Geriatric Update June 22, 2026

A new scientific statement from the American Heart Association (AHA) emphasizes that while physical activity alone is unlikely to produce clinically meaningful weight loss for most people overweight or with obesity, it plays a critical role in improving cardiometabolic health and in enhancing weight-loss outcomes when combined with dietary, pharmacologic, or surgical interventions. 

The combination exercise group (CG) who used an elastic band (EB) and Tai Chi significantly improved after the 12-week intervention compared to baseline on grip strength, muscle mass, physical performance, Stroop task reaction time and accuracy, and prefrontal cortex oxygenated hemoglobin concentration (P < .05). There were, however, no significant changes in any outcome in the health education group (HEG) (P > .05). Between-group comparisons showed that the CG exhibited greater improvements in physical performance, executive inhibitory function, and PFC oxygenated hemoglobin concentration compared to the EB-only group (P < .05).

Elastic band resistance training (EBRT) improved cardiometabolic risk factors in a meta-analysis of 23 trials with 1,134 older adults at risk of metabolic syndrome, age 70. EBRT reduced body fat percentage by -1.44% and fat mass by -1.57 kg, with total cholesterol -18.21 mg/dL, low-density lipoprotein -11.03 mg/dL, triglycerides -11.98 mg/dL, fasting glucose -9.02 mg/dL, systolic -7.73 mmHg and diastolic blood pressure -5.45 mmHg; high-density lipoprotein increased 2.42 mg/dL. This expands our armamentarium for those who don't want to or cannot afford to go to a gym.

Exercise prevented nearly half of fat-free mass (FFM) loss (45.7%) in patients with intended weight loss from calorie restriction. Mixed exercises of strength and endurance training had the largest effect (MD = +1.20 kg), followed by strength training (MD = +0.83 kg).

Patients with knee osteoarthritis (OA) who used glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were significantly less likely to undergo total knee arthroplasty (TKA) than matched non-users, with longer treatment showing the greatest benefit. At three years, therapy was associated with a 2.8% lower risk of knee replacement surgery (HR 0.90, 95% CI 0.83 to 0.98) and at 8 years −4.7% risk (HR 0.72, 95% CI 0.67 to 0.78). The mechanism is by weight loss decreasing the inflammatory cytokine production.

Overall, 28 of 527 patients (5.3%) on tirzepatide (mean age 54 years) experienced incident or worsening of thyroid disease over 12 months, most frequently nodular or goiter disease (32.2%) and drug-induced thyroiditis (21.4%). End-stage renal disease was associated with higher odds (odds ratio [OR], 2.94; P = .043), and preexisting thyroid disease was associated with new or worsening thyroid disease (OR, 3.78; P < .001). The study did not adjust TSH for age. Considering that the incidence of thyroid disease in 54-year-old women is 13.3%, this incidence or worsening is not unusual. 

Compared with no use of a GLP-1, semaglutide use was linked to a 42% decreased risk of worsening mental health (adjusted hazard ratio [aHR], 0.58), whereas liraglutide was associated with an 18% reduction of worsening mental health (aHR, 0.82). The cohort study was of 95,490 Swedish adults (mean age 50 years, 60% women) with diagnosed depression, anxiety disorders, or both, who were prescribed non-insulin antidiabetic medications from 2009 to 2022.

