Geriatric Update June 15, 2026
The combination of eMTBR-tau243 (plasma endogenously cleaved microtubule-binding region tau containing residue 243) and phosphorylated tau at threonine 217 expressed as a percentage of its unphosphorylated form (%p-tau217) correlated better with fluid- and PET-based dementia than using %p-tau217 alone. In this cohort of 872 patients, age 72.8 years, 516 [59.2%] were apolipoprotein E [APOE-E4] carriers, while the national percentage of APOE-E4 carriers is 25%. For most of us, the p-tau217 test is fine.
Lower respiratory tract infections (LRTIs) occurred more frequently among 522 Chinese participants with frailty, average age 82, with overall occurrence 20.9% vs 9.4% after adjusting for confounders (adjusted HR, 1.29; 95% CI, 1.10–1.52). Frailty was particularly strongly associated with LRTIs in participants with albumin levels <4.5 g/dl, or 45 g/L (HR 1.40; 1.18-1.66).
An initial UK Biobank analysis found that sarcopenia, lower grip strength, and slower walking pace were associated with a higher risk of incident stroke. Mendelian randomization analysis only supported a causal protective effect for fast walking pace, odds ratio 0.94 (95% CI, 0.90–0.97; P<0.001), while there was no causal protective effect for grip strength.
Patients with schizophrenia had a significantly elevated risk for Parkinson's Disease (PD) compared with matched control individuals (adjusted hazard ratio [aHR], 3.20; P < .001). Antipsychotics risperidone (aHR, 1.20; P < .001) and quetiapine (aHR, 0.95; P = .0317) seemed to have little effect in this retrospective cohort study of 42,522 adults with schizophrenia, mean age 66 years. I am not surprised at the high prevalence, as other neurodegenerative diseases such as dementia are also associated with schizophrenia (adjusted odds ratio [AOR], 4.7; 95% confidence interval [CI], 4.4-5.1).
Patients who were exposed to liothyronine (LT3) plus levothyroxine (LT4) had a 43% higher risk for any psychiatric morbidity (adjusted hazard ratio [aHR], 1.43; P < .001), anxiety (aHR, 1.44; P <.001) and psychotic morbidity (aHR, 1.46; P = .0067) when compared with those exposed to LT4 only. Women and patients <30 years (aHR, 1.91; P = .012) had an even higher risk for psychotic morbidity.
In patients with acute sinusitis, there was no difference in treatment failure between amoxicillin-clavulanate vs amoxicillin (3.0% vs 3.1%; risk ratio [RR], 0.96 [95% CI, 0.92-1.01]). In the 521,244 propensity score-matched patients age 18-64 years, there were significantly more yeast and C. diff (Clostridioides difficile) infections in the amoxicillin-clavulanate group.
Among people >60 years, 71.6% have hypertension in the US, 51.2% reported taking blood pressure–lowering medication and only 20.7% had controlled hypertension, defined as systolic blood pressure below 130/80 mm Hg. 90% reported at least one side effect commonly associated with antihypertensive medications. Commonly reported symptoms were fatigue (70%), urinary frequency (56%), dizziness (43%), leg swelling (37%), cough (34%), and sexual symptoms (24%).
Project Life Force (PLF), a group intervention that augments suicide safety planning (SSP) with skills training (10- to 12-session, 75-90 minutes per session) in 207 VA patients, age 46, had a lower hazard of actual suicide attempts over 1 year (HR, 0.49; 95% CI, 0.26-0.92; P = .03) than usual care. Time to suicidal behavior, however, was not different between groups.
In 254,720 Medicare beneficiaries with newly diagnosed metastatic cancer, broad genomic profiling (BGP) use was significantly higher among fee-for-service Medicare than Medicare Advantage enrollees, AOR 1.08 [95% CI, 1.06-1.10]). This was the case even for cancers with explicit guideline recommendations for BGP.
American Cancer Society Guidelines for Colorectal Cancer Screening, simplified:
Start Screening at age 45.
People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through age 85.
People over age 85 should no longer get colorectal cancer screening.
Stool-based tests:
Highly sensitive fecal immunochemical test (FIT) every year
Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
Multi-targeted stool DNA (mt-sDNA) test (original or next generation) every 3 years
Multi-targeted stool RNA (mt-sRNA) test every 3 years.
Visual (structural) exams of the colon and rectum:
Colonoscopy every 10 years
CT colonography (virtual colonoscopy) every 5 years
Sigmoidoscopy every 5 years.
Blood-based screening tests are not preferred screening options at this time because they don't detect precancerous growths and therefore cannot prevent cancer.
However, this might change soon. Shield is a blood test that detects DNA mutations that happen in cancer cells (somatic mutations) and changes in the chemical structure of DNA that can indicate someone has colorectal cancer.
Machine learning of nearly 3,000 proteins from the UK Biobank identified a 14-protein blood test that can predict and prevent lung cancer more than 5 years before it would be diagnosed. The proteins are produced in healthy lung tissue in response to early tumorigenesis. The signature stratifies benefit from anti-IL-1β lung cancer prevention, reducing the number needed to treat from 1500 to 50.
