Geriatric Update Jun 23, 2025
The CDC reports 1,214 confirmed measles cases in 36 states, up from 1197 in 35 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.
COVID-19 vaccination during pregnancy was not associated with major structural birth defects, (adjusted prevalence ratio [aPR], 0.96; 95% CI, 0.81–1.13). Findings were unchanged by insurance provider, SARS-CoV-2 infection during pregnancy, and concomitant of other maternal vaccines. No differences in the prevalence of birth defects were observed among vaccinated people by brand (aPR, 1.02; 95% CI, 0.77–1.37). Studies from Israel, Scotland, Scandinavia and the U.S. have similarly found no link between COVID-19 vaccination during pregnancy and birth defects. Thus, our findings are consistent with previously published research.
In patients, age 61, with gout (n=9060), who were propensity matched when starting allopurinol as a long-term urate-lowering therapy, the prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, was associated with a higher risk for major adverse cardiovascular events (MACEs) than the use of colchicine (hazard ratio [HR], 1.56; 95% CI, 1.11-2.17), cardiovascular death (HR, 2.50; 95% CI, 1.14-5.26) and all-cause mortality (HR, 2.00; 95% CI, 1.19-3.45), or no prophylaxis MACE (HR, 1.50; 95% CI, 1.17-1.91) and a 93% higher risk for myocardial infarction (HR, 1.93; 95% CI, 1.35-2.75), whereas the use of colchicine was not associated with risk for MACE or its individual components.
Supervised yoga reduced pain similarly to supervised strengthening exercises for knee osteoarthritis (OA) over the course of 3 months and seemed slightly more beneficial for symptoms of depression in 117 Australian participants aged 40 years or older, avg 62.5 and moderate pain. After 3 additional months of home exercise, yoga conferred modest benefits over strengthening exercises, including better adherence, less stiffness, less pain, and improved quality of life. We have also shown that yoga prevents falls in community living older adults.
A prospective cohort study tested the efficacy of US Department of Health and Human Services Physical Activity Guidelines, which advise Americans to perform a minimum of 150-300 min a week of moderate exercise (MPA) or 75-150 min a week of vigorous exercise (VPA), or an equivalent combination of both. The study followed the results of more than 116,000 US adults for 30 years. Long-term leisure-time VPA guideline (75-149 min/wk) versus no VPA were 0.81 (95% CI, 0.76-0.87) for all-cause mortality, 0.69 (95% CI, 0.60-0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79-0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150-299 min/wk) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. More than 300 min per week, which is about 1 hour a day, did not provide additional benefits.
Over 2 million patients with obesity and / or diabetes but not osteoarthritis, were 1:1 propensity score matched to balance GLP-1-RA use by age, sex, race, body mass index, and hemoglobin A1c, but not activity level. The article reports increase in OA based on outcome measure of joint injection that was higher in the GLP-1-RA group, but no differences between knee or hip replacement surgery. Many people who lose weight become more active and notice their joint aches.
Two patients who used GLP-1 RAs at less frequent dosing schedules than recommended; patient 1 with obesity and prediabetes self-administered 7.5 mg tirzepatide every 10-14 days, whereas patient 2 with uncontrolled type 2 diabetes managed intermittent dosing of 15 mg tirzepatide due to supply shortages. Patient 1 achieved an additional 13.7% body weight loss over 7 months and maintained it thereafter. Patient 2 lost 30% of her body weight and safely stopped insulin; even with intermittent dosing of tirzepatide, she retained a 22.8% body weight loss from baseline.
Compared with placebo, weekly tirzepatide (TZP) 15 mg gained 0.69 quality adjusted life years (QALYs), 0.58 life-years and a cost saving of $1409. TZP 10 mg QW gained 0.60 QALYs, 0.49 life-years and increased costs by $1855, resulting in an incremental cost-effectiveness ratio (ICERs) of $3092 per QALY in the US.
Patients exposed to GLP-1 RAs showed a higher incidence of neovascular age-related macular degeneration (AMD) than unexposed patients (0.2% vs 0.1%) HR, 2.11 (95% CI, 1.58-2.82; adjusted: HR, 2.21; 95% CI, 1.65-2.96). While it is statistically significant, the low risk of 0.2% vs. 0.1% is miniscule compared to the great weight loss benefits of the medication on multiple organs systems, life expectancy and diseases.
Average weight loss reached 16.7% after 64 weeks’ use of the digital health platform, Embla ($150/month), which combines lower, tailored semaglutide dosing 1 mg/wk with intensive behavioral therapy delivered via an app vs. 2.4 mg/wk in clinical trials of semaglutide.
Weight regain was significantly less with patient-to-patient treatment than standard-of-care treatment (led by professionals) (month 6: -1.44 kg [95% CI, -2.35 to 0.54] vs -0.16 [95% CI, -1.13 to 0.82]; month 12: 0.04 kg [95% CI, -0.86 to 0.95] vs 0.77 [95% CI, -0.21 to 1.47]; month 18: 0.77 kg [95% CI, -0.14 to 1.68] vs 2.37 [95% CI, 1.40 to 3.34]; P = .002). Parallel findings were observed for diastolic blood pressure, heart rate, physical activity, and sedentary behavior.
