Geriatric Update Jun 8, 2026

In Australia and the US in 2010, the Aspirin in Reducing Events in the Elderly (ASPREE) trial enrolled 19,114 community-dwelling individuals (age ≥65 years, avg 75.7) with no history of cardiovascular disease (CVD). This study matched patients by age, sex, and education, and found that patients who had an adjudicated CVD event, including fatal coronary heart disease (CHD), fatal or nonfatal stroke, and hospitalization for heart failure (HHF), had lower cognitive function starting at between 3 and 8 years before the event when compared to those still without CVD. Those who experienced nonfatal myocardial infarction (MI) were the exception who did not show a preceding cognitive effect. 

People who had been the most fit in middle age lived longer in old age than less-fit people, with fewer of the 11 common and serious age-related conditions diseases, which appeared 1 1/2 years later than in the least fit group. 

Individuals whose metabolomicage exceeded their chronological age faced significantly higher risks of all-cause, vascular, and unspecified dementia, as well as earlier disease onset, vascular dementia (HR = 1.61, 95% CI 1.28–2.02, p = 0.001). Individuals with a high MileAge delta and two APOE ε4 alleles had a 10.3-fold higher all-cause dementia risk (95% CI 7.95-13.34, p < 0.001). This was based on 223,496 UK Biobank participants, age 57, of whom 3,976 developed dementia over 13.7 years.

Twin studies showed heritability of life expectancy to be only 20 to 25%, and recent large pedigree studies suggest it is as low as 6%. However, analyses of twin cohorts raised together and apart to correct for environmental factors revealed that heritability of human lifespan due to intrinsic mortality is above 50%. 

This is a nice summary of the American Heart Association (AHA) updated nutrition guidance for cardiovascular health that builds on it's 2021 guidance and healthful dietary patterns rather than single foods or nutrients, starting heart-healthy eating early in life, at age 1. It continues the shift from meat to plant sources of protein with legumes, nuts, seeds and green leafy vegetables a focus. The new federal Dietary Guidelines for Americans (DGAs) promoted red meat, butter, beef tallow, high protein and 3 servings of full fat dairy , which stands in contrast to its own recommendation to limit saturated fats to 10% of daily calories.

Adopting a healthy plant-based diet, even starting at an older age, 12% (hazard ratio [HR] 0.88; 95% CI 0.85–0.92) was associated with a lower risk of dementia, while a low-quality plant-based diet was associated with a 6% higher risk (HR 1.06; 95% CI 1.01–1.10). 

Medication thromboprophylaxis was associated with relative risk reduction of symptomatic and clinically relevant venous thromboembolism; it increased bleeding and did not affect mortality.

SSRIs antidepressant users (n=110,540) who also used an anticoagulant, and were newly diagnosed with major bleeding, were matched with future cases (mean age 67.7 years). After accounting for the time-trends in exposure, concomitant use did not significantly increase the risk of major bleeding (aOR 1.07, 95% CI 0.89-1.28). Similarly, SSRIs and antiplatelet users, (n=105,464, mean age 58.6 years) did not show significant increase in bleeding risk (aOR 1.10, 95% CI 0.88-1.38), regardless of sex and age.

Discrimination was poor for all risk assessment models (RAMs) in predicting hospital venous thromboembolism (VTE). The area under the receiver operating curve (ROC) was 58.1% for the simplified Geneva score, 53.8% for the original Geneva score, 56.5% for the Padua score, and 55.0% for the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) score. An ROC of 50% is a coin toss, and a good ROC is >80%.

After full adjustment, osteoporosis was associated with a 47% increased risk of mortality (hazard ratio = 1.47, 95% CI: 1.16-1.86). The association was stronger with inverse femoral and trochanteric BMD. Although the receiver operating curve (ROC) for BMD at all femoral sites was greater than that for body mass index, the area under the curve was only 59%.

This UK study of wearable device measurements showed a much higher benefit from vigorous physical activity (VPA) than moderate physical activity (MPA) over 8 years. For a standardized 5%–35% risk reduction, the median MPA equivalent per minute of VPA is 4.1 minutes for all-cause mortality, 7.8 min for cardiovascular mortality, 5.4 major acute coronary events, 9.4 type 2 diabetes, and 3.5 minutes for cancer mortality.

Exercise or nutrition-based prehabilitation reduced complications by half (odds ratio (OR) 0.52. 95% confidence interval (CI):0.35,0.78) and LOS -0.44 days compared to standard treatment in 23 randomized controlled trials. When comparing interventions, nutrition only, had a greater reduction in LOS than exercise only (MD -1.09 days, 95% CI:-1.72,-0.47 vs. MD -0.20 days, 95% CI: -0.51, 0.09; p=0.01). While quality of life (QoL) was not reported in nutrition only RCTs, exercise alone improved QoL measures (standardized mean difference 0.94, 95% CI: 0.24,1.64, p=0.01, I2=93.6%) compared to standard treatment.

Each additional 1,000 steps per day after surgery are linked to 18% lower odds of complications, 16% lower odds of needing readmission to hospital, and 6% shorter hospital stays.

Post-operative cognitive decline was associated with age 6% per year (relative risk [RR]: 1.06, 95% confidence interval [CI] 1.03–1.10 per 1 year increase); delirium doubled the risk (RR: 2.15, 95% CI: 1.35–3.42) and the 3MS (Modified-Mini-Mental) score 5% per point on the 30 point scale (RR 0.95, 95% CI 0.92–0.99 per one point increase). Of the 560 participants (>70, average age 76.7 years) who underwent non-cardiac, orthopedic (81%), gastrointestinal (13%), and vascular surgeries (6%), 24% experienced postoperative delirium. The study did not look at exercise or other modifiable factors but reinforces the risk of post-op delirium for dementia development.

