Geriatric Update Mar 2, 2026

Hearing loss of more than a slight degree was associated with a 70% (hazard ratio (HR), 1.71; 95% confidence interval (CI), 1.01-2.90), increase in the risk of dementia, especially executive function deficit, over 15 years of follow-up and more so in APOE ε4 carriers (HR, 2.86; 95% CI, 1.12-7.28). This study adds brain magnetic resonance imaging (MRI) evidence with smaller brain volume, and greater white matter abnormalities to neuropsychological testing. Last month I reported that hearing aid use attenuated that effect, and this study also showed that hearing aid users did not have a higher risk of dementia.

Progressive white matter hyperintensity (WMH) burden, particularly in posterior regions on brain MRI, was associated with reduced driving frequency, complexity, and safety, especially among participants who later developed cognitive impairment over the 10 years of follow-up in 113 patients.

A portable neuroimaging method (functional near-infrared spectroscopy [fNIRS]) detected marijuana, ∆9-tetrahydrocannabinol (THC) impairment or intoxication better than current 45-minute behavioral field sobriety tests (FSTs). fNIRS data collected during rest produced a classifier for impairment, with a sensitivity over specificity (ROC-AUC) of 0.87 (95% CI, 0.83 to 0.91), accuracy of 0.90 (95% CI, 0.88 to 0.92), and false-positive rate of 0.05 (95% CI, 0.04 to 0.07), using clinical impairment assessment as ground truth. The FST showed an ROC-AUC of 0.75 (95% CI, 0.74 to 0.76), accuracy of 0.69 (95% CI, 0.67 to 0.71), and a false-positive rate of 0.34 (95% CI, 0.32 to 0.36).

Higher ultra processed food (UPF) consumption showed higher all-cause mortality, adjusted HRs of 1.48 [95% confidence interval (CI), 1.07–2.03 for highest vs. lowest third] and cancer mortality 1.57 (95% CI, 1–2.47), during a median follow-up of 14.6 years.

Low-fat and low-carb diets rich in plant-based foods, whole grains and unsaturated fats were associated with reduced risk of coronary heart disease. Conversely, diets that are high in refined carbs and animal-based fats and proteins were associated with higher risk. While the differences were significant, they were small, and too many to list in my short summary, but they are consistent with prior dietary recommendations.

Elevated intake of protein from total meat were associated with increased odds of reporting high psoriasis severity (OR, 2.47), while the percentage of protein intakes from plant-based sources was inversely associated with reporting high disease severity (OR, 0.36). Compared to participants in the lowest quartile of intake, those in the highest quartile of intake for % free sugars from beverages were more likely to report high psoriasis severity (adjusted Odds Ratio (OR) 3.85, 95% CI 1.507–9.831).

There was no increase in muscle mass, strength or physical performance from protein supplementation in older people in general, nor in healthy older people, in reviews with meta-analyses collating data from 441 unique studies. There was medium-certainty evidence of at least small increases in muscle mass and strength in older people with long-term conditions, and the benefits of protein supplementation were more certain with concomitant exercise. Evidence suggests that protein supplementation in hospital patients with hip fractures reduced the number of medical complications.

Exercise in frail nursing home patients improved: Fried frailty phenotype, physical functions (the Sit-to-Stands Test, the Time Up and Go Test, the Short Physical Performance Battery, and the Gait speed), and cognitive function as measured by the Mini-Mental State Examination, but handgrip strength, functional reach, and the Montreal Cognitive Assessment did not reach statistical significance. Of the 20 studies with 1,701 participants, subgroup analyses showed that interventions involving ≥ 3 sessions/week for ≥ 15 weeks, totaling > 2,000 minutes were associated with better overall functions.

Last week I mentioned the effect of GLP-1 on muscle mass and function. This study also found reductions in muscle fat infiltration across all doses of tirzepatide, mean difference –0·42% (95% CI –0·54% to –0·31%). Muscle quality includes intramuscular fat content, mitochondrial efficiency, insulin sensitivity, and microvascular perfusion, and is a more meaningful determinant of strength and physical function than muscle quantity alone. GLP-1s preserve or improve muscle quality despite modest reductions in absolute muscle volume, primarily through reductions in myosteatosis and enhanced metabolic efficiency. 

Neutrophils—the most common type of white blood cell—often cause more damage to tissues at the site of inflammatory injuries, such as heart attacks, during the day than at night. A drug compound called ATI2341, pharmacologically activated the receptor using, a “neutrophil dial” that can scale back the cell’s aggressiveness without interfering with its infection protective effects. If ATI2341 is tested in people, I would like to see effects on older adults' clearance of senescent cells and cancer cells if given daily, and the effect on the heart if given after presenting with symptoms of a heart attack, along with aspirin.

Dehydroepiandrosterone (DHEA) 0.50% (6.5 mg) a day, applied intravaginally has been shown to improve vulvovaginal atrophy (VVA) −0.23 (95% CI, −0.35 to −0.11) and dyspareunia −0.40 (95% CI: −0.66 to −0.15) in postmenopausal women in a review of 6 studies with 1611 participants.

For postmenopausal osteoporosis romosozumab for 3 months followed by denosumab vs 12 months romosozumab was non-inferior in a randomized controlled trial, total hip BMD was 5.7% in the 3-mo romosozumab group and 6.0% in the 12-mo group, 188 participants, age 69.6. Because of risk associated with MI and stroke, it is good to reduce the amount of romosozumab needed with similar effects.

