Geriatric Update Jun 2, 2025
The CDC reports 1088 confirmed measles cases in 33 states, up from 1046 in 31 states last week. This slowing may be due to less heat and dry air in homes, leading to less airborne transmission, similar to COVID. No new updates on the Ohio Department of Health website.
CIDRAP’s podcast by Dr. Osterholm addressed the plan to test all vaccines against placebo (start at 8 min): all vaccines have been tested against placebo and subsequent vaccines against previous ones because it would not be ethical to compare it against effective existing vaccines, e.g. Polio vaccine by Sabin was tested against the Salk vaccine, which had previously been tested against placebo as no other polio vaccine was developed. This spreadsheet lists the 219 vaccine approval studies, of which 111 are placebo controlled, the rest against active control.
Early intensive lifestyle intervention (ILS) is most effective in delaying type 2 diabetes progression among those with higher baseline HbA1c, whereas metformin treatment effects tend to be greater among younger patients than older patients, over 21 years in the US Diabetes Prevention Program randomized clinical trial. Diabetes incidence rate was reduced in the ILS group (hazard ratio [HR] 0C76 [95% CI 0.68 to 0.85], with median diabetes-free survival of 3.5 years. In the original metformin group (HR 0.83 [0.74 to 0.93], RD –1.17 [–1.85 to –0.49]), with diabetes-free survival of 2.5 years.
In 47,513 women, intakes of total and high-quality carbohydrates, from whole grains, fruits, vegetables, legumes, and total dietary fiber in midlife were associated with increased odds of healthy aging and several domains of positive health status in older adulthood (OR, 1.31; 95% CI, 1.22-1.41). Conversely, refined carbohydrate intake was associated with lower odds of healthy aging (OR, 0.87; 95% CI, 0.80-0.95). A higher glycemic index (OR, 0.76; 95% CI, 0.67-0.87) and carbohydrate-to-fiber ratio (OR, 0.71; 95% CI, 0.62-0.81) were inversely associated with healthy aging when comparing extreme quintiles.
Two weeks ago I mentioned that a meta-analysis of colchicine reduced the incidence of major adverse cardiovascular events by 25%. In a systematic review and study-level meta-analysis of randomized controlled trials including 30,659 patients with known coronary artery disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12% relative risk (RR) 0.88 [95% confidence interval (CI) 0.81-0.95. Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10-1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death.
Sustained weight loss of about 6.5% of body weight without medications or surgery (because these interventions were not available) in middle-aged people led to lower chronic diseases and mortality in 3 Finnish studies: Whitehall II study (WHII; baseline, 1985-1988), with weight loss had a decreased risk of developing chronic disease (hazard ratio [HR], 0.52; 95% CI, 0.35-0.78) compared with participants with persistent overweight, after adjusting for smoking, systolic blood pressure, and serum cholesterol at the first evaluation. In the Helsinki Businessmen Study (HBS; baseline, 1964-1973) HR was 0.43 (95% CI, 0.29-0.66) over a median (IQR) follow-up of 12.2 (8.2-12.2) years, and the Finnish Public Sector study (FPS; baseline, 2000) decreased mortality (HR, 0.81; 95% CI, 0.68-0.96) during an extended follow-up (median [IQR], 35 [24-43] years).
The 2024 report of the Lancet standing Commission added 2 more risk factors for dementia: vision and cholesterol. Specific actions to reduce dementia risk across the life course by the Commission, with several specific actions across the 14 risk factors:
Ensure good quality education is available for all and encourage cognitively stimulating activities in midlife to protect cognition
Make hearing aids accessible for people with hearing loss and decrease harmful noise exposure to reduce hearing loss
Treat depression effectively
Encourage use of helmets and head protection in contact sports and on bicycles
Encourage exercise because people who participate in sport and exercise are less likely to develop dementia
Reduce cigarette smoking through education, price control, and preventing smoking in public places and make smoking cessation advice accessible
Prevent or reduce hypertension and maintain systolic blood pressure of 130 mm Hg or less from age 40 years
Detect and treat high LDL cholesterol from midlife
Maintain a healthy weight and treat obesity as early as possible, which also helps to
Prevent diabetes
Reduce high alcohol consumption through price control and increased awareness of levels and risks of overconsumption
Prioritize age-friendly and supportive community environments and housing and reduce social isolation by facilitating participation in activities and living with others
Make screening and treatment for vision loss accessible for all
Reduce exposure to air pollution
A third (37%) of U.S. dementia cases are linked to eight conditions: diabetes, heart failure, atrial fibrillation, coronary artery disease, heart attack, stroke, high blood pressure and high cholesterol. Dementia cases were most strongly associated with stroke, with a 2.2-times higher risk, followed by heart failure (2.1 times increased risk) and high blood pressure (78% increased risk), and high cholesterol the weakest (27% increased risk). People living in the South were at greater risk for dementia, caused in part by heart problems, stroke or diabetes.