An observational validation study of 174 participants (mean age 66 years; 54% female) showed that a finger stick capillary blood test of p-tau217, validated against venous tests, correlated with episodic memory, attention, and executive function, a reflection of Alzheimer’s disease. Glial fibrillary acidic protein (GFAP) correlated with working memory and executive function as measured by computerized cognitive tests, associated with vascular disease. 

In centenarians, higher level neurofilament light chain (NfL) is associated with worse cognitive function and higher all-cause mortality. There were no significant associations for Aβ42/40 and p-tau181 in 495 Japanese participants, 80.4% women, avg age 104.1 years.

Ultra-brief intermittent theta-burst stimulation (iTBS) of 10 daily sessions (3 minutes and 20 seconds) for 2 weeks provided a time-efficient and effective alternative to standard high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) (20 minutes) over sham iTBS in treating depressive symptoms and anxiety with Parkinson's disease (PD).

A digital behavior change intervention (DBCI) designed to empower older adults (60+, community-dwelling and not frail) to adopt activity, vaccination, medication optimization, interaction and socialization, and diet and nutrition (AVOID) behaviors was shown to prevent frailty. In the 60 Australians, age 75.4 years, the DBCI group had improved quality of life and frailty index (FI) scores over 6 months from 0.135 to 0.115 while the wait-list group's scores worsened from 0.134 to 0.160.

Multidomain adaptive (intervention) versus traditional non-adaptive (positive control) computerized cognitive training  (CCT) showed improved cognitive abilities, health-related quality of life, and anxiety and depression in 224 Chinese patients with coronary heart disease and mild cognitive impairment. Training lasted 30 min/session, five sessions/week, for 12 weeks (both groups) or 24 weeks (intervention only). The adaptive group had better compliance (p=0.009) and significantly increased grey-matter volume compared with the traditional CCT group.

Distinct thyroid trajectory patterns (vs stable thyroid function) were associated with significantly increased all-cause mortality. Stronger associations were observed among men. These thyroid trajectory patterns included:

• increasing thyroid-stimulating hormone (TSH) with stable/decreasing free thyroxine (FT4) (hazard ratio [HR], 1.80, 95% CI 1·57–2·06);

• increasing TSH with increasing FT4 (HR, 2.45 CI 2·01–2·97);

• decreasing TSH with stable/increasing FT4 (HR, 1.94 CI 1·68–2·24); and

• decreasing TSH with decreasing FT4 (HR, 2.45 CI 1·99–3·01)).

When compared with other high-income countries (HIC), circulatory and metabolic diseases accounted for 52% of excess US deaths in 2022. Excess US deaths due to drug poisonings, alcohol and suicide accounted for 24% of the increase in excess US deaths overall, and for most of the increase in excess US deaths for individuals aged 0 to 44 years. In 2022, deaths from drug poisonings were 7.48 times higher in the US than in other HICs. Excess US deaths from COVID-19 (23% in 2021) and other causes also increased.

People’s risk of Lewy body dementia (LBD) nearly quadrupled for each 5 µg/m3 increase in PM2.5 particle pollution exposure, while risk for Parkinson’s disease dementia (PDD) more than doubled (aOR, 2.41; 95% CI, 1.88-3.08). Each 10 µg/m3 increase in NO2 exposure was associated with 95% greater risk of LBD (aOR, 1.95; 95% CI, 1.69-2.27) and 14% greater risk of PDD (aOR, 1.14; 95% CI, 1.01-1.29).

Of 201 participants, age 51, those randomized to tirzepatide had better quality of life than placebo over 72 weeks. The tirzepatide was also correlated with weight loss.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors improve glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM), and in this study also in quality of life (QoL) and patient-reported outcomes (PROs) on SHIELD WQ-9 overall QoL (OR: 2.11; p = 0.005), emotional health (OR: 2.16; p = 0.006), self-esteem (OR: 2.26; p = 0.006) and work performance (OR: 1.99; p = 0.04) when compared with placebo. This included 10 randomized controlled trials of 5,294 patients. 

The SGLT-2 med canagliflozin did not increase risk of first urinary tract infection (UTI) (HR 1.06; 95% CI, 0.93-1.21) or total UTI events (HR 1.01; 0.86-1.18) based on leukocyte esterase (LE) or nitrites (Nit) on urinary dipstick. The study was a drug company sponsored trial of 8,614 participants, age 62. While the authors commented that older adults had higher rates of LE and Nit, they did not sub-analyze older adults or use McGeer or Loeb criteria to identify UTI.

Women aged 18 years or older (avg 48 years) with both at least one UTI-specific symptom (dysuria, urinary urgency, urinary frequency, or suprapubic tenderness) and a positive urine dipstick test for either nitrites or leukocyte esterase were randomly assigned (1:1:1:1) to one of four open label treatments:

• a single 3 g dose of fosfomycin, resolution 59%, adverse events 19.9%;

• two 3 g doses of fosfomycin, resolution 67%, adverse events 26.3%;

• pivmecillinam (400 mg three times per day for 3 days), resolution 70%, adverse events 21.2%;

• nitrofurantoin (100 mg three times per day for 5 days) resolution 74%, adverse events 26.8%.

Nitrofurantoin showed best symptom resolution at 1 week but also the largest side effect events.

The CDC reports 2,020 confirmed measles cases in 40 states vs 1,974 cases in 40 states last week.

The OMDA call on Thu Jun 11 is: Ohio association of advanced practice nurses (OAAPN) HB 508 Update, Summer Davis, Spokesperson

The scientist is not content to stop at the obvious. Charles H. Mayo (1865–1939)