Geriatric Update July 7, 2025
The CDC reports 1227, confirmed measles cases in 37 states, up from 1214 in 36 states last week.
Of 102 survivors of severe COVID, requiring oxygen and 50% ventilated, 61% had fibrosis 3 years after their infection. Only 9% improved from 15 months to 3 years of follow up, but none worsened. Since we do not have any disease modifying drugs, this finding is not actionable, but reassuring.
Influenza, COVID-19, pneumococcal and respiratory syncytial virus (RSV) can increase the risk of major adverse CV events such as myocardial infarctions, can exacerbate heart failure, and increase mortality. This statement explains the inflammation and how vaccine prevention against pathogens such as influenza, RSV, COVID and pneumococcus can reduce the risk for major adverse cardiovascular events (MACE).
Pneumonia from secondary Streptococcus pneumoniae infection is twice as common within 30 days, of influenza (OR, 2.39; 95% CI, 2.15-2.64) and respiratory syncytial virus (RSV) infection (OR, 2.50; 95% CI, 2.07-2.99), while having a SARS-CoV-2 infection decreased the risk (odds ratio [OR], 0.56; 95% CI, 0.50-0.62), among 188,721 hospitalized veterans, avg age 70. Independent risk factors included liver disease, cancer, HIV, chronic obstructive pulmonary disease, and smoking.
Balneotherapy is effective in managing symptoms like fatigue, pain, and anxiety associated with long COVID. The mechanism is thought to be through 3 ways:
Chemical composition: Depending on the mineral content and method of application, thermal waters may have anti-inflammatory, analgesic, immunomodulatory, and keratolytic effects.
Water temperature: Warm thermal waters promote vasodilation, muscle relaxation, and improved circulation. In contrast, cold thermal waters are often used in acute phases to reduce inflammation or in vascular therapies.
Physical properties: The buoyancy and hydrostatic pressure of water reduce joint load and support movement, which is especially beneficial in functional rehabilitation.
While this program is not available in the US, hydrotherapy in a warm water pool may help individual patients.
Supine hypertension with or without seated hypertension (HTN) was associated with increased risk of adverse cardiovascular disease (CHD) events compared with seated hypertension alone, CHD (hazard ratio [HR], 1.60; 95% CI, 1.45-1.76), heart failure (HR, 1.83; 95% CI, 1.68-2.01), stroke (HR, 1.86; 95% CI, 1.63-2.13), fatal CHD (HR, 2.18; 95% CI, 1.84-2.59), and all-cause mortality (HR, 1.43; 95% CI, 1.35-1.52) over 25-30 years in 11,369 patients age 54. We were taught to not base HTN treatment on hospital measurement, but that’s when we obtain the most supine BP measurements, we should at least consider it.
HARMS2-AF score is a lifestyle risk score which helps identify individuals at risk of atrial fibrillation (AF) in the general community. Hypertension, age, body mass index, male sex, sleep apnea, smoking, and alcohol were predictive variables (all P < 0.001); physical inactivity [hazard ratio (HR) 1.01, 95% CI 0.96-1.05] and diabetes (HR 1.03, 95% CI 0.97-1.09) were not significant. The HARMS2-AF score had similar predictive performance [area under the curve (AUC) 0.782] (sensitivity divided by specificity )to the unweighted model (AUC 0.802) in the UK Biobank and AUC of 0.757 in the Framingham Health Professionals Study (FHS).
Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, was associated with resolution of metabolic dysfunction-associated steatohepatitis (MASH) without worsening of fibrosis in 23% (18/78) of participants in the dapagliflozin group and 8% (6/76) in the placebo group (risk ratio 2.91 (95% CI 1.22 to 6.97); P=0.01). Fibrosis improvement without worsening of MASH was reported in 45% (35/78) of participants in the dapagliflozin group, as compared with 20% (15/76) in the placebo group (risk ratio 2.25 (95% CI 1.35 to 3.75); P=0.001).
