Geriatric Update May 26, 2025

The CDC reports 1046 confirmed measles cases in 31 states, up from 1024 in 31 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.

The FDA is poised to overhaul COVID-19 vaccine approval to focus on older populations, high-risk individuals, and offer vaccine trials for younger and low risk participants.

Patients hospitalized for non-severe COVID-19, who received antibiotics for suspected community acquired pneumonia, according to CAP Clinical Pathway: ampicillin/sulbactam, ceftriaxone, cefotaxime, azithromycin, clarithromycin, doxycycline, levofloxacin, and/or moxifloxacin, had worse outcomes than propensity matched controls who did not receive antibiotics (odds ratio 1.33 [95% CI, 1.31-1.35]).

In a survey 1,135 Americans said that US health care spending funding primary care was 51.8%. Respondents’ average estimate of the percentage of health care needs addressed by primary care was 58.7% (SD 22.2, IQR 28.5) These results reveal a tremendous disparity between current levels of actual primary care spending of only 4.7%.

The FDA has cleared the blood test for Alzheimer’s G pTau217/ß-Amyloid 1-42 plasma ratio.  

Herpes simplex virus (HSV-1, which cause fever blisters) and varicella zoster virus (shingles) are associated with Alzheimer’s stratified by age: 50–70 years: OR 1.14, 95% CI 0.91 to 1.44; 71–74 years: OR 1.51, 95% CI 1.27 to 1.80; 75+ years: OR 2.10, 95% CI 1.88 to 2.35.  Those who used antiherpetic medications (40%) were less likely to develop AD compared with those who did not use antiherpetics (adjusted HR 0.83, 95% CI 0.74 to 0.92). More than 2/3 of the population has HSV, these odds ratios are not strong for an observational study, and other studies have shown no association, possibly because a weakened immune system with the onset of dementia and old age leads to herpes reactivation, yet it makes sense to treat with low cost, generic acyclovir.

In the US there are 7.2 million people aged 65 years or older living with Alzheimer's dementia (AD), up from an estimated 6.9 million in the 2024 report. Three quarters of people with AD are aged 75 years or older. This number is going to double by 2060, due to the Aging population, but hopefully with lifestyle interventions this rise will be attenuated.

Nearly 2/3 of Alzheimer’s patients are female, yet only 12% of Alzheimer’s research was centered on women as of 2019. the gender discrepancy was thought to be because women live longer than men do; the average woman lives to 80.2 years and the average man to 74.8 years in 2022. But even when looking at a cohort of men and women in the same age range, women are still more likely to be diagnosed with Alzheimer’s. And women are diagnosed later because of better language skills. The White House Initiative on Women’s Health Research has a major focus on Alzheimer’s disease and will hopefully be continued under HHS Secretary Kennedy’s focus on chronic diseases.

A decrease of systolic blood pressure (SBP) from 157.0 at baseline to 127.6 mm Hg at 48 months, and diastolic BP (DBP) decreased from 87.9 to 72.6 mm Hg, led to 15% lower risk of dementia over 4 years (risk ratio: 0.85; 95% CI 0.76 to 0.95; P = 0.0035) with fewer adverse events. In the control group, SBP decreased from 155.4 to 147.7 mm Hg, and DBP fell from 87.2 to 81.0 mm Hg, This was a cluster randomized controlled trial of a non-physician community healthcare provider-led intervention in 163 Chinese villages and 163 villages randomized to usual care, with 33,995 individuals aged ≥40 years and uncontrolled hypertension in rural China. 

After adjusting for confounders, metabolic syndrome was linked to increased risk for all-cause young-onset dementia (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.19-1.30), as well as young-onset Alzheimer’s disease (aHR, 1.2) and vascular dementia (aHR, 1.4). participants aged 40-60 years (mean age, 49 years over 7.8 years. Metabolic syndrome was defined as three or more of the following characteristics: Excess belly fat, high blood pressure, high fasting blood glucose, increased triglycerides, and reduced levels of high-density lipoprotein. Participants who had all five characteristics had a 70% higher risk of early onset dementia (aHR, 1.7; 95% CI, 1.5-1.9).

In patients with dementia and influenza, rates of hospitalization were 9%–10% lower, and the mortality rate 9% lower, for vaccinated compared to unvaccinated among 134,002 Danish people >65, during 2002 to 2018 influenza seasons.

Function Focused Care improved function and physical activity in hospitalized patients living with dementia, age 82.5, up to 1 month after discharge.

