rarely, seizures or hepatotoxicity. In Germany, the Federal Institute for Drugs and Medical Devices (BfArM) issued a strong warning against using kratom. In the US, the National Institute on Drug Abuse has reported serious side effects and deaths associated with kratom, often in combination with other substances.
Of 3.2 to 4.5 million Veterans, age 63 years, from 2005 to 2022, opioid use disorder (OUD) decreased from 1.12% to 1.06% in states without cannabis laws, increased from 1.13% to 1.19% in states that enacted medical cannabis laws (MCL), and remained stable in states that also enacted recreational cannabis laws (RCL). MCL/RCL enactment was associated with greater OUD prevalence, with more substantial increases in OUD among middle-aged and older adults and those with chronic pain.
Secretary Kennedy has removed the COVID vaccine for healthy children and healthy pregnant women from recommended immunization schedule, calling it "common sense and good science", even though scientific evidence supports the vaccine in these populations. Kennedy’s action “contradicts multiple federal and state laws that require reliance on ACIP [Advisory Committee on Immunization Practices] recommendations for the CDC immunization schedules, not the decisions of a single individual like him,” according to the complaint that was filed by 6 medical societies and an individual female physician who have sued to reverse his decision: the American Academy of Pediatrics, American College of Physicians, American Public Health Association, Infectious Diseases Society of America, Massachusetts Public Health Association, the Society for Maternal-Fetal Medicine, and Jane Doe (a physician >20 weeks pregnant and at risk of exposure to infectious disease). This has implications for our older adults who may want to visit a newborn (great)grandchild, risking infection or infecting the child before symptom onset.
This CIDRAP podcast addresses several misconceptions about immune systems and vaccines that swirl in social media: thimerosal, B-cell and antigen overload, etc.
The Individualized Positive Psychosocial Intervention (IPPI) assist providers in engaging in positive interactions between residents living with dementia and their direct care partner. The quality improvement program is for care communities in Ohio that want to empower direct care (STNA) staff in providing person-centered care and better manage the well-being of residents who communicate distress (e.g., experiencing behavioral and psychological symptoms of dementia such as aggression, wandering, persistent vocalizations).
The OMDA conference on Thu July 17th at 8 am is: IPPI ePCT, Katherine Abbott, Phd, MGS, Scripps Gerontology Center
In his TED talk, Dr. Blair-West discussed long-term relationships and instead of “are you the one?” encourages us to ask:
Do I accept my partner despite their shortcomings?
Do I commit to nurture them to achieve what’s important to them?
Do they accept me?
Do they commit to me?
