Geriatric Update Mar 16, 2026

In a randomized clinical trial of men with prostate cancer treated with radiotherapy and concomitant androgen deprivation therapy (ADT), the GnRH agonist leuprolide was associated with a significant increase in 12-month coronary artery total plaque volume of 68.9 mm3 and noncalcified plaque volume of 64.5 mm3 more than treatment with the GnRH antagonist relugolix. The noncalcified plaque is more risky than the more stable calcified and low-attenuation plaque volume. The cost is comparable, and the dosing is a daily pill for relugolix vs monthly shot of leuprolide.

In a study of patients with recurrent prostate cancer, the 8-year overall survival with enzalutamide and leuprolide was 78.9% (95% confidence interval [CI], 73.9 to 83.1) in the combination group and 69.5% (95% CI, 64.0 to 74.3) in the leuprolide-alone group; the hazard ratio for death was 0.60 (95% CI, 0.44 to 0.80). The survival with monotherapy was 73.1% (95% CI, 67.6 to 77.9), which did not differ significantly from that with leuprolide alone (hazard ratio, 0.83; 95% CI, 0.63 to 1.10; P=0.19).

In 196 patients, age 61, with 5-20 brain metastases, stereotactic radiation targeting only individual tumors had better outcomes of improved symptoms and less interference with daily functioning, key components of quality of life, than whole brain radiation that avoids the hippocampus in an attempt to spare memory and cognitive function. 

Grandmothers and grandfathers >50 years old who provide care show higher verbal fluency and episodic memory than propensity-matched non-caregivers. However, longitudinal analyses revealed slower cognitive decline only among grandmothers.

Super-agers — people 80 and up who have the memory ability of someone 30 years younger — had roughly twice as many new neurons as older adults with normal memory for their age, and 2.5 times more than people with Alzheimer’s disease. The aging brain is plastic, able to change and adapt even into our 80s, and contains: neural stem cells that are babies, neuroblasts that are kind of teenagers and immature neurons that are kind of almost-adults, but the amounts differed dramatically among them and appeared to relate to people’s cognition at the time of death. The super-agers had substantially more immature neurons in their hippocampi but people with Alzheimer’s had more neural stem cells compared with the other older adults, but many fewer neuroblasts and immature neurons.

In this study over 12 years, 45% of adults >65 improved in either physical or mental fitness: Approximately 32% improved their cognition on TICS, and 28% improved their walking speed. Positive age beliefs predicted improvement.

Caregivers of patients with dementia often have difficulty leaving the patient safely to attend appointments. Digital psychological interventions significantly reduced caregiver burden [Standardized mean difference (SMD) = -0.21, 95% CI: -0.35 to -0.07; P = .003] and improved self-efficacy (SMD = 0.38, 95% CI: 0.15 to 0.61, P = .001) and quality of life (SMD = 0.59, 95% CI: 0.27 to 0.91, P < .001) even over a short time, <2 months, but had no effect on depression.

Cerebral microbleeds detected on MRI were associated with increased dementia risk in older people with: mixed subcortical and lobar microbleeds (HR 1.99, 95% CI 1.40-2.83); lobar-only microbleeds, with or without cortical superficial siderosis (iron deposit indicating past bleeds) (HR 1.96, 95% CI 1.30-2.97); any cortical superficial siderosis (HR 2.57, 95% CI 1.36-4.89).

The decisions we make at 35 are going to affect us at 45, 50, 60, etc. Here are 4 unthreatening questions to ask our 35 year olds: 

1. “When is the last time you talked to a doctor about your heart health?” 

2. “Has anyone in your family died young?” 

3. “What does a typical week look like in terms of physical activity?” 

4. “Do you wake up feeling rested?”

Among 296 participants, avg age 55, with obesity (BMI 36.7), 72% perceived themselves as being overweight and only 24% as having obesity (BMI >30).