Adding salt to food always was associated with new onset metabolic dysfunction-associated steatotic liver disease (MASLD) by 40%, cirrhosis, and hepatocellular carcinoma (HCC), compared to never or rarely adding salt, in 492,265 UK Biobank participants.
A new blood test for celiac disease, mixes blood samples with gluten in a test tube for a day to see if the IL-2 signal appeared. For patients with HLA-DQ2.5+ genetics, sensitivity was 90% and specificity was 95, with lower sensitivity (56%) for patients with HLA-DQ8+ celiac disease. It does not require patients to eat gluten, which can cause severe symptoms in some.
The American College of Gastroenterology (ACG) has issued updated Crohn’s disease (CD) guidelines that include the new treatments since the 2018 version: interleukin-23 (IL-23) blockers risankizumab, mirikizumab, and guselkumab; the anti-IL-12/23 agent ustekinumab; the Janus kinase inhibitor upadacitinib; and the anti-integrin vedolizumab.
In their Scientific Statement, the American Heart Association Food is Medicine review of 14 randomized controlled trials in the United States, found clinical outcomes as inconsistent and often failed to reach statistical significance. In my experience of having seen many patients reach >100 years of age, keeping a healthy weight or losing excess weight is most important, followed by exercise and then diet quality. I would like to see studies control for waist circumference and exercise, when evaluating diet. At the same time, diet quality improves weight mgmt. and quality of life.
Walnut consumption modified the fecal microbiota and metabolome, improved insulin response and reduced gut permeability in adults with obesity. Among 18 healthy men and women with a mean age of 53 years, walnuts enriched intestinal microorganisms, including Roseburia that provide important gut-health promoting attributes, like short-chain fatty acid production, and lower proinflammatory secondary bile acid concentrations. This larger study, presented at NUTRITION 2025, found similar benefits among 30 adults with obesity but without diabetes or gastrointestinal disease.
Magnesium had a significant protective effect against obstructive sleep apnea (OSA), with a 64% likelihood that an individual would develop OSA if magnesium depletion score (MDS) > 1. The MDS includes 4 factors: 1) diuretic use (current use for 1 point), 2) PPI use (current use for 1 point), 3) kidney function [60 mL/(min · 1.73 m2) ≤ estimated glomerular filtration rate (eGFR) <90 mL/(min · 1.73 m2) for 1 point; eGFR <60 mL/(min · 1.73 m2) for 2 points], and 4) alcohol drinking (heavy drinker for 1 point). The MDS was also associated with increased stroke and mortality.
Reduced risk of all-cause dementia and vascular dementia (VaD) with angiotensin receptor blockers (ARB) compared with angiotensin-converting enzyme inhibitors (ACEI) over 5.6- 8.4 years, [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.89–0.94] and VaD (HR 0.87, 95% CI 0.78–0.96) but not AD, no difference was found between ACEI and other classes: beta-blockers, calcium channel blockers (CCB), diuretics, and combinations. While the difference was statistically significant, I think the difference is not clinically significant given the small difference in this observational study of a large database (n=1,925,563). The best blood pressure (BP) medicine is the one that controls the BP and the patient will take.
Daily walking volume reduced chronic low back pain (LBP), with 78-100 minutes a day by 13% and >100 minutes by 23%. Walking intensity reduced LBP by 15-18%, in this cohort study of 11,194 participants aged 55.3 years over 4.2 years.
Compared with a nonactive travel mode, multivariable-adjusted hazard ratios for cycling and mixed-cycling/ walking were 19% lower for all-cause dementia, 22% for Alzheimer’s disease, 40% for young onset dementia (<65 years old), and 27% for LOD (>65).
A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and findings consistent with longer overall survival.
A multi-cancer early detection (MCED) blood tests can detect a cancer signal from circulating cell-free DNA. Current MCED tests still have relatively low sensitivity, typically less than 60%, and the American Cancer Society, cautioned that widespread use could create a false sense of reassurance and potentially deter patients from following up with standard screenings. It was less accurate for pancreatic and stomach cancers, correctly identifying the origin in 50% or fewer cases.
