Geriatric Update July 20, 2026
Every additional hour of prolonged sedentary behavior per day was linked to a 10% higher hazard of cancer mortality (hazard ratio [HR] 1hour 1.09; 95% confidence interval [CI] 1.06- 1.11). Replacing an hour of sedentary behavior daily with light physical activity reduced cancer mortality by 12% (HR 0.88; 95% CI 0.79- 0.99). Thirty minutes of moderate physical activity also reduced cancer mortality (HR 0.92; 95% CI 0.86- 0.99) as did an additional five minutes of vigorous physical activity per day (HR 0.77; 95% CI 0.46- 1.29). The study of 91,292 UK Biobank participants associated several specific cancer sites, including lung, breast, and oral cancers, leukemia and non-Hodgkin’s lymphoma.
The 34-circular RNA (circRNA) model classified biomarker-confirmed Alzheimer’s Disease (AD) with high accuracy (area under the curve [AUC], 0.945), outperforming plasma pTau217 alone (AUC, 0.877). Combining circRNAs with pTau217 further increased diagnostic performance (AUC, 0.977). The circRNA signature also showed high specificity for AD over other neurodegenerative disorders and was a stronger predictor of progression to symptomatic AD than pTau217 or amyloid PET in 1,221 individuals with AD and healthy individuals. Validated in the Knight-Alzheimer Disease Research Center discovery cohort (n = 551) and preclinical A4 (n = 1,767) cohorts, these circRNAs (hazard ratio = 2.92) outperformed pTau217 (hazard ratio = 1.81) and amyloid-positron emission tomography when predicting progression to symptomatic AD.
Cardiovascular-Kidney-Metabolic (CKM) syndrome is common: up to 90% of adults have it, and various societies have issued the 2026 guideline highlighting the interconnected roles of obesity, diabetes, chronic kidney disease, and cardiovascular disease. The 10 recommendations include staging of the various diseases and risk factors, including the PREVENT calculator.
Immediate aspirin discontinuation following percutaneous coronary intervention (PCI) for acute coronary syndromes, followed by potent P2Y12i monotherapy, was associated with a higher risk of ischemic events at 30 days (HR 1.40; 95% CI 1.11 to 1.78), with an absolute risk increase of 1.12% and a number-needed-to-harm of 89. In the graph, the curves start running parallel at 2 weeks, consistent with studies showing lower risk with 1 month than >3 months of dual platelet therapy.
In this systematic review of 39 studies and a meta-analysis of 29 studies representing 603,256 veterans, Black veterans with cancer receiving care through the VHA had similar or better overall survival (HR, 0.93; 95% CI, 0.89-0.97) and cancer-specific survival (HR, 0.94; 95% CI, 0.90-0.98) compared with those whose race was categorized as either White or non-Black.
This is an excellent video by some of the millions of people who care for older dependent adults, one of the hardest jobs in America. Millions are doing it alone and mostly for free.
The population of Americans age >80 years, who are most likely to need institutionalization, is projected to increase by more than 45% over the next decade, from less than 15 million in 2026 to approximately 22 million in 2036. At the same time nursing homes are closing due to narrow operating margins, private equity takeover, high regulatory environment (second only to nuclear energy regulation), and Medicaid cuts under the Big Beautiful Bill, which in 2023 covered only 84% of the cost of providing long-term care. The demand for dementia care provided by nursing homes is expected to continue to increase as Medicaid for home care is cut and families have fewer children to do caregiving. This will lead to extended hospital stays as patients await a nursing home bed to become available, and will cause a strain on families.
The American College of Physicians came up with 5 guidance statements for breast cancer screening:
In asymptomatic, average-risk adult females-
Aged 40 to 49 years, clinicians should discuss risk of breast cancer, values and preferences, and benefits and harms of screening, and after shared decision making, should initiate screening mammography every 2 years (biennial).
Aged 50 to 74 years, clinicians should use biennial mammography for screening for breast cancer.
Aged 75 years or older or asymptomatic average-risk with a limited life expectancy, clinicians should discuss discontinuation of breast cancer screening based on shared decision making that includes the female's risk of breast cancer, values and preferences, and uncertainty around benefits and harms of screening for breast cancer.