Among 1,463,996 patients with non-small cell lung cancer (NSCLC), adjusted 3-year overall survival (OS) increased from 24% to 51% in the 79,027 Veterans Health Administration patients and from 24% to 41% in the 1,384,96 National Cancer Database participants between 2007 and 2019. An integrated, publicly funded system is associated with greater and more rapidly improving survival than a fragmented private health insurance or Medicare system.
Adults who quit vs. did not quit smoking during follow-up demonstrated a 16% lower risk for developing dementia (hazard ratio 0.84, 95% CI 0.73–0.95). This is similar to the 21% decreased risk in those who quit smoking before baseline (HR = 0.79, 0.72–0.87) and the 25% decreased risk in those who never smoked (HR = 0.75, 0.69–0.83). These benefits were observed in those who gained no weight or <5 kg after quitting but were not significantly different in those who gained >10 kg after quitting.
Excess weight is a key modifiable risk factor for breast cancer. GLP-1 exposure was associated with a lower incidence of breast cancer (OR 0.649, 95% CI 0.569-0.741; p < 0.0001). In the matched logistic regression (30,528 observations; 600 cancer cases), GLP-1 exposure was also associated with a lower breast cancer incidence (OR 0.695, 95% CI 0.590–0.819; p < 0.0001).
A Cochrane review of 6 trials with a total of 789,086 randomized participants found that prostate cancer screening (PSA) likely reduces prostate cancer-specific mortality (Rate Ratio 0.87, 95% CI 0.80 to 0.95) and may reduce overall mortality (Rate Ratio 0.99, 95% CI 0.97 to 1.00). PSA may, however, have little to no effect on adverse events (RR 1.32, 95% CI 0.48 to 3.65).
Daraxonrasib helped people with advanced pancreatic cancer live longer (13.2 months vs 6.6 months) by blocking a mutated protein, RAS G12, that fuels tumor growth in more than 90% of patients with pancreatic cancer (HR 0.40, 95% CI 0.30-0.54, P<0.001). Adverse events that led to treatment discontinuation occurred in 1.2% of the patients in the daraxonrasib group versus 11.2% of those in the chemotherapy group.
The US federal government enacted a complete ban on immigration from 19 countries on December 2, 2025. US counties with at least one physician from a banned country were more likely to be designated a primary care Health Professional Shortage Area (HPSA) (adjusted odds ratio [aOR], 2.42; 95% CI, 1.71-3.40), and have fewer high school graduates (aOR, 0.87; 95% CI, 0.85-0.89). This is affecting patientcare and decreases soft power originated in the US under Woodrow Wilson.
This graph shows that solar delivered the fastest energy transition in human history, followed by wind, set in context with oil, gas, coal, nuclear and hydro, etc., but battery dispatch is exceeding all.
Although fecal microbiota transplant (FMT) for recurrent Clostridium difficile was associated with increased bacterial diversity and enrichment with bacteria capable of producing short-chain fatty acids, it showed no significant differences in multidrug-resistant organisms' (MDROs) decolonization (18 patients [31.0%] in the FMT group vs 17 patients [30.4%] in the sham group; P = .94) or antimicrobial resistance (AMR) genes (median [IQR], 2.5 vs 2.0; P = .68), with comparable adverse events. I would like to see a study comparing the effects of a diet high in fiber with leafy and cruciferous vegetables, legumes and whole grains vs regular American diet as they affect C. diff outcome.
This CIDRAPpodcast episode is a good summary of where we are with COVID-19 now. The negative study of Paxlovid (in my May 18 Update, last month) is a reflection of high immunity in the population and the drug should still be considered for high risk patients as patients still die from COVID-19, with 25,000 a year in 2025, which is much lower than the 26,000 deaths per week in March of 2021. It also addressed the COVID vaccine effectiveness study that was blocked from publication in the NEJM by the acting CDC director. This is a good time for older adults to get another 6-month COVID booster before the summer surge due to spending more time in air conditioned low humidity indoors. Listen at 9 min 15 sec and 55 min 30 sec. This podcast also covered HPV vaccine and the Hantavirus outbreak.
Ensitrelvir is another pill for COVID and inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 3C-like protease. In 2,041 patients with COVID infection, age 42.4 years, 71.1% had undergone randomization within 48 hours after symptom onset in the index patient, and 37.0% had at least one risk factor for severe Covid-19. The incidence of Covid-19 in contacts was lower in the ensitrelvir group than in the placebo group (2.9% vs. 9.0%; risk ratio, 0.33; 95% confidence interval [CI], 0.22 to 0.49; P<0.001). The incidence of adverse events during the trial was similar in the two groups (15.1% vs 15.5%).
The CDC reports 2,063 confirmed measles cases in 40 states vs 2,020 cases in 40 states last week.
The OMDA call on Thu Jun 18 is: Serious Mental Illness and National Alliance on Mental Illness (NAMI), by Frank Murray
Today is World Elder Abuse Awareness Day. For information from the American Geriatrics Society on preventing and addressing elder abuse and my presentation on the topic.
