Geriatric Update July 28, 2025

The CDC reports 1319, confirmed measles cases in 40 states, up from 1309 in 40 states last week.

The global spread of Aedes aegypti and Aedes albopictus mosquitoes has increased with global warming. This WHO guideline addresses the clinical management of four major arboviral infections: dengue, chikungunya, Zika virus, and yellow fever: for non-severe disease use Tylenol for fever, but not non-steroidal anti-inflammatory medications (NSAIDs) or corticosteroids. NSAIDS have the potential for harm related to platelet inhibition in dengue and other arboviral diseases causing potentially severe hemorrhage. For severe cases, I refer readers to the document.

Last week I reported no increased risk for autoimmune, atopic or allergic, or neurodevelopmental disorders associated with early childhood exposure to aluminum-adsorbed vaccines. Aluminum is the 3rd most common element in the earth’s mantel, after oxygen and silicone. This Information handout from Philadelphia Children’s Hospital puts it into context: adults ingest 7-9 mg of aluminum a day through food. While infants receive about 4.4 milligrams of aluminum in the first six months of life from vaccines, they receive more than that in their diet. Breast-fed infants ingest about 7 milligrams, formula-fed infants ingest about 38 milligrams, and infants who are fed soy formula ingest almost 117 milligrams of aluminum during the first six months of life.

Intensive blood pressure (BP)-lowering after intracranial hemorrhage significantly decreased the chances of poor outcomes. Mean systolic BP was 149·6 mm Hg (SD 21·8) in the intensive treatment group and 158·8 mm Hg (22·8) in the guideline group within 1 hour: improved outcomes: physical function (mRS scores of 3–6; odds ratio [OR] 0·85, 95% CI 0·78–0·91), neurological deterioration within 7 days (OR 0·76, 95% CI 0·66–0·88; p=0·0002), death (0·83, 0·75–0·94; p=0·002), and any serious adverse event (0·84, 0·76–0·92; p=0·0003). This effect was lost if BP lowering was delayed to 3 hours. Adequate hydration will be critical to provide blood volume for perfusion, and leaving the head of the bed flat (in large vessel ischemic strokes).

In another study, no difference was found with the mean systolic BP in the intervention group of 159 mm Hg vs. 170 mm Hg in the usual-care group. It seems like the reduction was not enough to make a difference in this group of Chinese patients treated in the ambulance within 61 min, 46.5% had a hemorrhagic stroke.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) is associated with a reduced risk for diabetic macular edema (DME) (HR: 0.77, 95% CI: 0.70–0.85), and fenofibrates to a smaller degree, while calcium channel blockers appear to increase the risk (HR: 1.66, 95% CI: 1.54–1.78). I would not change my patients' calcium channel blockers based on this relatively small (HR <2) difference in an observational study of patients with type 2 diabetes from the TriNetX database.

A quarter of lung cancer cases occur in people who have never smoked. In a whole-genome analysis of 871 never-smokers with lung cancer from 28 global geographical locations found that fine-particulate air pollution from vehicles and industry, exhibited an increase in most types of genetic changes causing lung cancer. As air pollution levels rose, gene changes previously associated with tobacco smoking also increased, while telomere length decreased, indicating shortened longevity.

Urinary antimicrobial peptides (AMPs) are part of the innate immune system and prevent and respond to acute bacterial infection. Baseline levels of several AMPs (human neutrophil peptides 1–3 (HNP 1–3), human alpha-defensin-5 (HD-5) and cathelicidin (LL-37) did not vary by age, but baseline human beta-defensin-2 (hBD-2) levels were lower. Measuring an elevated level may then be able to distinguish negative culture/asymptomatic bacteriuria from true infection where urinalysis cannot. Urinalysis results varied between 162 asymptomatic older adult patients with 11% positive asymptomatic bacteriuria and the rest negative cultures, but AMP values did not differ (p > 0.2 for all four AMPs).

