Geriatric Update July 27, 2026

This is my last blog from this website as it will shut down next month, August. Please sign up on my RSS feed at www.PG-65.com, the Practical Geriatrician, with a riff on PG-13.

Compared to meat eaters, poultry eaters had lower risk of prostate cancer (0.93, 0.88–0.98), pescatarians had lower risks of colorectal (0.85, 0.77–0.93), breast (0.93, 0.88–0.98) and kidney cancer (0.73, 0.58–0.93), vegetarians had lower risks of cancers of the pancreas (0.79, 0.65–0.97), breast (0.91, 0.86–0.97), prostate (0.88, 0.79–0.97), kidney (0.72, 0.57–0.92) and multiple myeloma (0.69, 0.51–0.93) but higher risk of squamous cell carcinoma of the esophagus (1.93, 1.30–2.87), and vegans had higher risk of colorectal cancer (1.40, 1.12–1.75). This pooled analysis of 1.8 million women and men in nine prospective studies on three continents over 15 years will hopefully trigger randomized controlled trials. For now, getting screening colonoscopy is an effective way to prevent colorectal cancer. 

To get complete protein as we cut back on meat or are vegan or vegetarian, we can use this Protein Complementation table from the American Society for Nutrition.  

Leafy green vegetables, dark yellow vegetables (comprising carrots, yellow squash, and yams), pizza, wine, beer, coffee, fruit juice, snacks, and tea were inversely related to concentrations of inflammatory markers. I was surprised to read "pizza" and "snacks" as they usually fall under processed foods. While previous studies have shown that wine and beer are anti-inflammatory, given the brain toxicity and carcinogenicity, I recommend limited use. Fruit juice packs a fast sugar punch even if it is fruit sugar, and we miss out on fiber from fruits.

Last month I mentioned that Vitamin C concentrations are more than twofoldhigher in the cerebrospinal fluid than in blood levels. Higher vitamin C intake was associated with an 18% lower relative risk (RR) for Alzheimer’s. Vitamin C levels were associated with gray matter volume/intracranial volume ratio (p < 0.001) and default mode network connectivity.

High doses of intravenous vitamin C reduced the risk of death and sepsis in hospitalized trauma patients by 28% to 86% based on a review of 3 randomized controlled trials (RCTs) and 3 cohort studies with variable quality of evidence. However, in burn injury patients, high-dose intravenous vitamin C (50 mg/kg every 6 hours for 96 hours) increased 28 day mortality (15.0% vs 7.6%; adjusted RR, 1.96 [95% CI, 1.32-2.90]) and hospital mortality (23.3% vs 16.1%; adjusted RR, 1.44 [95% CI, 1.03-2.00]; P = .03).

Glucosamine, a joint-pain supplement, is associated with accelerated Alzheimer’s Disease (AD) progression and worsened survival in a retrospective analysis of electronic health records from patients with AD with varying disease severity. The mechanism of hyperglycosylation as shown in mice, driven by increased glycan biosynthesis and worsened with glucosamine, leads to reduced glucose uptake in AD brains. This is detectable years before clinical symptoms manifest, underscoring the importance of metabolic impairments in early disease pathology.

Among 1,756,388 Medicare beneficiaries hospitalized for hip fracture, age 82.5 years, the 29.2% older adults with dementia who survived 1 year after fracture died 50.3 days earlier. They also had 53.9 fewer days at home compared with those without dementia due to more time in skilled nursing (adjusted mean days, 38.2 vs 24.2) and long-term care facilities (adjusted mean days, 52. vs 12.4).

Super movers are about 10% of older adults >80 years who walk 1.5 standard deviations faster than the average. A meta-analysis showed lower risk of incident cognitive impairment (HR 0.49, 95% CI 0.28–0.71) over follow-up of 3.4 and 5.4 years, slower memory and non-memory–related cognitive decline and preserved hippocampal volume in specific subfields, and better antemortem cognition in super movers. There was also lower Alzheimer's disease and dementia prevalence, though there were no differences in postmortem dementia-related pathologies. 

A new dementia diagnosis was detected in 31% more patients in clinics randomized to the combined Quick Dementia Rating System (QDRS), a patient-reported outcome tool, and a Passive Digital Marker (PDM), a machine learning algorithm that uses existing data captured by the electronic health record PDM approach, when compared with usual care clinics. This was a study of 5,325 patients, age 71, over 12 months, with odds ratio (1.31; 95% CI, 1.05-1.64).

