Geriatric Update May 25, 2026

764 randomized patients with chronic pain (age 60.5) showed better pain control with a whole health team including a primary physician or nurse practitioner, a second clinician providing non-pharmacological or integrative pain care, and a coach over 12 months. Pain interference scores improved from 6.6 to 4.9. Cognitive behavioral therapy, however, did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46).

In 529 patients with early Parkinson’s, age 63.7, the D1/D5 agonist tavapadon (5 or 15 mg) resulted in significant improvements in Movement Disorder Scale combined scores at week 26 vs placebo. With a 5-mg dose of tavapadon there was a 9.7-point decrease in combined scores vs a 1.8-point increase with placebo (treatment difference, −11.5 points; 95% CI, −13.8 to −9.2; P < .001; d = 1.14). With a 15-mg dose of tavapadon there was a 10.2-point decrease vs a 1.8-point increase with placebo (treatment difference, −12.1 points; 95% CI, −14.4 to −9.8; P < .001; d = 1.20).  Adverse events were minimal due to low D2/D3 receptor activation. 

A 5 mm Hg reduction in systolic blood pressure reduced the risk of major cardiovascular disease in individuals with chronic kidney disease (CKD) (hazard ratio [HR] 0.91 [95% CI 0.87-0.94]) and in those without CKD (0.90 [0.88-0.93]). The effect was slightly more in those without diabetes (0.88 [0.84-0.93]). This was based on a meta-analysis of 363,684 individual-participants from 52 RCTs followed for an average of 4.4 years. 

Regardless of frailty level, 1,445 patients >75 years with myocardial infarction and multivessel disease benefited from revascularization procedures, with similar side effects in this randomized controlled trial.

Medication review and deprescribing interventions in older LTCF residents with polypharmacy showed no significant effects on falls, hospitalizations or mortality, possibly because only very few meds were stopped. From 3,548 records, in 38 studies (22 RCTs, 16 quasi-experimental) the number of drugs reduced slightly per patient [within 12 months: -0.89 (95% CI -1.46, -0.32); at ≥12 months: -1.60 (95% CI -2.68, -0.52)] as did potentially inappropriate medications [at 6 months: -0.48 (95% CI -0.74, -0.22); at ≥12 months: -0.26 (95% CI -0.40, -0.13)].

Initial therapy for atrial fibrillation is usually antiarrhythmic medications but this study found better outcomes with pulse field ablation (PFA). At 12 months, treatment success was observed in 128 of 207 patients (Kaplan–Meier estimate, 56%; 95% confidence interval [CI], 48 to 63) in the PFA group and in only 40 of 103 patients (Kaplan–Meier estimate, 30%; 95% CI, 21 to 40) in the antiarrhythmic-drug group (hazard ratio for composite treatment failure [a lack of short- and long-term success], 0.46; 95% CI, 0.33 to 0.65; P<0.001).

An electric spoon makes food taste salty with a small electric current that stimulates our salt-sensing taste buds.

This New York Times article includes 3 simple strengthening and stretching exercises to keep your feet pain-free from plantar fasciitis.

Deprescribing of proton pump inhibitors (PPIs) was twice as high in the group randomized to patient education brochure on PPI deprescribing that was posted directly to patients with a PPI deprescribing algorithm sent to their physicians (14.9% vs a physician-facing intervention, in which only the physician received the letter and algorithm, 7%). Gastroesophageal Reflux Disease Impact Scale (GIS) scores were similar in both groups, 1,498 patients, age 68.

Skilled nursing facility (SNF) nurse staffing is associated with shorter length of hospital stay (LOS). Each additional nurse staffing hour per patient-day was associated with a 3.5% shorter LOS.

From 2000 to 2024, hospital shootings increased by a mean (SD) of 1.1 (0.2) events per year, from 6 to 34 events (6.4% increase per year). They primarily occurred in large, urban, and southern US hospitals, and nearly one-third of shootings (32.1%) were potentially preventable by weapons screening.

This article on firearm safety across the lifespan raises the issue of cognitive decline and the need for public awareness similar to drunk driving. In my normal aging video I discuss a contract that can be drawn up before the development of dementia that includes driving cessation and firearm safety but also placement, should independent living no longer be safe.

This article on several dementia studies identified 3 trajectories of the disease process, with 70% showing a stable course, slow decliners, and the group with the most rapid decline showing a steep rise in various tau markers. In my experience each person has a distinct trajectory, determined by their number of neurons in a given brain region and how fast they atrophy over time.

Hidden fat stored between internal organs increases stress-induced urinary incontinence for women by 51% (odds ratio [OR] 1.51; CI 1.03–2.21), even in women with normal BMI. Higher levels of visceral fat were also linked to a 16% increase in urinary discomfort and a 9.3% increase in impact on daily activities for women with incontinence.

Reducing visceral adipose tissue (VAT) was associated with slower brain atrophy on MRI and improved cognitive performance on MOCA 5-16 years after lifestyle intervention. In my experience, VAT is the most important lifestyle change we can make, followed by exercise and then diet.

Physical activity is highly beneficial for improving symptoms of depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42) compared with usual care across all populations in 97 reviews of 1,039 trials and 128,119 participants. Higher-intensity physical activity was associated with greater improvements in symptoms.

The Department of Health and Human Services (HHS) announced a new action plan focused on psychiatric deprescribing. AGS, PALTMed and I have been big advocates for deprescribing and welcome this initiative especially in older adults, when dementia and atrophy of neurons may require a lower dose to control symptoms, or may even allow for the med to be stopped entirely. In light of firearm violence, it is important that we taper judiciously to not endanger our patients. Yet, with counseling and exercise many patients may be able to taper off meds.

In a letter to Mr. Trump, Rich Danker, spokesman and assistant secretary for public affairs for the Department of Health and Human Services (HHS), resigned, saying that allowing the sale of flavored e-cigarettes would enhance their appeal to children. Dr. Marty Makary, the F.D.A. commissioner who also resigned, sought to block the marketing of flavored e-cigarettes but was overruled. President Trump was personally involved in advancing it. 

Nicotine-based e-cigarettes are likely to be carcinogenic to humans who use them, causing an indeterminate burden of oral cancer and lung cancer. Large, long-term studies are required to quantify the extent. 

The CDC reports 1,943 confirmed measles cases in 40 states vs 1,884  cases in 40 states last week.

Even the darkest hour is only 60 minutes. Morris Mandel‍ ‍