Geriatric Update June 30, 2025

The CDC reports 1227, confirmed measles cases in 37 states, up from 1214 in 36 states last week.

The new Advisory Committee on Immunization Practices (ACIP) voted Thursday to no longer recommend influenza vaccines that contain the preservative thimerosal, based on the presentation of a single vaccine critic. This information is based on multiple news sources, the CDC website has not been updated for >2months.

Gut microbiota are susceptible to 17 categories of meds: antibiotics, antivirals, antifungals, anthelmintics, proton pump inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), laxatives, oral antidiabetics, antidepressants, antipsychotics, statins, chemotherapeutics, and immunosuppressants can trigger dysbiosis.

The FDA is recalling the antibiotic Sulfamethoxazole / Trimethoprim Tablets, USP, 400 mg/80 mg produced by Amneal only, due to microbial contamination of 3 lots, released in Dec 2024.

No association between preprocedural fasting and witnessed pulmonary aspiration were found in a systemic review and meta-analysis of 17 studies between 2016 - 2023, involving nearly 1,800 patients: in 4 of 801 (0.5%) patients who fasted vs. 7 of 990 patients (0.7%) who did not fast, 1.17 (95% confidence interval: 0.32–4.23).

People with a high body-fat percentage or high waist circumference, were 78% more likely to die within 15 years from any cause and 3.6 times more likely to die from heart disease. Body mass index (BMI) – an estimate based on height and weight – was not associated with a statistically significant higher risk of death.

Greater pulse rate complexity at baseline was associated with a slower decline in global cognition. The effect of 1‐standard deviation increase in distribution complexity was equivalent to being approximately 3 years younger, in 503 participants, age 82.4, over 4.5 years. The authors did not control for cardiac conditioning, which leads to greater heart rate variability.

The ease with which a person can sit on the floor and rise to their feet, using as little support as possible, may help predict how long they will live. Scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee) and 0.5 for an unsteadiness execution, death rates of 3.7, 7.0, 11.1, 20.4, and 42.1%, respectively, for groups 5 to 1 of SRT scores, in 4282 adults aged 46–75 years over 12.3 years.

Higher brain care scores (BCS) were associated with reduced risk of stroke, dementia and depression. A 5-point higher baseline BCS, max 21 points, was associated with a 37% decrease in the risk of incident cerebrovascular events after adjusting for age, menopausal status, use of hormonal replacement, and other known cardiovascular disease risk factors (hazard ratio [HR] 0.63, 95% CI 0.56–0.71), in the 21,271 women's health study, median age 58 years, over 22.4 years.

What’s good for the brain is also good for the heart, and vice versa. A 5-point higher BCS at baseline was associated with a 43% lower incidence of cardiovascular disease (hazard ratio 0.57, 95% CI: 0.55–0.59) and lower incidence of the three most common cancer types (lung, colorectal, and breast cancer) (HR: 0.69, 95% CI: 0.66–0.72). Based on a UK Biobank study of participants aged 40 to 69 at enrolment, over 12.5 years.

Lowest Diet Index tertile (less plant-based, fiber, more red/processed meat and sugary drinks) had a higher prevalence of coronary plaques (44.3% vs 36.3%), significant stenosis (6.0% vs 3.7%), and high-risk non-calcified plaques with ≥50% stenosis (1.5% vs 0.9%) based on coronary CT angiography, compared with those in the highest tertile, based on 24,079 Swedes, age 50-64.

And in another connection between heart and cancer, higher baseline levels of high-sensitivity cardiac markers of: troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with an increased risk of developing colorectal cancer over 17.8 years of follow-up in 6,244 participants aged 45 to 84 years. Only NT-proBNP was linked to lung cancer,  and none of the sex-specific cancers were associated with baseline levels of cardiac biomarkers. 

In mice and other lab experiments, serotonin selective reuptake inhibitors (SSRIs) shrunk a variety of cancers, improved the immune system’s ability to kill cancer cells, and bolstered the effectiveness of immunotherapy.

Cell-free, circulating tumor DNA (ctDNA) is an established measure of minimal residual disease, in melanoma, positivity rate and mutant copies per mL plasma were significantly higher in patients with higher disease substages. As a binary variable, ctDNA detection was associated with worse recurrence-free survival (placebo group: median 3.71 months [95% CI 2.39–6.89] vs 24.41 months [17.28–43.13]; hazard ratio [HR] 2.91 [95% CI 1.99–4.25]. p<0.0001)

Vitamin D3 (2,000 IU/day) supplements for 5 years among 25,871 US females ≥55 and males ≥50 years of age, has a promising role in protecting telomeres and slowing telomere shortening, which correlate with aging. Marine omega-3 supplementation had no significant effect on telomeres. Other ways to lengthen telomeres are: pregnancy and exercise.

Handgrip weakness was associated with higher hazard ratio for early all-cause mortality: 1.45 (95% confidence interval [CI]: 1.36-1.55) for absolute weakness of <20.0 kg (44 lbs) for women and <35.5 kg (78 lbs) for men.

Individuals who walk faster than 4 miles per hour have a 43% lower risk of developing an abnormal heart rhythm, compared with those who amble at a pace of less than 3 miles an hour. The time spent walking also influenced risk, with people who spent more time at an average or brisk pace enjoying a 27% lower risk of heart rhythm problems.

Alpha-1 blockers are known to cause intraoperative floppy iris syndrome (IFIS), a complication during cataract and other eye surgery. Other medications also can cause it: tricyclic antidepressants, atypical antipsychotics, carbonic anhydrase inhibitors, corticosteroids, 5-alpha reductase inhibitors, beta-blockers, prostaglandin analogs, and beta-2 agonists were linked to cases of IFIS. Imipramine demonstrated the highest disproportionate association with the incidence of IFIS (reporting odds ratio [ROR], 251.66), followed by tamsulosin, an alpha-1 blocker (ROR, 171.44), and chlorpromazine, an atypical antipsychotic (ROR, 91.30; P < .0001 for all). Use of brinzolamide, a carbonic anhydrase inhibitor (ROR, 409.63), and salbutamol, a beta-2 agonist (ROR, 67.12; P < .0001 for both), caused IFIS among women but not among men.

After legalization of cannabis, the number of people in Ontario who required hospital care for cannabis use disorder (CUD) jumped by 270%, from about 1.3 in every 1000 people before legalization to 4.6 after legalization. The proportion of new cases of schizophrenia associated with CUD increased from 3.7% to 10.3% after legalization, with young men aged 19-24 years most likely affected.

A once-weekly capsule of the antipsychotic risperidone, LYN-005, provided similar bioavailability and symptom control as daily doses of the drug in a phase 3 trial of patients with schizophrenia or schizoaffective disorder.

Exposure to ground-level ozone (60 ppb) and high temperatures — roughly 90-95 °F — increased the risk for a myocardial infarction (MI) by 33% compared to cooler, low-ozone days, in 270,123 people aged 18-64 years with MI. Even under moderate conditions, such as an ozone count of 50 ppb and typical temperatures around 70 °F, the risk increased by 15%. 

This was an excellent 17 min podcast about ultraprocessed foods, how it evolved and contributes to obesity and chronic disease.