Risk of recurrence of atrial fibrillation (AF) after ablation was substantially reduced with a glucagon-like peptide 1 (GLP-1) compared to use of DPP-4 or sulfonylureas. According to the presentation at the Heart Rhythm 2025 conference, AF hospitalization, an AF-related procedure, or all-cause mortality was reduced by 13% (OR, 0.87; P = .03) over 3 years of follow up.
Recurrence risk after AF-related stroke is high, with an estimated 1 in 6 patients at 5 years. Recurrence risk was 7.20% per year after stroke despite anticoagulation.
Ageism is a problem. Only about 30% of older adults with a new diagnosis of late-onset rheumatoid arthritis (RA) are started on any kind of disease modifying anti-rheumatic drug (DMARD) within the first year, despite the fact that DMARDs (methotrexate, hydroxychloroquine, or sulfasalazine) are standard of care, and are relatively safe and effective in older adults. In comparison, about 80% of younger adults diagnosed with RA are started on DMARDs after diagnosis. Despite of physicians hesitancy initiating DMARDs, older adults with late-onset RA are still getting striking amounts of steroids.
In patients, age 61, with gout (n=9060), who were propensity matched when starting allopurinol as a long-term urate-lowering therapy, the prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, was associated with a higher risk for major adverse cardiovascular events (MACEs) than the use of colchicine (hazard ratio [HR], 1.56; 95% CI, 1.11-2.17), cardiovascular death (HR, 2.50; 95% CI, 1.14-5.26) and all-cause mortality (HR, 2.00; 95% CI, 1.19-3.45), or no prophylaxis MACE (HR, 1.50; 95% CI, 1.17-1.91) and a 93% higher risk for myocardial infarction (HR, 1.93; 95% CI, 1.35-2.75), whereas the use of colchicine was not associated with risk for MACE or its individual components.
Blood-based test demonstrated acceptable accuracy for colorectal cancer detection, with sensitivity of 79.2% (57/72; 95% CI, 68.4%-86.9%), but for advanced precancerous lesions was only 12.5% (321/2567; 95% CI, 11.3%-13.8%), in an average-risk colorectal cancer screening population. Additionally, it doesn't allow for removal of polyps that would stop colorectal cancer progression.
A blood test for DNA fragments shed by tumors predict if melanoma survivors will have a future recurrence of 80% and cancer returned more than four times faster in this group than in patients with melanoma and no detectable DNA fragments in blood. And the higher the levels, the faster their cancer returned. Droplet digital PCR measurements of ctDNA to assess minimal residual disease before adjuvant targeted therapy and during follow-up can identify patients at high risk of early recurrence.
Testing for thyroid disease in older adults needs different levels than the standard deviation of population mean, which lab values are based on. Adding subgroup differences according to age, sex, or race, reduced by half the number of persons eligible for L-thyroxine, a treatment for hypothyroidism.
In the TEARS study, a retrospective population analysis of prescription data from 999 patients who were taking levothyroxine, iron, calcium, proton pump inhibitors and estrogen all resulted in a statistically significant increase in serum TSH concentration of 0.22 mU/l (P < 0.001), 0.27 mU/l (P < 0.001), 0.12 mU/l (P < 0.01), and 0.08 mU/l (P < 0.007), respectively, and a decrease of 0.17 mU/l for statins, consider recheck 6-8 weeks after starting them.
In older adults, age 82, and 32% frail, with non-ST elevation myocardial infarction (NSTEMI), an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction than a conservative strategy over a median follow-up of 4.1 years. Primary outcome, MI, CV mortality, occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P=0.53) Procedural complications occurred in less than 1% of the patients.
Last month I reported on a review that showed similar results: In older patients (≥ 70 years) with non-ST segment elevation acute coronary syndromes (NSTE-ACS), reported clinical outcomes with invasive versus conservative strategies were not different for all-cause death, cardiovascular death, stroke, and major bleeding.
Sleep parameters associated with a significantly increased risk for dementia included: changes in sleep efficiency (OR, 2.2), wake after sleep onset (OR, 2.3), nap duration (OR, 2.0), and nap frequency (OR, 2.2), in 733 women age 82.5 over 5 years. No significant associations were found between dementia risk and total sleep time and circadian rest-activity rhythm parameters. Similarly, no associations were found between MCI risk and sleep-wake change profiles or any individual parameter.
A low-density lipoprotein cholesterol (LDL-C) level below 70 mg/dL was associated with a 26% reduced risk of all-cause dementia and a 28% lower risk of Alzheimer’s disease-related dementia (ADRD), with statin use further decreasing that risk
The OMDA conference on Thu June 26th at 8 am is: Topic TBD, by Barb Bull, RN, JAG Healthcare
Happy National Hydration Day. To learn more about the importance and need of hydration in older adults, visit my website for the presentation.