Among 838 older patients with dementia receiving the following medications for agitation: haloperidol (n = 117), droperidol (n = 129), lorazepam (n = 350), midazolam (n = 68), olanzapine (n = 101), quetiapine (n = 56), and ziprasidone (n = 17), adverse events were most common among patients receiving midazolam (53%; 36/68). Relative to haloperidol, midazolam significantly increased the risk for any adverse events (OR 5.25 [95% CI: 2.64–10.45]). Quetiapine was the only drug observed to have a lower frequency of adverse events (OR 0.27 [95% CI: 0.08, 0.97]).
In cognitively intact patients who underwent Aβ PET, positron emission tomography, age 65, a negative result, no amyloid (Aβ) detected, was associated with reductions in all emotional parameters compared to baseline (p < 0.001). Elevated Aβ disclosure was found in 21 of the 199 patients, age 80, and was associated with no changes in depression or memory complaints and a modest decrease in anxiety and, motivation to change lifestyle (p < 0.048). This last point of decreased motivation to change lifestyle was surprising, and present in both groups.
Age is the biggest nonmodifiable risk factor for age-related macular degeneration (AMD), while genetics accounts for 71%. For modifiable risk factors, smoking increases risk 2-3 fold, depending on study type, exercise reduces risk 40%, vitamins reduced risk by 25% and mediterranean diet by 21-31% depending on outcome measured (progression from various stages and drusen).
Of 1733 reports of GLP-1 associated ocular (eye) adverse drug events between 2004- 2024, >50% were nonserious, occurred in those aged 45-64 years, occurred within the first month of administration, with the median time to onset 3.5 days, and more in women 62.72% than men 33.47%.
After chemotherapy, patients with colon cancer randomized to 3 years of exercise (445 patients) vs. health-education group (444 patients), had lower disease recurrence, new primary cancer, or death, 0.72; 95% confidence interval [CI], 0.55 to 0.94; P=0.02) at a median follow-up of 7.9 years. The 5-year disease-free survival was 80.3% in the exercise group and 73.9% in the health-education group (difference, 6.4% ; 95% CI, 0.6 to 12.2) or 1 death for 14 people exercising,. The 8-year overall survival was 90.3% in the exercise group and 83.2% in the health-education group (difference, 7.1%; 95% CI, 1.8 to 12.3). Musculoskeletal adverse events occurred more often in the exercise group than in the health-education group (in 18.5% vs. 11.5% of patients).
Cruciferous vegetable consumption (broccoli, cauliflower or cabbage family vegetables) improved postprandial glycemic control compared with root/squash vegetables, in a 2-week dietary intervention (300 g/day cruciferous [active] and root/squash [control] soups with standardized lunch/dinner meals) separated by a 2-week washout in 18 participants, age 68. This makes sense and supports recommendations of 50% non-starchy vegetables, 25% plant and/or fish protein, and 25% carbohydrates including, fruits, rice, pasta, starchy vegetables, such as carrots, sweet potatoes, corn, etc.
GLP-1 meds effects on the skin, improve wound healing, psoriasis, and hidradenitis suppurativa (HS). Obesity is a major driver of all, and 48% of people with psoriasis and psoriatic arthritis have obesity. GLP-1 weight loss reduced inflammation, improved lesion severity and quality of life. The effect on HS is also published in this systematic review.
In giant cell arteritis, upadacitinib 15 mg, a selective Janus kinase (JAK) inhibitor that blocks the signaling of several cytokines, including interleukin-6 and interferon-γ, produced more sustained remission at week 52 than placebo after a 26 week steroid taper (46.4% [95% confidence interval {CI}, 39.6 to 53.2] vs. 29.0% [95% CI, 20.6 to 37.5]; P=0.002). Cost is >$6,000 a month.
