Geriatric Update Jun 1, 2026

Of 2098 adults with prediabetes, age 60, the 618 with ApaI AA alleles of the vitamin D receptor exhibited no decrease in developing diabetes with daily 4000 IU vitamin D3 (hazard ratio [HR], 1.02 [95% CI, 0.72-1.44]) when adjusted for study site, race and ethnicity, sex, baseline age, body mass index, usual physical activity, statin use, and weight change. In contrast, 1480 participants with ApaI AC and CC genotypes showed a 19% decrease in the risk of diabetes with vitamin D3 (HR, 0.81 [95% CI, 0.66-0.99]).

I patients with newly diagnosed type 1 diabetes, T cell-targeted immunotherapy provides sustained preservation of ß-cell function and improvements in HbA1c levels and insulin requirements for at least 24 months, the younger, <18 years, the better the outcome.

Falls in hospitals are common and trials of interventions that include integration with the local setting, tailoring approaches to the needs and abilities of patients, and engaging patients and/or their family or carers may reduce the rate of falls (RaR 0.68, 95% CI 0.55 to 0.84; I² = 23%; 12 trials, 18,183 participants; low-certainty evidence). Other interventions, including exercise did not reduce falls in the hospital. 

The VIVIFRAIL exercise program was feasible for older adults residing in nursing homes and significantly improved frailty status, health indicators, activities of daily living and quality of life over 3 months.

A 12-week group-based multi component exercise program incorporating peer interaction and self-efficacy strategies showed greater reductions than usual care in physical frailty (risk difference [RD] = -13.23%; 95% CI: -21.68% to -4.78%; P = .002), psychological frailty (RD = -13.87%; 95% CI: -25.04% to -2.69%; P = .015), cognitive frailty (RD = -18.98%; 95% CI: -28.17% to -9.79%; P < .001), and multidimensional frailty (RD = -17.79%; 95% CI: -29.21% to -6.36%; P = .002), but not social frailty over 24 weeks in 156 randomized participants, age, 69 years.

From 2009-2023, there were 402 tetanus cases reported to the CDC in 47 states and the District of Columbia, with 16 states reporting 37 tetanus-associated deaths. Most tetanus deaths (85%) occurred in adults age >65, with a case-fatality rate of 30.8% in those ages 65-79 and 63.3% in those ages 80 and older. Remember to give TDaP to also prevent pertussis, also called the 100-day cough, and to reduce transmission to grandchildren and great-grandchildren.

Systematic review and exploratory network meta-analysis (NMA) of 4 randomized controlled trials of 16,823 hypertensive older adults without dementia at baseline, showed that antihypertensive treatment significantly improved cognitive function scores (SMD, 0.06; 95% CI, 0.03-0.09), and a trend toward reduced dementia incidence (OR, 0.89; 95% CI, 0.76-1.05) which did not reach statistical significance due to short follow-up of 2.0-3.9 years.

Intensive BP control (< 130/80 mmHg) reduced stroke (RR: 0.64; 95% CI: 0.51-0.81) and major cardiovascular events (RR: 0.86; 95% CI: 0.72-1.03) with no significant differences in mortality or heart-failure hospitalization. The meta-analysis included 12 trials with 24,308 participants with diabetes.

People who consumed the most non-antioxidant preservatives had a 29% greater risk of high blood pressure and a 16% greater risk of heart attack, stroke and angina, those who consumed more antioxidant preservatives were also 22% more likely to develop high blood pressure. The eight preservatives tied to high blood pressure include sodium nitrite, potassium sorbate and citric acid, and found that ascorbic acid (vitamin C) was specifically linked to heart disease. I think that preservatives are only a piece of the processed food puzzle that raises risk, and I would not want people to stop vitamin C supplements if they do not eat any fresh fruits and vegetables.

Participants with migraine had a lower risk for both all-cause dementia (hazard ratio [HR], 0.70; 95% CI, 0.51-0.95) and Alzheimer’s dementia (AD) (HR, 0.58; 95% CI, 0.40-0.85) than those without migraine. During the 9.4-year follow-up, 491 of the 6888 participants, age 66, developed dementia (incidence rate, 7.9 per 1000 person-years at risk), of whom 379 (77%) had AD. Consistent protective effects of migraine were observed in women (HR, 0.69 for dementia; HR, 0.55 for AD) but did not reach statistical significance in men.

A single dose of psilocybin was associated with rapid antidepressant effects, observed by day 2 (mean difference, −9.58; 95% CI, −16.05 to −3.11; P = .004) and persisting for more than 3 months (mean difference, −6.60; 95% CI, −13.01 to −0.19; P = .04); psilocybin was generally well tolerated, but some individuals required additional support after dosing due to anxiety.

A cohort study of 6064 patients with low-risk pancreatic cystic lesions (PCLs) followed up for 20 145 person-years, pancreatic cancer incidence was 1.89 cases per 1000 person-years, approximately 14-fold higher than the general population rate of 0.14 cases per 1000 person-years. 31.6% of cancers arose outside the cyst site; 26.3% occurred more than 5 years after PCL detection.

Colorectal cancer is treatable with early identification by colonoscopy, fecal immunochemical test (FIT) or other screens. Patients randomized to receive 3 automated, 1-way text message reminders on days 2, 5, and 8 (intervention) vs a single nurse-led telephone call reminder on day 8 had higher FIT completion 58.9% vs 49.8%. This will save significant staff time for a topic many would rather not discuss.

