Geriatric Update May 19, 2025

The CDC reports 1024 confirmed measles cases in 31 states, up from 1001 in 30 states last week. This slowing may be due to less heat and dry air in homes, leading to less airborne transmission, similar to COVID. No new updates on the Ohio Department of Health website.

FDA and the CDC followed the European Medicines Agency suspending use of the chikungunya vaccine Ixchiq in people >65, the FDA recommends against it in >60 years of age. Postmarketing reports have uncovered 17 serious adverse events, including two deaths, in vaccinated adults between the ages of 62 and 89. 

Lumipulse G pTau217/ß-Amyloid 1-42 Plasma Ratio received FDA clearance for detection of amyloid plaques associated with Alzheimer’s disease in adult patients, >55 years, exhibiting signs and symptoms of the disease. clearance less rigorous than approval, only requiring equivalence to an existing, in this case spinal fluid test. Approval requires more rigorous testing and demonstration of safety and effectiveness through clinical trials.

Lecanemab caused reactions in 37% of 234 Alzheimer’s patients and amyloid-related imaging abnormalities (ARIA) emerged in 42 of 194 people (22%) who received at least four lecanemab infusions and had at least one MRI. Most ARIA cases were asymptomatic (74%) and radiographically mild (62%). Patients with mild dementia at baseline had a 15-fold higher rate of symptomatic ARIA compared with those with mild cognitive impairment or very mild dementia.

Long-acting muscarinic antagonists (LAMAs), such as tiotropium, are inhaled anticholinergic bronchodilators, but do not seem to have an association with dementia in as treated analysis.

Colchicine reduced the incidence of major adverse cardiovascular events (cardiovascular mortality, MI, ischemic stroke, and urgent coronary revascularization) compared with placebo [pooled hazard ratio 0.75, 95% confidence interval (CI) 0.56–0.93]. The meta-analysis was based on 6 randomized trials of 21,800 patients with CAD, MI or stroke. Adverse effects were similar. 

In the 1980s we instructed patients with diverticulitis avoid nuts and seeds but stopped restrictions in the 1990s. Intake of peanuts, nuts, and seeds (aHR,1.07 [95% CI, 0.91 to 1.25]) and fresh fruits with edible seeds (aHR,1.06 [CI, 0.90 to 1.24]) was not associated with incident diverticulitis. Moreover, women in the highest quartile of healthy diets compared with the lowest quartile had lower risk of diverticulitis: the Dietary Approaches to Stop Hypertension diet (aHR, 0.77 [CI, 0.65 to 0.90]), the Healthy Eating Index (aHR, 0.78 [CI, 0.66 to 0.91]), the Alternative Healthy Eating Index (aHR, 0.81 [CI, 0.69 to 0.95]), and the Alternative Mediterranean diet (aHR, 0.91 [CI, 0.78 to 1.06]).

Social determinants of health at the community level, such as age, sex, home discharge vs. non-home discharge, comorbidity burden, median income and walkability, have a larger influence on hip replacement outcomes, and found that race was the least important factor in the models for 90-day revision and mortality. Community factors, particularly walkability of patients’ neighborhoods was inversely correlated with their likelihood of readmission.

In 10 000 patients with device-detected subclinical atrial fibrillation (age 77), those receiving anticoagulant therapy had 233 fewer ischemic strokes (21.7%), 55 fewer deaths (1.1%), and 453 more major bleeding events (37.3%) over a 10-year simulation period. Based on an analytical model, per patient, these differences translated to approximately 1 additional quality-adjusted week of life (0.024 QALYs) with NOAC treatment during the 10-year simulation. While it seems small, in a given patient, who avoids a stroke, this is huge, and blood comes in a bag, but brain doesn't come in a box.

Risk for thyroid cancer with GLP-1s was not increased hazard ratio (HR, 0.93, CI 0.66- 1.31) compared with DPP-4 inhibitors, or with SGLT2 inhibitors, the HR for thyroid cancer was 1.16 (0.65- 2.05).

Thickened liquids in patients with dementia and dysphagia, did not improve hospital mortality over thin liquids (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46) in 8916 propensity score matched hospitalized patients, age 85.7 years. Patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91). No difference in dehydration was likely due to hospital IV fluids.

Intensive behavioral intervention within an e-health weight management clinic and an online app (Embla) can produce weight loss of -16.7% with about half of the semaglutide used 1.08 mg/week compared to control, in 2694 Danish participants, age 46.8 years, and mean BMI 34.3 over 64 weeks. 

The OMDA conference on Thu May 22nd at 8 am is A Turnkey Solution for Improved Patient Care, Reduced Staff Workload, and Improved Practice Net Profitability (Chronic Care Management, Remote Physiologic Patient Monitoring, Remote Therapeutic Monitoring, and Behavioral Health Integration Programs), Jim Bland of Remote Care Today - Senior Home Services