30 patients, age 55, with knee pain from osteoarthritis were treated with a transcutaneous auricular (to the ear) vagus nerve stimulation (tVNS) device for an hour, 11 felt a noticeable improvement in their knee pain following the treatment. Compared to baseline, knee pain was reduced by 27%, 1.27 (95 % CI, −1.74, −0.80) immediately after and by 87%, 1.87 (−2.33, −1.40) 15 min after tVNS. Wrist pressure point threshold and a weighted probe applied at a frequency of 1 Hz for 10 s did not affect knee pain.
Exercise improved erectile function more than 3-fold over usual care (3.5; 95% CI, 0.3-6.6; P = .04). The 112 Australian men, age 66.3, participated in 20-30 min moderate to vigorous aerobic and resistance training 3 days per week for 6 months. Effects were largest in the radiotherapy and androgen deprivation therapy compared with the prostatectomy subgroup. Brief psychosexual education with self-management did not result in additional improvements.
Sexual dysfunction is a common side effect of SSRI and other antidepressants, 14% by self-report and 58% when asked. Saffron has been used in Iran, which produces 90% of it, for sleep, melancholy and sexual well-being. A presentation at the psychiatry conference, described by Medscape, summarized 5 studies. In women, 30 mg of saffron daily showed greater improvements in arousal (mean difference vs placebo: −0.72; 95% CI, −1.36 to −0.08; P = .028) and lubrication (mean difference, −1.08; 95% CI, −2.02 to −0.08; P = .035) and experienced less pain during intercourse (mean difference, −1.34; 95% CI, −2.42 to −0.26; P = .016). A study in men showed that 5 mg of saffron twice daily improved Erectile Function on a scale by 7.0 (95% CI, 4.2-9.7; P < .001). They also reported higher intercourse satisfaction (mean difference, 2.3; 95% CI, 1.1-3.5; P = .001) in 30 men, age 32. Dosages above 5 g are considered unsafe and may lead to nausea, diarrhea, constipation, dizziness, anxiety, uterine contraction, and serotonin syndrome with increased blood pressure. In older men, delayed ejaculation is an additional issue that can be treated with Gingko or Wellbutrin an hour before intercourse, which raise dopamine levels. The mechanism of saffron is unclear, but may affect the serotonin system, however, in the 5 presented studies, depression ratings were not affected between the randomized groups.
Advanced care planning (ACP) documentation was greater in the intervention phase compared with the usual care phase (adjusted rate difference, 6.8% [95% CI, 2.8%-10.8%]; P < .001), in a cluster randomized clinical trial using an open cohort design, of 13,800 patients, age 74.5 in 29 oncology clinics of 3 health care systems of the US South, Midwest, and Mid-Atlantic regions. Palliative care, 9.6% [1517 of 15 754]; hospice, 5.4% [847 of 15 754]; and limitation of life-sustaining treatments 8.4% [1149 of 13 603], were not different from the usual care groups.
The development of electronic artificial urinary sphincters is hopeful control of incontinence for those who cannot do Kegel exercises, or in whom they are not enough.
This presentation on cannabis at the American Geriatrics Society conference addressed current evidence on benefits and adverse effects, drug interactions, and differences between THC and CBD.
Thank you, Tim, for the article of a relatively large bacterium that adds a piece to the puzzle of evolution. At 9000 micrometers it is almost a centimeter and visible with the naked eye. Segregation of chromosomes into daughter cells, compartmentalization of genomic material active transport throughout the cell and organelles bound by bioenergetic membranes, such as ribosomes, are early features of eukaryotes, cells of plants and animals.
New medical therapies generated 48% of the 3.3-year increase in life expectancy in the US between 1990 and 2015. Years of life are valued at roughly between $100,000- $200,000 per year. Even using the lower value in calculations, the lost health from the NIH cuts translates into more than $8.2 trillion (see detailed calculations in the article. In comparison, over 25 years, the proposed annual savings of $20 billion amounts to $500 billion in budgetary reductions. Not to mention the economic benefits of medical developments for the USA.
Removing fluoride from public water in the U.S. would lead to 25.4 million excess decayed teeth in children and adolescents within five years, along with $9.8 billion in health care costs. After 10 years, these impacts would more than double to nearly 54 million excess decayed teeth and $19.4 billion in costs. The IQ lowering is not a concern with the current amounts of fluoride in supplemented water, 0.7 milligrams per liter (mg/L), after the level was lowered in 2015.
The OMDA conference, CMD credit provided free, on Thu June 5th at 8 am is: The Challenges of Residents with SMI in Long Term Care...what could change to make things better, by Jim Griffiths, CEO, JAG Healthcare, Barb Bull, RN JAG Healthcare