In 136 men >40 years old with prostate cancer, 2 years after radical prostatectomy, undetectable PSA and hypogonadism, testosterone replacement therapy 100 mg, or placebo intramuscularly weekly for 12 weeks significantly improved sexual activity, sexual desire, physical function, and peak aerobic performance (VO2 peak) compared to placebo In this randomized trial, without biochemical recurrence during treatment on the 3-month follow-up. however, the trial was neither long enough nor large enough to evaluate clinical recurrence or long-term safety, and excluded men on androgen deprivation therapy. 

In a TriNetX database review of 841,831 propensity score matched patients with breast cancer (BC), age 69.1, patients with obesity, on GLP-1 vs no GLP-1 were associated with 2/3 lower hazard of all-cause mortality (HR, 0.35; 95% CI, 0.21-0.58; P < .001) and BC recurrence (HR, 0.44; 95% CI, 0.30-0.64; P < .001) over a 10-year follow-up period. Among patients with T2D, GLP-1 RAs vs insulin or metformin were associated with lower hazard of all-cause mortality (HR, 0.09; 95% CI, 0.06-0.15; P < .001) and recurrence (HR, 0.33; 95% CI, 0.21-0.50; P < .001). No significant differences were observed between GLP-1 RA and sodium-glucose cotransporter 2 inhibitor groups. This is encouraging, and the insulin comparisons were not surprising because insulin is a growth factor, but I would have liked to have seen a separate comparison of GLP-1 with metformin, which also lowers weight. 

34.6% of cancer survivors reported receiving advice on controlling weight (33.7% from 2011-2014; 34.3% from 2017-2020), 46.6% on increasing physical activity (47.2% from 2011-2014; 44.9% from 2017-2020), 32.8% on watching or reducing salt/sodium intake (33.9% from 2011-2014; 32.6% from 2017-2020) and 35.7% on watching or reducing fat/energy in diet (33.6% from 2011-2014; 34.7% from 2017-2020). Older adults and those with obesity had greater odds of getting any lifestyle advice.

Clinician-directed nudges improve Goals of care discussions (GOCDs) documentation (OR 3.30, 95% CI 2.40-4.53). Multicomponent interventions with a nudge component had larger effects than nudges alone (OR 4.03 vs. 1.89; P = .03) and improved quality of communication (2/2 studies) and reduced readmissions (2/2), with inconsistent effects on palliative care referrals (5/19) and no impact on hospital length of stay (0/5), in a meta-analysis of 51 studies between 2004 and 2024.

 The FDA has published voluntary firm-initiated recalls of 2 lots because of quality issues:

• Metoprolol Succinate Extended-Release 25 mg tablets (NDC 67877-590-01), lot #25140859

• Enalapril Maleate 20 mg tablets (NDC 64980-688-10), lot #GEH25023

This might be an opportunity to reevaluate the need for metoprolol and switch enalapril (half-life 11 hours) to a longer acting ACEI.

The Centers for Disease Control and Prevention (CDC) has issued a health advisory about hantavirus, usually transmitted by rodents and causes hemorrhagic fever with renal syndrome (HFRS), that testing is available. As of 22 May, 11 cases have been reported in total, including 9 confirmed and 2 probable cases with 3 deaths. Andes virus, a type of hantavirus endemic in South America, is the only type of hantavirus that is known to spread from person to person by prolonged close contact and causes hantavirus pulmonary syndrome (HPS). Since the case count is not rising, there seems to be no further person to person transmission.

The 2018-2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome in Argentina showed an R0 (a measure of transmissibility) of 2.12 and after quarantine measures 0.96 (<1 causes the virus to die out due to low transmission). Patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission.

As many as 15 different kinds of rodents – including the deer mouse – that carry hantavirus are most commonly found in Virginia, Colorado and Texas. But to put it into context, the CDC, reported 890 cases of hantavirus in the U.S. since health officials started tracking it in 1993. The majority have occurred out West, with Colorado and New Mexico reporting more than 120 cases each. Ninety-two cases have been reported in Arizona, 79 in California, and Virginia 2 cases, one in 1993 and another in 2021. 

After restructuring the Health and Human Service agency (HHS), Robert F Kennedy, Jr. fired the vice chairs of the USPSTF “The decision to terminate the two United States Preventive Services Task Force (USPSTF) leaders was made to ‘avoid uncertainty that could jeopardize the validity of future Task Force actions,’ the letters state.” Additionally, “They note that it was an administrative decision and didn’t reflect the performance of the two leaders.” The American Medical Association (AMA): “is extremely concerned by today's HHS decision to remove the vice-chairs of the USPSTF. The task force serves an essential, non-partisan role in making evidence-based recommendations on clinical preventive services and screenings that physicians rely on to prevent disease.” And the Osteopathic Association wrote: “Access to evidence-based preventive services is central to delivering whole-person care and supporting long-term patient wellbeing. Representing more than 207,000 osteopathic physicians (DOs) and medical students in the U.S., we are deeply concerned by the abrupt dismissal of the USPSTF Vice Chairs and political interference in the USPSTF process.”

The CDC reports 1,974 confirmed measles cases in 40 states vs 1,943 cases in 40 states last week.

“I don’t meditate to improve my mental acuity, to lower my blood pressure, reduce my stress slow down the effects of aging. Sure, all those things can be byproducts of meditation. The goal for my meditation practice is to let myself be filled, over and over, so that I can act as a streaming, saturated sponge, leaking Love in a dry and dusty world. Therese DesCamp