Geriatric Update March 30, 2026

In 2314 patients who underwent colorectal cancer surgery, those who received multimodal prehabilitation significantly reduced the length of hospital stay (by-2.47 days, 95% confidence interval [CI] [-3.56, -1.39]), postoperative complication rate (odds ratio; [OR] = 0.74, 95% CI [0.59, 0.94]), and time to the first passage of flatus (MD = -0.43 days, 95% CI [-0.66, -0.20]) when compared with participants in the control group.

Metastatic spread of breast cancer occurs by hematologic dissemination of circulating tumor cells (CTCs) and occurs much more so while sleeping, 78%, than while active. Moreover, rest-phase CTCs are highly prone to metastasize, whereas CTCs generated during the active phase are devoid of metastatic ability. The mechanism is through the marked upregulation of mitotic genes exclusively during the rest phase in both patients and mouse models, driven by circadian rhythm hormones such as melatonin. In mice the CTC was even greater during rest, 87%-99% depending on mouse strain, and CTC were higher in mice with interrupted sleep, mimicking jet-lag, and even higher after melatonin administration.

Within 3 years of a first recorded brain metastasis, patients on a GLP-1 drug had a third lower risk of all-cause mortality compared with nonusers (HR 0.63, 95% CI 0.54-0.72). The matched analysis of 1700 patients propensity-matched patients with cancer, brain metastases, and diabetes, and the 866 GLP-1 RA users showed the association to be consistent across three of the most common cancer types: lung cancer (HR 0.75, 95% CI 0.62-0.92), breast cancer (HR 0.55, 95% CI 0.38-0.80), and melanoma (HR 0.66, 95% CI 0.44-0.97).

Compared to insulin, GLP-1RA medications were associated with a significantly lower risk of liver cancer (HR: 0.47, 95% CI: 0.27–0.82) and pancreatic cancer (HR: 0.23, 95% CI: 0.11–0.51). Risk of all other cancers remained comparable between the two groups (all p > 0.05).

Colorectal cancer (CRC) was associated with increased risk among patients receiving GLP-1 (RR, 2.31; 95% CI, 1.82–2.93; I2 = 36%; p < 0.0001) in 7 retrospective cohort studies involving 5,066,681 patients in a pooled analysis. However, the incidence of CRC was not significantly associated with GLP-1 use compared with other drugs (OR, 1.73; 95% CI: 0.21–14.18, p = 0.61; I2 = 100%). We should stress CRC screening, especially for patients on GLP-1s.

Compared to meat eaters, poultry eaters had lower risk of prostate cancer (0.93, 0.88–0.98), pescatarians had lower risks of colorectal (0.85, 0.77–0.93), breast (0.93, 0.88–0.98) and kidney cancer (0.73, 0.58–0.93), and vegetarians had lower risks of cancers of the pancreas (0.79, 0.65–0.97), breast (0.91, 0.86–0.97), prostate (0.88, 0.79–0.97), kidney (0.72, 0.57–0.92) and multiple myeloma (0.69, 0.51–0.93) but higher risk of squamous cell carcinoma of the esophagus (1.93, 1.30–2.87). Vegans had higher risk of colorectal cancer (1.40, 1.12–1.75), possibly because vegans do not eat dairy products and may not take calcium supplements, which have been shown to protect against colorectal cancer. The esophageal cancer link is based on 31 cases in this study of 1.8 million, but low riboflavin and zinc, mostly found in meat and fish, have been implicated, along with high incidence of esophageal cancer in certain regions of the world.

Menopausal hormone therapy is linked with breast cancer risk (OR = 1.15, 95% CI: 1.09–1.22), but only when progestin is involved (OR = 1.44, 95% CI: 1.26–1.64). A meta-analysis of more than 4.5 million women showed the increased risk was not observed with estrogen-only therapy (OR = 1.00, 95% CI: 0.91–1.10). As little as once a year withdrawal bleed with progestin protects the uterus lining from hypertrophy and prevents uterine cancer.

A majority, 71.7%, of older patients age >70 years with advanced cancer preferred to prioritize maintaining quality of life, compared to 8.4% who preferred to extend their survival, and 20.0% who had no preference. This is similar to a 2011 study that showed preference for independence, 76%, over staying alive, 11%

Being overweight is the second most common risk factor for cancer cases, second to smoking. Other risk factors in order of frequency are: alcohol consumption, UV radiation, physical inactivity, papillomavirus infection, low fruit and vegetable intake, processed meat intake, low dietary fiber intake, etc.

