Geriatric Update July 14, 2025

The CDC reports 1309, confirmed measles cases in 40 states, up from 1288 in 39 states last week.

Updated COVID-19 vaccines remain effective for keeping people out of the hospital, regardless of variant, with a 24% lower risk of ER and urgent care visits related to COVID-19; a 29% lower risk of hospitalization; and a 48% lower risk of ICU admission or death in a hospital. Protection stretched from a week after vaccination out to 299 days, but maximum protection came during the first two months after vaccination, reducing severe cases of COVID by up to 68%, vaccine effectiveness waned over time, particularly beyond 6 months. The test-negative case-control study included 345,955 emergency department and urgent care encounters and 111,931 hospitalizations among adults with COVID-19–like illness.

Aluminum in vaccines caused no increased risk of 50 chronic conditions, including autoimmune diseases, allergies and autism. Per 1-mg increase in aluminum exposure adjusted hazard ratios (HR) 0.98 (95% CI, 0.94 to 1.02) for any autoimmune disorder, 0.99 (CI, 0.98 to 1.01) for any atopic or allergic disorder, and 0.93 (CI, 0.90 to 0.97) for any neurodevelopmental disorder. Based on 1.2 million detailed health records of people born in Denmark from 1997 through 2018 and followed them until the end of 2020. (A HR that crosses 1 is not statistically significant. In observational studies, not randomized trials, usually a HR of <0.5 or >2 is considered significant).

The FDA is requiring added class safety warnings for myocarditis and pericarditis to COVID-19 messenger RNA (mRNA) vaccines’ prescribing information. The article fails to report the 5 fold increased risk of myocarditis with COVID-19 compared to the incidence of vaccine induced myocarditis. The incidence of myocarditis caused by COVID is 7 to >100 times more than that of mRNA vaccines.  The relative risk of heart failure or death was markedly higher for myocarditis associated with COVID than for myocarditis associated with vaccination (relative risk 5.78, 1.84 to 18.20).

Our bodies convert 1,3-butanediol to the ketone  β-hydroxybutyrate, leading to decreased energy production and neuroprotection. Administration as an alternative strategy to calorie restriction led to modulation of stress response in hippocampus of healthy rats.

Different from appetite suppressing drugs, SANA (a nitroalkene derivative of salicylate), activates creatine-dependent thermogenesis and increases energy expenditure, in mouse studies and 41 human volunteers over 2 weeks for dose finding, safety and tolerability. By increasing caloric intake, radical production increases, raising inflammation and risks of various chronic illnesses. In contrast, calorie restriction promotes longevity. I hope they will do long term studies.

Weight loss achieved solely through physical activity consistently has positive effects on mental health, including reduced suicidal ideation, improved mood, reduced depression and anxiety symptoms, and better sleep quality in various age groups.

Patients (n>660,000), who underwent bariatric surgery showed twice the risk for suicide compared with individuals who did not undergo surgery hazard ratio (HR) 2.12 (95% confidence interval [CI] 1.54−2.92). GLP-1 agonists showed no increased risk for suicide or self-harm compared to the placebo group. 

GLP-1RA users, avg age 58, had a lower risk of dementia (HR, 0.63; 95% CI, 0.50-0.81), stroke (HR, 0.81; 95% CI, 0.70-0.93), and all-cause mortality (HR, 0.70; 95% CI, 0.63-0.78), after propensity score matching, during a 7-year follow-up, with no significant differences in the risk of Parkinson disease or intracerebral hemorrhage. Greater benefits were seen in patients aged >60 years or older, women, and patients with a body mass index of 30 to 40.

In April I listed 12 areas in which GLP-1 meds improved health, including alcohol use disorder. This is another study showing a significant reduction in alcohol consumption and cravings with semaglutide, by reducing: grams of alcohol consumed,  peak breath alcohol concentration, drinks per drinking day and weekly alcohol craving. This effect increased over time, and also affected smoking.

The European Society of Cardiology added vaccines against influenza, SARS-CoV-2, respiratory syncytial virus, herpes zoster, and other viruses as the 4th pillar of medical cardiovascular (CV) prevention besides antihypertensives, lipid-lowering drugs, and medications that treat diabetes. The US 2025 AHA/ACC guidelines recommend  annual influenza vaccination (level 1A).

This is a nice summary of the evidence on vitamin D for CV prevention and treatment: low serum 25-hydroxyvitamin D [25(OH)D] concentrations (<20 ng/mL) are associated with the highest risk of CVD incidence and mortality. CV incidence rates are lowest in summer and CV mortality rates are significantly higher in late winter—when vitamin D concentrations are lowest, compared to late summer. Supplementation has reduced CV risk factors of major CV events by 13-17%.

Patients hospitalized for stroke, who received psychological counseling had improvement of their depression, PHQ-9 scores decreased by 6.5 (of 27 point scale, moderate amount) and anxiety, GAD-7 score improved 5.5 points (of 21 point scale, large amount). Starting counseling a year or more after a stroke were less likely to reliably recover from symptoms of depression or anxiety than those seen within six months.

APOE ε4 carriership was associated with a 3-fold increase in the risk of intracranial hemorrhage (ICH) (hazard ratio, 3.07; 95% CI, 1.42-6.65). Of 413 477 US participants, 2038 were eligible because of a-fib and apixaban use. Mean age was 71 years, 1710 (83%) had European ancestry, and 483 (23.7%) were carriers of at least 1 APOE ε4 allele.

This network meta-analysis showed that mindfulness-based interventions (MBIs) was the most effective psychosocial interventions in reducing burden for caregivers of individuals with cognitive impairment, while cognitive behavioral therapy (CBT) was highly effective in home-based settings.

Clozapine has been used for schizophrenia for decades but was limited by the need for monitoring absolute blood neutrophil count (ANC). New international guidelines, based on years of evidence states, this is no longer necessary beyond 2 years of clozapine treatment.

This New York Times article recommends against the use of Benadryl for allergies or insomnia. It encourages newer allergy meds such as Cetirizine, Loratadine or Fexofenadine and sleep hygiene for insomnia.

Hearing intervention in the participants with hearing loss of the 977 older adults, age 76.3, retained a mean of 1 additional person in their social network and experienced positive effects in social network diversity and quality and loneliness measures relative to health education control over 3 years.

In patients with pancreatic cancer, 2 months after starting treatment, the cell-free DNA blood test ARTEMIS-DELFI was better at predicting outcomes than imaging or other existing clinical and molecular markers.

Cannabis hyperemesis syndrome (CHS) among adolescents, 13- to 21-year-olds increased by 49% per year, from 160.4 per million ED visits in 2016 to 1,968.3 per million in 2023, more than 10-fold, regardless of states’ recreational cannabis legalization (RCL) status. Taking a shower or bath seems to help, but only stopping cannabis will resolve it.

Betel nut is chewed by twice as many than in 2000 for its psychostimulant effect, like nicotine and caffeine. The US is seeking regulation because of the carcinogenesis established since 2000, mainly oral cancer, as well as obesity, metabolic syndrome, cardiovascular disease, and all-cause mortality.

The OMDA conference on Thu July 24th at 8 am is: Infectious Disease, by Steven Burdette, MD, FIDSA, Wright State University