In a sample of 1,282,796 Taiwanese patients with newly diagnosed type 2 diabetes, 165,333 pairs (mean age 58.6 years, 56.2% male) were matched for treatment with or without dipeptidyl-peptidase 4 inhibitors (DPP-4is). DPP-4i use was associated with lower risks of osteoarthritis (OA) (aHR: 0.42; 95% confidence interval (CI): 0.41–0.44), total hip replacement (THR) (aHR: 0.38; 95% CI: 0.30–0.48), and total knee replacement (TKR) (aHR: 0.42; 95% CI: 0.37–0.46), with benefits increasing with dosage. Moreover, DPP-4i use was associated with a significantly lower cumulative incidence of OA, THR, and TKR. The concurrent use of metformin, meglitinides, thiazolidinediones, insulin, steroids, and GLP-1 receptor agonists was also associated with lower incidence of OA (RA; aHR: 0.21; 95% CI: 0.14–0.32). However, the use of sulfonylureas and statins was associated with a higher risk of incident OA. DPP-4is are the oral forerunners of GLP-1s and are not as effective for weight loss, but have fewer GI side effects. I de-escalate patients with intolerable side effects from GLP-1 to DPP-4is, or prescribe them when a little maintenance after GLP-1 weight loss is needed.

In heart failure with preserved ejection fraction (HFpEF), GLP-1 meds significantly reduced HF-worsening events (hazard ratios [HR] 0.67, 95% confidence intervals [CI] 0.50-0.89; I² = 9.9%, high certainty), improved 6-minute walk distance (+17.6 m), and improved systolic blood pressure (-3.6 mmHg) but did not improve outcomes in patients with reduced ejection fraction (HFrEF).

Mazdutide mimics the Oxyntomodulin peptide in the small intestine which binds both the GLP-1 receptor and the glucagon receptor. GLP-1 suppresses appetite and glucagon increases energy expenditure, inhibits fat synthesis in the liver, and promotes lipolysis (fat burning). In 461 Chinese adults, age 34, weight reduction was 16.65% in the mazdutide group vs 1.50% in the placebo group after 60 weeks. The most common adverse events were vomiting (53.1%), nausea (46.9%), and diarrhea (39.4%).

Higher estimated basal metabolic rate (BMR) increases the risk of diabetes, with each standard deviation higher estimated BMR associated with a 55% increase in diabetes risk (HR 1.54, 95% confidence interval [CI] 1.49–1.59 in men; HR 1.56, 1.49–1.62 in women). Higher BMR also carried a substantive increased risk for cardiac complications among those with diabetes (1.71, 1.55–1.89 in men; 1.78, 1.56–2.03 in women), as well as increased risk for diabetic coma, ketoacidosis and glycemic disturbances (1.18, 0.99–1.42 in men; 1.35, 1.21–1.50 in women) along with increased stroke risk (1.27, 1.08–1.50 in men; 1.41, 1.14–1.76 in women). Over 12 years follow-up, 4,626 cases of diabetes accrued in 341,790 participants, aged 55.7 years, among whom the mean estimated BMR was 1,849 (234) kcal/day in men and 1,340 (147) kcal/day in women. For more reading on lowering basal metabolic rate for longevity, the CALERIE trial and author interview may be of interest.

Of 13,970 participants (mean [SD] age 65.5 [9.0] years) with 6,992 randomized to the cholesterol medicine bempedoic acid 180 mg daily and 6,978 randomized to placebo, 275 participants (2.0%) had a history of venous thromboembolism (VTE), and 1,219 (8.7%) were receiving systemic anticoagulation at baseline. Over 40.6 months 39 VTE events occurred in the bempedoic acid group and 67 in the placebo group (hazard ratio [HR], 0.58; 95% CI, 0.39-0.86; P = .006). Findings were consistent for deep vein thrombosis (HR, 0.56; 95% CI, 0.31-0.996; P = .045) and pulmonary embolism (HR, 0.61; 95% CI, 0.37-0.996; P = .046), and consistent with statin reducing blood clots.

In 3,000 patients with atrial fibrillation, randomization to left atrial appendage closure with a device such as Watchman was non-inferior to anticoagulation over 3 years for death from cardiovascular causes, stroke, or systemic embolism in 81 patients (5.7%) in the device group and in 65 patients (4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], −0.8 to 2.6); there was less bleeding in the device group.