Breast arterial calcification (BAC) on mammogram, quantified by artificial intelligence, can indicate heart risk. Compared with zero BAC, mild [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.10–1.59], moderate (HR 1.75, 95% CI 1.23–2.50), and severe BAC (HR 3.29, 95% CI 2.15–5.05) were all prognostic for any MACE (major adverse cardiovascular events) in the Emory University cohort, with similar results from a Mayo Clinic validation cohort.

Mortality was inversely related to strength in a study of women age 63 to 99 years. Compared to the lowest quartile: grip strength 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) showed significantly lower mortality. Similar inverse associations were observed when controlling for walking speed and the inflammatory marker C-reactive protein regardless of age, race and ethnicity, body mass index, moderate-to-vigorous physical activity level, sedentary time, or timed walk.

Stable supportive shoes did not improve hip osteoarthritis pain compared to flat flexible shoes (mean difference -0.5 point [95% CI, -1.3 to 0.2 point]) in this study of footwear in self-management of osteoarthritis hip pain. Few secondary outcomes differed by shoe type, but flat flexible shoes showed greater improvement in the Hip Disability and Osteoarthritis Outcome Score symptom subscale (MD, 6.6 points [CI, 1.4 to 11.7 points]) and quality-of-life subscale (MD, 7.8 points [CI, 1.1 to 14.4 points]).

Participants (n=42) randomized to receive psilocybin had more than 6 times greater odds of prolonged smoking abstinence 6 months after treatment than 40 participants who received the nicotine patch (odds ratio, 6.12; 95% CI, 1.99-23.26).

Patients with gout who achieved serum urate levels <6 mg/dL with urate-lowering treatment had a considerably lower risk of cardiovascular events than those who did not (weighted HR, 0.91; 95% CI, 0.89-0.92), with a greater effect in high cardiovascular risk patients. Those who achieved a lower serum urate target of <5 mg/dL had a larger risk reduction (weighted survival difference, 2.6%; 95% CI, 0.9%-3.6%; weighted HR, 0.77; 95% CI, 0.72-0.81).

In 144 patients with rheumatoid arthritis in remission, age 58.2 years, disease activity remained low and comparable in the 3 groups: continued same treatment with ozoralizumab and methotrexate (77.4%), ozoralizumab spacing group (76.7%), and methotrexate dose reduction group (79.2%).

Of patients with multiple sclerosis (MS), 96.2% had high-level Epstein-Barr virus titers in 2 or more of 4 follow-up samples, versus 7.7% in patients with MOGAD (odds ratio [OR], 303.4; 95% CI, 94.4-908.6) and 18.0% in patients (11 patients) with NMOSD (OR, 114.9; 95% CI, 43.0-280.0). This was a retrospective, multicenter, longitudinal, case-control study of 2091 patients, age 31 years, with multiple sclerosis versus other demyelinating diseases.

The inflation reduction act (IRA) 2024 prescription drug provisions were associated with a 4.9% reduction in cost-related medication nonadherence among eligible Medicare beneficiaries in their first year. Among Medicare beneficiaries with multiple chronic conditions, the decline was more pronounced (−7.8%; 95% CI, −12.9% to −2.8%), with implications for chronic disease management, downstream clinical outcomes and healthcare costs.

The VA has eliminated thousands of medical positions that were left vacant after a wave of resignations and retirements last year, according to internal agency records.

The cuts include empty slots for more than 1,500 physicians and 4,900 nurses. In total, the VA chose not to hire replacements for roughly 14,400 unfilled medical vacancies at its healthcare division. Those jobs were the equivalent of about 5% of the VA’s medical staff as of December. The VA has long struggled to hire medical providers. More than 90 percent of the department’s facilities reported “severe shortages” of doctors last year according to a 2025 report by the department’s inspector general. Nearly 80 percent reported severe shortages of nurses.  

In a search for medications to treat long COVID, recovery occurred in 63.6% (84 of 132) with metformin, 68.2% (90 of 132) with ursodeoxycholic acid (UDCA), and 68.2% (90 of 132) with placebo. The mean baseline PASC score was 19.3 (SD, 5.7), and mean changes in PASC scores from baseline to week 8 were -10.05 (95% CI, -11.35 to -8.76) with metformin and -10.62 (CI, -11.79 to -9.45) with UDCA, compared with -10.43 (CI, -11.69 to -9.18) with placebo -- no significant difference.

The CDC reports 1,566 confirmed measles cases in 32 states vs 1,478 cases in 32 states last week.

Ohio’s respiratory dashboard showed 217 flu hospitalizations (393 last week), 136 COVID hospitalizations (208), and 316 RSV (364).

The OMDA call on Thu April 2 is on: The Impact of Tardive Dyskinesia in the LTC Setting, by Jennifer Gibbs, LNHA, CEAL, CDP, Teva

Wishing those who celebrate a Happy Easter and a Happy Passover.