After stroke, we would raise the head of the bed by 30° to prevent aspiration pneumonia. This study compared it with a flat head of bed before thrombolysis, and found early neurologic deterioration was more common in the 30° group than in the 0° group (55% vs 2%; hazard ratio [HR], 34.4; P < .001), as was severe neurologic deterioration (n = 20 vs n = 1; HR, 23.6; P = .002), and all-cause mortality rate at 90 days (4% vs 22%; P = .03). A greater proportion of patients in the 0° group than in the 30° group showed neurologic improvement at 24 hours post-thrombectomy (87% vs 60%; odds ratio, 0.2; P = .01).

Brain scans from a very large UK database, showed that during the pandemic years of 2021 and 2022, people’s brains showed signs of aging, including shrinkage.

The number of people with dementia will increase as the population aged >80 years will double between 2025 and 2050, but the percentage of people with dementia at a given age will decline because of better control of modifiable risk factors: blood pressure, cholesterol, exercise, weight, education, etc.

Sit and Rise Test (SRT) is a good indicator of a person’s muscle strength, flexibility, core stability and joint mobility. A perfect score of 10 indicates lower risk of death from natural and cardiovascular causes (5 points for sitting; 5 points for standing) with a point deducted any time support is needed to transition to either position. Among adults aged 46-75, those with low scores (0-4) had a 42% mortality rate compared to just 3.7% for those with a perfect score of 10.

Frail older adults who deliberately walked faster saw a meaningful improvement in the distance, 14 additional steps per minute, for six minutes straight. regardless of age, the intensity of the workout can lead to greater improvements in physical function.

Self-perceptions of aging as a strong predictor of physical recovery and disability following a fall, independent of other important factors such as age, gender, and pre-fall physical function. Individuals with positive self-perceptions of aging at baseline had significantly lower odds of slow gait speed (OR = 0.729; 95% CI = 0.627–0.849), ADL dependence (OR = 0.667; 95% CI = 0.561–0.792) and physical inactivity (OR = 0.795; 95% CI = 0.700–0.904) following a fall at a 2-year follow-up.

Tai Chi improved anxiety (standardized mean difference (SMD) -0.47, 95% credible interval (CrI): -0.65 to -0.30), depressive symptoms (SMD: -0.41, 95% CrI: -0.50 to -0.33) and sleep quality (SMD: -0.12, 95% CrI: -0.20 to -0.04). The systematic database search included 37 randomized controlled trials, including 2843 older adults 1424 (50.1%) in the Tai Chi group. The optimal therapeutic target was 500-700 MET-minutes/week, equivalent to 150-210 minutes of moderate-intensity exercise or 75-105 minutes of vigorous-intensity exercise per week.

Eating >1 egg/week reduced the risk of Alzheimer’s disease (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34, 0.83). Subgroup analysis of brain autopsies from 578 deceased participants showed that intakes of >1 egg/wk (HR: 0.51; 95% CI: 0.35, 0.76) and ≥2 eggs/wk (HR: 0.62; 95% CI: 0.44, 0.90), in 1000 adults, age 82, followed over 6.7 years. Desserts or mixed dishes were not counted. Mediation analysis showed a 34% longer time to develop Alzheimer’s dementia, and that 39% of the total effect was mediated through dietary choline in the yolk.

Okra, high in fiber and vitamin K, and okra water are trending in social media to decrease blood glucose levels and improve glucose tolerance.  The mucilage of the vegetable has a significant hypoglycemic effect due to its backbone chain that consists mainly of L-rhamno-D-galacturonan.

Also trending in social media is taurine for longevity. Taurine is an amino acid that our body produces, and is made also as a breakdown of methionine, which most of us eat too much in bread, pasta, rice and other grains. This article refuted the longevity claim and a recent article actually found taurine may play a role in both the development and progression of acute myeloid leukemia.

The shortage of geriatricians calls for an appropriate distribution across healthcare settings. Acute care and rehabilitation settings, with the option of adding community clinics if cost and resources permit were cost saving and most economically attractive for the Canadian healthcare system.

The OMDA conference on Thu July 31st at 8 am is: Nursing Home Explanatory Clinical Trials, Alice Bonner, Moving Forward Nursing Home Quality Coalition