Mortality was significantly lower with increased muscle strength: compared to quartile 1, grip strength of quartile 4: HR, 0.67; 95% CI, 0.58-0.78 and chair stand time quartile 4: HR, 0.63; 95% CI, 0.54-0.73. This controlled for walking speed, the inflammatory marker C-reactive protein, age, sociodemographic factors, lifestyle, and clinical factors in 5,472 women, age 78.7 years over 8.4 years follow-up.

In patients with stable new-onset symptoms suggestive of coronary artery disease (CAD), computed tomographic angiography (CTA) or stress testing were helpful at predicting mortality. Any degree of abnormality on CTA (including non-obstructive disease) was associated with worse outcomes than normal scan results over 10 years, whereas only severe abnormalities differentiated outcomes with stress testing.

Radiation doses for the same cardiac imaging procedure differed significantly between world regions, lowest in Western Europe (median [IQR], 4.8 [2.3-7.3] mSv for nuclear cardiology and 4.6 [2.4-9.8] mSv for coronary computed tomography angiograph (CCTA) and highest in Latin America for nuclear cardiology (median [IQR], 7.8 [5.3-9.7] mSv) and Africa for CCTA (median [IQR], 25.2 [14.7-35.3] mSv). Our annual background radiation exposure is 23 mSv. In regression modeling, there was an inverse relationship between country income level and dose. Patient dose was 20% (95% CI, 3.6%-38.4%) higher in low- and middle-income countries than in high-income countries for nuclear cardiology, and as much as 96% (95% CI, 41.7%-170.8%) for CCTA in European countries, likely due to newer, more sensitive equipment.

Anterior myocardial infarction (MI) is associated with increased risk of left ventricular (LV) thrombus (blood clot). Adding rivaroxaban to dual antiplatelet therapy (DAPT) did not make a difference. Among 560 patients with anterior MI, age 61 years, a LV thrombus was detected in 38 patients (13.7%) receiving rivaroxaban plus DAPT and 47 patients (16.6%) with DAPT alone (difference, −2.9%; 95% CI, −8.9% to 3.2%; P = .34). No difference was observed between the 2 groups regarding the largest diameter of LV thrombus, the incidence of major adverse cardiovascular events, or major bleeding. Minor bleeding events occurred more frequently in the DAPT plus rivaroxaban group (45 [16.4%] vs 20 [7.2%]; difference, 9.3%; 95% CI, 3.6%-14.8%).

Among 363,203 cardiovascular deaths, mortality tripled from 3.40 in 1999 to 10.34 per 100,000 in 2023 (average annual percent change [AAPC]: +4.88%). The 75–84 years group showed the steepest increase (+5.66%), non-Hispanic Black adults maintained the highest (18.30 per 100,000 in 2023), the South transformed from lowest to highest regional burden (+5.52%), and the disease spectrum shifted toward atherosclerotic and hypertensive conditions. Hopefully, the new hypertension guidelines to control systolic BP <120 will have an impact in the future.

In patients with chronic limb-threatening ischemia (CLTI) and infrapopliteal artery disease, angioplasty has been associated with frequent restenosis. At 1 year the everolimus-eluting resorbable scaffold had better outcomes, no events in 78%, and angioplasty 44% for: above the ankle amputation of the target limb, occlusion of the target vessel, clinically-driven revascularization of the target lesion, or restenosis of the target lesion. While the statistics were not transparent or clear in this device-company-sponsored trial, I am concerned about long-term outcomes after the stent is resorbed in about 3 years.

In a palliative care center, hypodermoclysis (HDC), a subcutaneous infusion of fluids, was compared with intravenous (IV) infusion. Complications were 12.9% in the HCD group, vs 36.7% in the IV group. The preparation time for HDC was 2.13±0.56min, and IV was 8.5±4.76min. The cost for HCD was 114.93 Turkish Lira, vs IV 141.73 Turkish Lira. In the US it has been used in nursing home and home care for years, but hospitals have not found a payment mechanism. With more accountable care organizations taking on risks and payments, HDC may be a better alternative to central line placement when IV access is not possible, with less risk of thrombosis or fluid overload.