Ambroxol, a cough medicine available in Europe, increases the levels of β-glucocerebrosidase, which lowers α-synuclein in cell and animals. This study of 75 patients with Parkinson’s dementia, age >50, showed no improvement in cognition over 1 year, on the Assessment Scale–cognitive subscale, version 13 (ADAS-Cog-13) and Clinician’s Global Impression of Change (CGIC).
Higher cooking time-years were associated with an increased risk for lung cancer in never-smokers. Cooking three meals per day was associated with a threefold higher risk for lung cancer than cooking one meal per day (OR, 3.1; 95% CI, 1.6-6.2). Compared with cooking dish-years ≤ 50, cooking dish-years > 200 conferred an OR of 8.09 (95% CI, 2.57-25.45). Deep frying was associated with the highest risk (per 10 dish-years), with an OR of 2.56 (95% CI, 1.31-5.00), followed by pan frying (OR, 1.47; 95% CI, 1.27-1.69) and stir frying (OR, 1.12; 95% CI, 1.07-1.18). Ventilation hoods showed a protective effect against lung cancer in never smokers (adjusted OR, 0.49; 95% CI, 0.32-0.76).
Lyme disease vaccine VLA15 showed immunogenicity at month 7, compared with the placebo group, with the three-dose regimen group showing higher titers (333.2-656.0 units/mL) than the two-dose regimen group (197.3-460.3 units/mL), and Children > adolescents > adults. No older adults >65 were included.
In patients 4.5-24 hours after large vascular stroke, who received thrombectomy, function, as measured by the Modified Rankin score of 0 to 1, at 90 days was 40.5% in the group who was randomized to receive additional intra-arterial thrombolysis with tenecteplase (n = 51) and 26.4% in the standard medical treatment group (n = 34) (relative risk, 1.44 [95% CI, 1.06-1.95]; P = .02).
Patients with asymptomatic hemorrhagic infarction (HI) and subarachnoid hemorrhage (SAH) after endovascular treatment for acute ischemic stroke had worse long-term functional outcomes based on worse modified Rankin scores at 90 days than the control group (odds ratio [OR], 2.6; P = .001). Propensity score matching did not account for dementia, the greatest risk factor for brain bleed.
The relative risk of intracranial hemorrhage with apixaban was lower than aspirin (relative risk 0.67 [95% CI, 0.43-1.08]; P=0.10), in 3 randomized controlled trials with 10,626 patients and 74 incident intracranial hemorrhage events. These findings were consistent in sensitivity analyses utilizing alternative statistical estimators, in analyses limited to primary prevention trials, and in analyses utilizing the outcome of hemorrhagic stroke (relative risk, 0.72 [95% CI, 0.39-1.31]; P=0.28).
Thank you, Joe, for sending this article about a mutation that ramps up activity of the enzyme leucine-rich repeat kinase 2 (LRRK2), which disrupts how dopamine-producing neurons are structured and how they communicate. By inhibiting the enzyme for 3 months, mice were able to regain the ability to move like mice without Parkinson's.
Immunoglobulin replacement therapy (IRT) is essential for patients with primary immunodeficiency (PID) and the subcutaneous (cSCIG ) route is better than intravenous (IVIG). Viral infections occurred in 3.79%, among all routes and: IVIG (n = 32, 4.2%), cSCIG (n = 16, 2.5%).
In the June issue of AFP, an article n Nocturia recommends fluid restriction, but that is problematic as so many (35-75%) of older adults are dehydrated. Instead, I recommend to drink fluids earlier in the day. Blood shifting to the lower extremities when getting up, increases fluid capacitance and prevents dizziness and falls early in the day, allowing fluid restriction later in the day. See my presentations on fluid intake, incontinence and UTI for further information.
Here is the link to my Urinary Tract Infection (UTI) presentation if you are interested and missed it on the OMDA call. I address how to read a urinalysis, apply the McGeer criteria and how to have a conversation with the patient, caregiver or provider who requests an unneeded antibiotic. See under media on my website.