The Bacillus Calmette-Guérin (BCG) vaccine, long administered intradermally to prevent tuberculosis in Africa and Asia and found to decrease Alzheimer’s in observational studies, appeared to reshape the immune environment surrounding the brain and modify Alzheimer's disease-related biomarkers in 12 older adults without existing Alzheimer’s but not in 11 with the disease. Amyloid in blood increased and in CSF decreased in healthy older adults over 12 months, but did not in the Alzheimer’s group. 

Patients with end-stage Parkinson's were followed for 9 years during which 92% died. The most common cause of death was pneumonia 47%, (aspiration pneumonia 34% and unspecified pneumonia 13%), followed by sepsis (16%). This is likely due to the increasing swallowing difficulty as the disease progresses.

A Parkinson’s research team produced 4,400 groups of cells, each engineered to display a different surface protein. They found that misfolded α-synuclein would bind to 16 surface proteins and 2 of them, mGluR4 and NPDC1, were found on dopamine-producing neurons in the substantia nigra, the brain region most heavily affected by Parkinson's disease. This facilitated misfolded α-synuclein transport into the cells in mice. Cultured neurons lacking both Grm4 and Npdc1 fail to bind α-synuclein fibrils, do not accumulate phosphorylated α-synuclein, and don’t lose synapses, increasing mouse survival, motor function and spinal motoneuron number. 

Patients receiving P2Y12monotherapy, aspirin monotherapy, dual antiplatelet therapy (DAPT) with both of these, or no antiplatelet meds had similar severe Intracranial hemorrhage (ICH) (20.5%- 25.3%). In-hospital mortality rates were highest in patients using DAPT (24.0%), followed by patients receiving P2Y12 inhibitor monotherapy (23.8%), no antiplatelet (16.8%), and aspirin monotherapy (16.5%) (P < .001). After risk adjustment, patients with prior use of P2Y12 inhibitors were more likely to present with severe stroke, and were less likely to be discharged to home, to be able to ambulate independently, or to have functional independence at discharge. No differences in in-hospital outcomes between the aspirin monotherapy and the no antiplatelet therapy groups were found.

Opioid prescribing decreased from 2010 to 2024, for long-term prescriptions in commercial prescribers by 81.3% (from 33.2 fills per 100-person years in 2010 to 6.2 in 2024) and for short-term opioid use episodes 74.6% (from 36.2 fills per 100-person years in 2010 to 9.2 in 2024). The numbers were slightly higher in Medicare Advantage patients and for Patients seen by pain specialists. 

Leading artificial intelligence (AI) chatbots answered correctly less than a quarter of the time: Gemini 3 Pro Preview 16.06%, GPT-5.1 14.60%, Kimi K2 Thinking 27.74%, DeepSeek V3.2 15.33%, Qwen3-Max 13.87%, and Claude Opus 4.5 26.28%. Each fell far short of a passing grade on a colorectal cancer (CRC) knowledge test of 137 text-based multiple-choice questions when barred from explaining their reasoning, with the top performer answering just 27.7% of questions correctly. 

Voice changes measured by a smartphone app identified 13 of 39 speech features that indicated an asthma attack or COPD exacerbation at the very start. Features such as the duration of sustained vowels decreased, while shimmer (irregularity of vocal fold vibrations) and noise-to-harmonics ratio increased, demonstrating the deterioration of overall voice quality and warning of an oncoming symptom flare-up.

The FDA has recalled several lots of levothyroxine for being subpotent.

For long COVID, rivaroxaban, colchicine or famotidine-loratadine led to small, statistically significant improvements in patient-reported Fatigue Assessment scores over 12 weeks. These improvements, however, disappeared 12 weeks after stopping the interventions, or were not at all effective.

The CDC reports 2,302 confirmed measles cases in 45 states vs 2,245 cases in 44 states last week. The number exceeds the total of 2,263 in all of 2025.

CDC has received reports of 4,173 laboratory-confirmed domestic cases of cyclosporiasis and is aware of more than 7,400 additional cases under investigation. The CDC is sending a delegation to Ohio because of >2,600 cases in Ohio—double the number reported the week before. The Ohio Department of Health has no new cyclospora information since January. 

Today, July 27 in 1921, Researchers at the University of Toronto, led by biochemist Frederick Banting, prove that the hormone insulin regulates blood sugar.