Geriatric Update Mar 23, 2026

The 8 lifestyle habits explored in this analysis included getting a recommended amount of exercise, not smoking, sleeping well, drinking minimal alcohol, properly managing stress, connecting with others socially and avoiding opioids. Adults with diabetes on a GLP-1 RA reduced their risk of major adverse cardiovascular events (MACE), defined as non-fatal stroke or myocardial infarction, or cardiovascular death, by 16% HR 0.84 (0.76–0.92). Following 6-8 of these healthy habits on a GLP-1 was associated with a 43% lower risk than those not taking GLP-1 RA or adhering to these habits. If all 8 habits are followed, the risk was approximately 60% lower HR 0.40 (95% CI 0.30–0.54).

Older adults with diabetes had more than double the risk of dementia, compared with Americans without diabetes. Those with type 1 diabetes (HR 2.82, 95% CI 2.28-3.48) over a 2.4-year follow-up period, after adjusting for sociodemographic factors, and type 2 diabetes (HR 2.08, 95% CI 1.87-2.31).

Prediabetes and diabetes significantly shorten the timeframe before a potentially clinically noticeable change in global and domain-specific cognition. Thus, lifestyle modification to reverse prediabetes and prevent diabetes could potentially reduce the rate of cognitive decline in aging populations.

Based on 6 randomized controlled trials with 4531 participants and moderate risk of bias, Tirzepatide 10 or 15 mg once-weekly improved function on the 36-Item Short Form Health Survey (SF-36) physical function domain (MD 2.26 points; 95% CI, 1.76-2.76; I2 = 99.8%; p < 0.001) and in the Impact of Weight on Quality of Life-Lite Clinical Trials (IWQOL-Lite-CT) physical function subscale (MD 10.10 points, of 100; 95% CI, 8.61-11.60; I2 = 99.8%; p < 0.001). 

However, the evoke(+) randomized trials (n=9981) did not show a difference in participants with amyloid-confirmed Alzheimer's disease, aged 55–85 years, with mild cognitive impairment or mild dementia due to Alzheimer's disease. In evoke+, participants with significant small vessel pathology were included. Participants were randomly assigned (1:1) to once-daily semaglutide 14 mg (flexible dose) or placebo for up to 156 weeks. In evoke and evoke+, mean changes in CDR-SB score from baseline to week 104 were 2·3 (SE 0·1) and 2·2 (0·1) with semaglutide, compared with 2·3 (0·1) and 2·1 (0·1) with placebo (estimated difference −0·08 [95% CI −0·35 to 0·20], p=0·57 in evoke and 0·10 [−0·17 to 0·38], p=0·46 in evoke+). Thank you, Joe, for sending this.

Among people with pre-existing substance use disorder (SUD), initiation of GLP-1 receptor agonists was associated with significantly reduced risk of SUD-related emergency department visits (0.69; CI 0.61 to 0.78), SUD-related hospital admissions (0.74; CI 0.65 to 0.85), SUD-related mortality (0.50; CI 0.32 to 0.79), drug overdose (0.61; CI 0.42 to 0.88), and suicidal ideation or attempt (0.75; CI 0.67 to 0.83).

Legalization of online gambling and sports betting increased help-seeking contacts by 317% among Canadian men and teen boys between ages 15 and 24 years and by 108% among men between ages 25 and 44 years. This was based on help seeking and likely underestimates the extent of the gambling problem.

Reducing semaglutide or tirzepatide frequency to every other week after weekly weight loss plateaued did maintain 30 participants’ weight loss over 36 weeks: 87.9 ± 2.4 kg at pre-treatment to 74.1 ± 2.4 kg at plateau and further to 72.4 ± 2.2 kg on maintenance dosing.

Orforglipron, an oral non-peptide (GLP-1) receptor agonist that can be taken without food or water restrictions, showed greater HbA1c reduction -1.8% than oral semaglutide -1.3% that must be taken on an empty stomach. Gastrointestinal side effects were 59% in the Orforglipron group vs 40% with semaglutide, prompting twice as many participants to stop Orforglipron, 10% vs 5%. The study was funded by the manufacturer and the cost is expected to be $150-$400, depending on dose, when it comes to market.

A protocol-driven outreach by a clinical pharmacist led to fewer hypoglycemia-related emergency department or inpatient encounters (0 vs 5 [5.3%]; risk difference (RD), -5.3% [95% CI, -11.8% to -1.3%]) due to safer (less hypoglycemia-prone) diabetes regimens. At baseline 87.4% of patients were on insulin and 24.1% on sulfonylurea, and after the intervention 28.1% in the intervention group and 15.8% in the control group were on safer meds.  There was no worsening of HbA1c control in the intervention arm compared with the control arm (47 [61.8%] vs 49 [63.6%] with HbA1c <8%; RD, -1.8% [95% CI, -17.0% to 13.5%]) in 191 patients, age 71.3 years, over 6 months.

Consultant pharmacists providing patient-specific opioid or benzodiazepine tapering recommendations for prescribers in primary care clinics showed no difference, including falls, in this cluster randomized trial of 2075 patients, age 74.6, over 2 years. Patients who discontinued opioids were 21.4% in intervention clinics and 19.9% in control clinics that did not get deprescribing support, not statistically significant (odds ratio [OR], 1.20; 95% CI, 0.85-1.71); falls (OR, 1.36; 95% CI, 0.94-1.96).