Long-term use (> 24 months) of non-steroidal anti-inflammatory (NSAID) medication was associated with lower dementia risk (HR [95% CI]: 0.88 [0.84–0.91]), and an increased risk with short-term use (< 1 month) (HR [95% CI]: 1.04 [1.02–1.07]) or intermediate-term use  (between 1 and 24 months) (HR: 1.04 [1.02–1.06]), over 14.5 years in the 9520 (81.1%) participants, who used NSAIDs of the prospective population-based Rotterdam Study.

In patients taking NSAIDs, proton pump inhibitors (PPIs) may have no effect on the presence of global symptoms of dyspepsia and adverse events compared with placebo, and probably reduces incident ulcers but not as good as histamine 2-receptor antagonists (H2 meds) or misoprostol. Further research is needed to assess the effect of PPIs compared to other active treatments such as sucralfate, misoprostol, or H2 meds. 

Patients with chronic kidney disease (CKD) who underwent percutaneous coronary intervention (PCI) after acute myocardial infarction (MI) , de escalation from ticagrelor to clopidogrel was associated with a reduced rate of bleeding events vs control (2.5% vs 8.3%), without increased ischemic events (4.4% vs 5.5%) in 305 patients, aged 67. I would like to also see studies in patients with dementia and the very old as their blood vessels become more friable. 

Amiloride showed noninferior efficacy in lowering blood pressure (BP) at 12 weeks compared with spironolactone in a randomized clinical trial with 118 participants, age 54, with true resistant hypertension. Side effects of hyperkalemia and gynecomastia was similarly low in both groups. Funding for this study of 2 generic medications, was the Korean NIH and Health Care system.

This study used the existing cardiovascular disease risk prediction calculators American College of Cardiology/American Heart Association (ACC/AHA), 2008 Framingham, GloboRisk, Predict and National Vascular Disease Prevention Alliance (NVDPA), as well as an age-specific SCORE2-OP model,  to assess heart risk of older adults >70 participating in the ASPREE trial, and found them reliable in healthy White older adults. Adding depression, creatinine and socioeconomic status did not change results.

Patients with intermediate size pulmonary embolus, age 59, underwent thrombectomy with the AVENTUS Thrombectomy System that removed blood and clots. Blood and clot was suctioned out during the 40 min procedure, the clot filtered out and the blood reinfused again immediately, reducing blood loss to 50 ml and reducing clot burden by 36%. Mean pulmonary artery pressure (PAP) decreased by 4.8 mm Hg, even more, 6.1 in those with PAP >25 (normal <15), over 30 days, 6 minute walk distance improved by 50% and quality of life by 60%.

Incidence of recurrent ischemic stroke in patients with atrial fibrillation (A-fib) was 3.75% per year (95% CI, 3.17%-4.33%), in a systematic review and meta-analysis of 23 studies including 78,733 patients and 92% oral anticoagulant (OAC) use. The rate was almost twice as high, 7.2% per year in observational studies, in patients with stroke despite OAC. The difference may be that the attention of randomized trials increasing adherence to OACs.

This interview with an oncologist from Anderson Cancer Center addressed: Microbiome and Risk for Cancer Outcomes. The recommendation is to get >50 g of fiber a day to feed the microbiome, most Americans get <15 g, and probiotics did not help.

Nausea is the most common side effect of GLP-1 meds 44.2%, but other side effects are: abdominal pain in 10%, , diarrhea 31.5%, vomiting 24.8%, and constipation 23.4%. Other suspected side effects are muscle and bone loss, but both are avoided with exercise. If patients cannot tolerate even low dose GLP-1 meds, changing to DPP-4 inhibitors have worked well for my patients.

A weighted vest use cut weight regain in half after weight loss interventions were stopped. The vest was worn >10 hours daily and titrated up to 15% of baseline patient weight. The 16 older patients, age 70, received 1100–1300 kcal/day over 6 months, assisted by dieticians, without exercise intervention, and were followed for 24 months. The mechanism of action is felt to be due to increased resting metabolic rate.

In the updated position statement: Making medical treatment decisions for unrepresented older adults, the American Geriatrics Society (AGS) replaced the term “unbefriended” with “unrepresented” for patients who (1) lack decisional capacity to provide informed consent for a particular medical treatment, (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so, and (3) lack representation from a surrogate decision-maker (i.e., family, friend, or legally authorized surrogate). 

Congratulations on University of Cincinnati’s Age Friendly University achievement, one of <120 universities world wide.  Thank you, Dr. Joanne Mitro for leading the initiative and the many collaborators who have made it happen.  More info to follow.

Take care of your body. It’s the only place you have to live. (John Rohn)