In 2,286 patients with sleep apnea, age 58, the 30-day postoperative mortality and cardiovascular complications increased significantly from 1.6% in patients with a low sleep apnea-specific hypoxic burden (SASHB; <32% min/h) to 5.8% among those with a high SASHB (>80% min/h) at diagnosis. The risk climbed with odds ratios of 1.76 for those with 32-80% min/h and 2.79 at >80% min/h vs <32% min/h.

Older adults face a lot of losses: career, independence and loved ones, and dealing with grief is needed. There was moderate strength of evidence (SoE) that individual psychotherapy improves grief and depression symptoms and low SoE that expert-facilitated support groups and enhanced contact with health care providers may improve depression symptoms. Other interventions showed conflicting results, indicated no benefit, or had insufficient SoE, in this systematic review of 169 randomized controlled trials. 

The cost of three sunscreens with identical protection factor (SPF) varied by as much as 17.5-fold per ounce of the SPF 50 sunscreens from $0.57 to $10.

The COVID vaccine can cause rare cases of myocarditis in some young men. This study found higher levels of C-X-C motif chemokine ligand 10 (CXCL10) and interferon-γ (IFN-γ) in serum of these men, and in mice showed that blocking these cytokines prevented myocarditis. Because it occurs in men, they gave the soy-derived oral phytoestrogen genistein a week before the second shot of the vaccine, blunted the surge of these cytokines and reduced myocardial injury in young male mice and in human iPSC-derived cardiomyocytes, without reducing titers of vaccine-induced antibodies in mice.

A single COVID vaccine dose reduced the risk of long COVID by 21%, two doses reduced it by 59% and three by 73%. Vaccine effectiveness clearly climbed with each successive dose. However, no protection against post-COVID conditions was seen among those who received COVID-19 vaccination after COVID-19 infection.

Of >1 million COVID-19 positive patients at risk for severe COVID-19, only 9.7% were treated with Paxlovid. Participants who were treated with Paxlovid had a 26% (RR, 0.742; 95% CI, 0.689-0.812) reduction in hospitalization risk and 73% (RR, 0.269, 95% CI, 0.179-0.370) reduction in mortality risk in the 28 days following COVID-19 diagnosis date.

Respiratory syncytial virus (RSV) vaccine effectiveness against severe RSV disease was shown in real-world evidence of 8 cohort and case-control studies in pooled analyses. Vaccination was associated with lower odds of RSV-related hospitalization (odds ratio [OR]: 0.23; 95% CI: 0.20–0.27) and ED visits (OR: 0.23; 95% CI: 0.21–0.27). Slightly lower effectiveness against RSV-related hospitalization was seen in immunocompromised adults (OR: 0.31; 95% CI: 0.27–0.34) than in immunocompetent individuals (OR: 0.20; 95% CI: 0.11–0.35). Effectiveness did not differ by age group (60–74 vs ≥75 years) or vaccine product.

Arthur Brooks’ book “From Strength to Strength” addressed happiness with increasing age:

• Crystallized intelligence increases with age, causing us to be better teachers as we age

• Reverse the bucket list: give up wants and firm beliefs

• Stop wanting to be special or a striver, and embrace friendships and happiness

• Change from polishing leaves to nurturing roots that lead to family and friendships

The CDC reports 1,353 confirmed measles cases in 31 states vs 1,277, cases in 31 states last week.

Ohio’s respiratory dashboard showed 453 flu hospitalizations (518 last week), 305 COVID hospitalizations (316), and 389 RSV (383).

Those who cannot remember the past are condemned to repeat it. (George Santyana, 1905 in The Life of Reason)

Our new website: www.PG-65.com is up (please note the dash between PG and 65), which stands for Practical Geriatrician.  (or Parental Guidance-65...)  

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Irene