Over a 20-year follow-up, 2,021 older adults randomized to speed-of-processing training and completed ≥1 booster sessions had a significantly lower risk of being diagnosed with dementia compared with controls (HR: 0.75, 95% CI: 0.59, 0.95). In contrast, speed-trained participants who did not receive booster sessions showed no reduction in dementia risk, and neither memory nor reasoning training was associated with long-term protection.

An increased risk of incident myasthenia gravis (MG) was observed during the first half year after statin initiation: Days 0–179 (pooled incidence rate ratio [IRR] [95% CI]: 2.662 [1.276–5.553]), Days 180–364 (1.407 [1.014–1.954]) and no increased risk after 1 year. It is rare, incidence 3 to 30 people per million each year. The theory is possibly autoantibodies against acetylcholine receptors, depletion of the cholesterol involved in synaptic transmission in neuromuscular junctions and direct myotoxicity of statins.

On 8 body mass index (BMI)–adjusted MRI-derived fat quantification metrics, pancreatic fat and skinny fat, with an elevated weight-to-muscle ratio, especially in male individuals, were associated with adverse neurologic outcomes compared with the lean profile: extensive gray matter atrophy, elevated white matter hyperintensity load, cognitive decline, and increased risk of neurologic disease.

6 weekly sessions of capacitive-resistive monopolar radiofrequency (n=32) to the external genitalia and vagina improved sexual function in women, age 56, on lubrication, orgasm, and pain vs sham treatment (n=30). Nonablative radiofrequency is a form of electromagnetic energy that uses a high-frequency current of 448 kHz to generate controlled heating to 41°C-43°C causing vasodilation, stimulating fibroblasts and promoting neocollagenesis, neoelastogenesis, and collagen remodeling. The vaginal probe was rotated clockwise every minute for 10 minutes total each session. About 95% of women in both groups had vaginal atrophy at baseline and decreased significantly in the intervention group at 7 weeks to 68.8% and at 19 weeks to 29.3%, but in the control group stayed at 96.7% at 7 weeks and to fewer, 70.7% at 19 weeks. Vaginal estrogen status was tested and did not change.

People with irregular sleep schedules had nearly double the risk of falling back into a depressive episode. The most telling sign that a relapse was pending wasn’t just how long someone slept, but also less difference between daytime movement and nighttime rest.

5 Sleep Habits to Steal From Winter Olympians

• If you’re sleeping somewhere new, make the place your own.

• Develop a calming evening routine.

• Wake up at a consistent time.

• Don’t obsess over your sleep score.

• Remember your body is resilient.

Extending sleep by ~1 hour/night for ~6 weeks in people overweight or with obesity and with short sleep schedules, <7 hours per night, improves sleep health but not insulin sensitivity or glycemic control.

Patients with acute or subacute low back pain (LBP) receiving 4-8 hours of clinician-supported biopsychosocial self-management training with or without spinal manipulation showed statistically significant but small reductions in disability, but not pain, vs medical care over 1-year follow-up, and spinal manipulation alone showed no significant difference for either outcome. All 1,000 randomized participants received the Back In Action booklet.

Supraventricular tachycardia (SVT) is a fast hearbeat >100 beats per minute, can be treated with Valsalva Maneuvers (VM). After 2 VMs 67 of 106 participants in the VM with device use group (63.2%) vs 31 of 106 participants in the standard VM group (29.2%) converted to sinus rhythm within 1 minute (odds ratio, 4.16; 95% CI, 2.36-7.47; P < .001).

For SVT, the FDA approved Cardamyst (etripamil) nasal spray, a class 4 antiarrhythmic that inhibits calcium ion influx into vascular smooth muscle and myocardium.  It relieved SVT in 64% of patients vs. 31% with placebo within 30 minutes. The time to return to normal was 17 minutes for patients taking etripamil compared with 54 minutes for patients taking the placebo.

Black adults who attended a historically Black college or university (HBCU) compared with a predominantly White institution (PWI) had better z-scored memory (ATE, 0.13; 95% CI, 0.05-0.21), language (ATE, 0.19; 95% CI, 0.08-0.29), and global cognition (ATE, 0.22; 95% CI, 0.09-0.34). No difference was found in those who attended college before 1955 (during legal racial segregation), 1955 to 1964 (during sanctioned racial discrimination), but this could be confounded by the advanced age of participants of that era.

Higher concentrations of particulate matter with a diameter of 2.5 µm or less (PM2.5), PM with a diameter between 2.5 and 10 µm (PM10-2.5), and nitrogen dioxide (NO2) were associated with a higher risk of transitioning to more severe states of physical disability. A higher concentration of PM2.5 was also associated with a lower likelihood of reverting from physical function limitation to healthy physical function in the cohort study of 29,790 adults age >50 years, over 20 years.  

Maryland’s House Bill (HB) 931 requires nursing home medical directors to hold an approved medical director certification or be actively pursuing one, and to serve no more than two nursing homes at a time.

This 30 minute TED podcast is about the societal and personal dangers of inaccurate history knowledge and gives examples.

The CDC reports, 1,130 confirmed measles cases in 28 states since the start of 2026 vs 975, cases in 26 states last week.

Ohio’s respiratory dashboard showed 659 flu hospitalizations (530 last week), 372 COVID hospitalizations (372), and 442 RSV (324).

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...)  As we move and add more content, categories, and transcribe presentations, the search function (a favorite with many) will become more robust. Please sign up for the RSS feed on the opening page, which then sends notification of new content to your e-mail.