In the CALERIE study, calorie restriction (CR) by 11.9% reduced all cardiometabolic risk factors over 2 years, including LDL-cholesterol, systolic and diastolic blood pressure, C-reactive protein, insulin sensitivity index, and metabolic syndrome score relative to control group in 218 young volunteers. An elevated resting metabolic rate is considered a key risk factor for accelerated aging. Calorie restriction led to a 5% lower resting metabolic rate, significantly lower tissue oxidative damage and significant suppression in homeostatic dysregulation.  CR led to an increase in mitochondrial efficiency, with younger mitochondria that more efficiently scavenged reactive oxygen species, and recycled waste products in autophagy (self eating). Biologic aging was decreased in the CR group to an average of 0.11 years per 12-month period vs 0.71 years in the control group. All participants were normal weight. Excessive insulin growth factor (IGF-1) is implicated in accelerated aging. CR led to a 21% increase in circulating IGF-binding protein-1 (IGFBP-1), which reduced the effect of free IGF-1. CR-induced reductions in circulating insulin may have increased hepatic production of IGFBP-1. Low levels of thyroid hormones are attributed to lower reactive oxygen species generation and oxidative stress as a result of lower thermogenesis, linking them to longevity. Exercise time during the maximal-oxygen-uptake treadmill test increased to a greater extent in the CR group (2.9 min) compared with the control group (1.8 min), suggesting aerobic performance was enhanced. If interested in longevity, I encourage you to read the well-written phase 2 CALERIE article that describes the physiology in detail -- fascinating. The study lead Eric Ravussin, expert on obesity, metabolism, aging and caloric restriction, discusses the CALERIE study with Peter Attia in a 2-hour interview; aging-related content starts at 1 hour, 47 minutes.

Daily morning calorie loading (bigger breakfast) reduced appetite and hunger responses without changes in energy metabolism in healthy subjects with obesity.

A Chinese mobile app-based dementia care intelligent recommender system (DCIRS) based on WeChat Mini reduced caregivers' distress related to care problems and lessened caregiver burden on the Zarit Burden Interview scores (an 88 point scale) from baseline to week 6 (MD = -1.61) and further to week 12 (MD = -3.43) (P < .05). Depressive symptoms did not improve significantly. The difference is small and albeit statistical significance, may not be clinically significant.

Of 602 adults aged 41 to 76 years in Finland who had undergone clinical assessment and magnetic resonance imaging (MRI) of their shoulders, 98.7% of the individuals had rotator cuff abnormalities, with 25% having tendinopathy, 62% having partial-thickness tears, and 11% having full-thickness tears. But only 18% of participants reported current shoulder symptoms. And although rotator cuff abnormalities were present in 98% of symptomatic shoulders, they were also present in 96% of asymptomatic shoulders. Severity appeared to increase with age.

Constipation was associated with double the fecal incontinence (FI) (adjusted OR, 2.29; 95% CI, 1.76-2.98; P < .001), with a sensation of incomplete evacuation most strongly associated with FI (adjusted OR, 2.51; 95% CI, 1.81-3.47; P < .001). The prevalence of FI was 7.4% (122 of 1658) in the group without constipation, and 18.3% (165 of 903) in the group with constipation, avg age 79. 

Spherical nucleic acids (SNAs), a form of DNA invented in 1996, can enter cells that linear DNA can’t. Liposomal SNA containing the chemotherapy 5-fluorouracil (5-Fu) were selectively taken up by myeloid cells, including acute myeloid leukemia (AML) cells, 12.5-fold over conventional encapsulation, leading to 59-fold better antitumor efficacy than 5-FU alone, without the side effects.

Brief bouts of high-intensity exercise reduced panic disorder (PD) symptom severity more than relaxation therapy on the Panic Agoraphobia Scale (PAS) score (14.9 ± 5.3 vs. 23.1 ± 9.4; t = −4.72, p < 0.001), and this difference was maintained at week 24 (14.2 ± 5.5 vs. 24.7 ± 8.5; t = −6.07, p < 0.001). It also decreased the number of panic attacks, and the Hamilton Anxiety and Depression Rating Scales.

Negative social ties, or “hasslers,” people in one’s close social networks who create problems or make life more difficult, are associated with accelerated biological aging and a broad range of health outcomes, including inflammation and multimorbidity. Each additional hassler corresponds to approximately 1.5% faster pace of aging and roughly 9 month older biological age. Kin and non-kin hasslers show detrimental associations, whereas spouse hasslers do not.

ChatGPT Health ‘under-triaged’ 51.6% of emergency cases. Instead of recommending the patient go to the emergency room, the bot recommended seeing a doctor within 24 to 48 hours, compared to 3 doctors who reviewed the scenarios and triaged each one based on medical guidelines and clinical expertise. The bot also over-triaged 64.8% of nonurgent cases, recommending a doctor’s appointment when it wasn’t necessary. Suicidal ideation presentations activated inconsistently, firing more when patients described no specific method than when they did.

Copilot AI-powered assistant platform had >500,000 health-focused conversations in January. Microsoft found that 40.7% of Copilot questions were related to understanding medical symptoms, conditions or treatments, 10.9% concerned interpretations of lab or imaging results or specifics about signs of illness, and symptom-related questions increased in the evening and overnight. Personalized lifestyle and fitness coaching made up 9% of queries, with nutrition and exercise the top two sub-categories.

Release of sterile Wolbachia-infected male Aedes aegypti mosquitoes reduced the risk for symptomatic laboratory-confirmed dengue by at least 71% over 3 months in Singapore.

Antifolate antimalarials included sulfadoxine-pyrimethamine, sulfisoxazole plus pyrimethamine, atovaquone-proguanil, and proguanil; if >1 mg folate is given, treatment failure can occur on day 7 (RR 2.12; 95% CI 1.41 to 3.19), day 14 (RR 1.97; 95% CI 1.44 to 2.70), and day 28 (RR 1.35; 95% CI 1.21 to 1.51). Treatment failures did not occur with 400 mcg (recommended dose for preventing neural tube defects). 

If you cannot explain it simply, you don’t understand it well enough. (Albert Einstein)