With breast density of Breast Imaging Reporting and Data System (BI-RADS) category C or D, clinicians should consider using supplemental digital breast tomosynthesis based on benefits, harms, additional radiation exposure, availability, values and preferences, and cost.
With breast density of BI-RADS category C or D, clinicians should not use supplemental magnetic resonance imaging or ultrasound.
Artificial sweeteners were linked to higher fasting insulin levels, reduced insulin sensitivity, higher HbA1c, and glucose area under the curve during oral glucose tolerance test (OGTT), potentially mediated by effects on the composition and functional potential of the gut microbiome. This meta-analysis of 21 randomized clinical trials compared artificial sweeteners with non-caloric options like water or a placebo.
In 2,133 patients with peripheral artery disease (PAD) and diabetes (DM), those taking GLP-1 receptor agonist were matched with the same number taking metformin but not GLP-1 over 5 years. GLP‐1 RA therapy was associated with lower mortality (10.31% vs 14.49%; hazard ratio [HR], 0.74 [95% CI, 0.62–0.88]), lower hospitalization (69.3% vs 74.7%; HR, 0.87 [95% CI, 0.81–0.94]), lower revascularization (4.69% vs 7.27%; HR, 0.64 [95% CI, 0.50–0.82]), lower major amputation (2.30% vs 4.36%; HR, 0.52 [95% CI, 0.37–0.74]), and lower minor amputation (4.03% vs 6.42%; HR, 0.63 [95% CI, 0.48–0.83]). Major adverse cardiovascular events, myocardial infarction, stroke, and major adverse kidney events were similar between groups.
The Department of Health and Human Services (HHS) is removing testosterone replacement warning labels put in place by the FDA in 2015 because of: polycythemia (elevated red blood cell counts), worsened sleep apnea, shrinking testicles, and limited sperm production. In 1941 a small study concluded testosterone injections activated prostate cancer, but a review in 2004 highlighted the lack of evidence linking testosterone therapy to worsened prostate health. Among veterans who underwent coronary angiography and who had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of heart attacks and strokes (hazard ratio, 1.29; 95% CI, 1.04 to 1.58). The TRAVERSE trial on which the new reversal is based showed no increased risk, but was criticized for excluding patients at risk of prostate problems, for its short follow up (33 months) and for the average age 63, less applicable to our older population. A separate analysis published after the main TRAVERSE trial results raised concerns about an increased risk of fractures. Testosterone trials showed small increases in walking distance, sexual function and improvements in mood but no noticeable improvement in overall vitality or cognitive function. This JAMA podcast describes it well. For hypogonadism in our older adults, we must make sure that obesity is not causing the conversion of testosterone to estrogen (man boobs), which would be worse with supplemental testosterone. Instead, we should encourage weight loss, as testosterone levels will then increase.
Developmental delay occurred less often in offspring of mothers with high cardiovascular health (CVH) at 8.8%, vs 12.1% with moderate CVH, and 16.8% with low CVH.
Among older adults who received repeated COVID-19 vaccination, booster doses - particularly with >4 doses - enhanced antibody breadth, producing unexpectedly strong neutralization of certain bat and pangolin coronaviruses in addition to COVID-19. This suggests that breadth of coronavirus neutralization is driven primarily by vaccine-induced immune maturation rather than by Omicron infection.
The CDC reports 1,645 cases of Cyclosporiasis in 34 states, with 141 hospitalizations, linked to shredded iceberg lettuce distributed by Taco Bell locations in IN, KY, MI, OH, and WV. The tracing was slowed down by the long incubation period of weeks, requiring food reporting from weeks ago, and the administration’s stop of tracking and reporting of 7 food borne infectious diseases, I reported on Dec 15, 2025.
The CDC reports 2,245 confirmed measles cases in 44 states vs 2,218 cases in 42 states last week.
The OMDA call on Thu July 23 – TBD by Tammy Cassidy, RN, BSN, LNHA, RAC-MT, CEAL, Regulatory Directory, Ohio HealthCare Association
Great intelligence, and high position in a patient, bear no relation to his understanding of medical problems. (Dr. Mark M. Ravitch, surgeon who pioneered the use of surgical staples, and non-operative management of intussusception).
Today, 50 years ago, the American Viking 1 lander successfully landed on Mars.
I will close my www.DrHamrickMD.com website next month. If you are accessing it, please change to www.PG-56.com.