The top non-modifiable risk factors associated with later strokes are older age (adjusted hazard ratio [aHR], 1.04 per year increase; 95% CI, 1.02-1.05) and male sex (aHR, 1.25; 95% CI, 1.15-1.36). The leading modifiable factors are:  hypertension (aHR, 1.60; 95% CI, 1.31-1.94), smoking (aHR, 1.29; 95% CI, 1.05-1.60), and etiologic stroke subtypes including cardioembolism (aHR, 2.16; 95% CI, 1.53-3.05), large artery atherosclerosis (aHR, 2.19; 95% CI, 1.68-2.86), and small vessel disease (aHR, 1.69; 95% CI, 1.14-2.49). Prevention with exercise and medications to prevent atherosclerosis, as well as controlling blood pressure, are key. 

In 391 patients (age 68) presenting to endovascular treatment (EVT)-capable centers 4.5-24 hours after stroke onset with proximal middle cerebral artery (MCA) occlusion, those randomized to intravenous tenecteplase before EVT (removing the blood clot) did not have better clinical outcomes than those receiving EVT alone (adjusted relative rate, 1.01 [95% CI, 0.83-1.24]).

In 447 patients with ischemic stroke, age 77, the group randomized to receive endovascular treatment (EVT) in addition to best medical treatment (BMT) had better clinical outcome at 90 days compared with BMT alone. The BMT plus EVT group also had a higher rate of >80% of the brain tissue initially at risk not infarcted at 24 hours when compared with BMT alone (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.3), also true for successful reperfusion compared with no successful reperfusion (aOR, 2.5; 95% CI, 1.3-4.8).

Male siblings of centenarians were at least 17 times as likely to attain age 100 themselves, while female siblings were at least 8 times as likely.

Another study has shown that even low levels of alcohol intake increase mortality. The alcohol industry lobby has pushed back strongly against the report, prompting the administration's Health and Human Services to block the report from going to congress. Robert M. Vincent, the former government official who commissioned the study, said he believed he was fired because the report produced evidence “at odds with commercial interests.”  

With the new evidence of harm from any amount of alcohol, the new Canadian recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above the low-risk threshold according to Canada's Guidance on Alcohol and Health.

Heat-related hospitalization rates among U.S. adults increased from 1998 to 2022, with steeper increases (absolute rate difference 0.85 per million per year) in Blacks than in Hispanics and Whites (absolute rate difference 0.10 per million per year).  

National public health emergency preparedness was rated as "high" in 20 states, "middle" in 17 states and Washington, DC and "low" in 13 states as assessed by Trust for America’s Health.

Fully driverless cars, with 56.7 million miles on public roads, found an 85% reduction in serious-injury-or-worse crashes when compared with human drivers on the same streets. This is exciting news for patients with dementia, vision problems or dexterity issues. Even newer, better data are reported in this TED talk by Waymo’s co-CEO Takedra Mawakana.

The influenza mRNA-1010 vaccine was 26% more effective than standard-dose licensed vaccines, with 2% vs 2.6% for prevention of RT-PCR–confirmed, protocol-defined influenza-like illness in this randomized controlled trial of >40,000 adults >50 years. Solicited adverse reactions were more frequent with mRNA-1010 but serious adverse effects were similar. I would have liked to have seen a comparison with high-dose standard vaccine as well.

More than 150 service members fall ill at Lackland, TX Air Force Base after Pete Hegseth makes flu vaccine optional in April, as an “absurd, overreaching” mandate.

A systematic review of 59 studies found no causal association between aluminum-adjuvanted vaccines and serious or long-term health outcomes including asthma, autism spectrum disorder, headache, myalgia or other chronic conditions. This was based on high-quality evidence from randomized controlled trials and large cohorts.

The CDC reports 2,093 confirmed measles cases in 41 states vs 2,063 cases in 40 states last week.

Happy National Hydration Day. Make sure to drink 2 quarts daily, more on hot days and when exercising. Watch my Dehydration presentation for reasons why.