Geriatric Update May 4, 2026

Regardless of sex, in individuals without knee osteoarthritis (KOA) but who are at risk for KOA, high ultra-processed food (UPF) consumption was associated with higher muscle fat content on thigh MRI scans. UPF was quantified by questionnaire based on the NOVA-4 dietary items that are ready-to-eat foods and beverages prepared using industrial-level chemical processing methods. These items are high in cosmetic additives such as flavorings, colorings, and emulsifiers, designed to enhance shelf life, palatability, and consumer appeal. The 615 participants, age 59.5, were limited to those without KOA to limit disuse muscle atrophy as a confounder.

GLP-1 receptor agonist use may be associated with a 26% increase in erectile dysfunction (ED) risk in men with type 2 diabetes vs DPP-4 inhibitor use (HR, 1.26; 95% CI, 1.08–1.46) based on electronic health record data over 3 years of follow-up. Added to this, GLP-1 use lowers dopamine level, which may delay ejaculation. This may motivate men to make lifestyle changes to keep their weight off, thus raising their testosterone. They may be able to taper GLP-1s with the option of switching to DPP-4s, a weaker, oral method of raising GLP-1.

GLP-1 receptor agonist (GLP-1) therapy was associated with hair loss, particularly in female patients, in those with the greatest weight loss and those using tirzepatide. Of 254 Saudi participants, hair loss was reported by 76%, and 22% experienced hair loss before starting the GLP-1. It is unclear if it was due to the weight loss or the medication because of lack of a control group, and weight loss is known to cause hair loss.

Sodium-glucose co-transporter 2 inhibitor (SGLT-2) therapy in individuals with type 2 diabetes was associated with increased DKA risk overall in observational studies in those with elevated HbA1c (RR 1.63, 95% CI 1.46-1.81) but not in those with lower HbA1c (RR 1.10, 0.80-1.51). In randomized controlled trials, the effect was even larger, RR 2.37 (1.44-3.90) in high and 2.01 (0.84-4.79) in low HbA1c groups. The study didn't describe the rate of insulin or sulfonylurea co-use. It lowers blood glucose with very low risk of hypoglycemia and is beneficial for heart failure through sodium excretion. We don't use it as often in older adults because of the risk of dehydration, perineal infection and diabetic ketoacidosis due to lower capacity for hepatic gluconeogenesis. 

The FDA approved Dapagliflozin (Farxiga), the first generic SGLT-2.

The FDA also approved Orforglipron (Foundayo), the first daily GLP-1 pill that has no food or water restrictions.

Antibiotics with the greatest Clostridioides difficile infection (CDI) risk were lincosamides (aOR=31.4, 95% CI 27.9 to 35.3), combinations of penicillins (aOR=19.8, 95% CI 15.9 to 24.5), sulfonamides and trimethoprim, and cephalosporins, though there was no association for tetracyclines. Among non-antibiotic drugs, this study found decreased risks of CDI for lipid-modifiers (aOR=0.8, 95% CI 0.8 to 0.8) and aspirin (aOR=0.8, 95% CI 0.7 to 0.8) and increased risks for antidiarrheals (aOR=7.3, 95% CI 6.8 to 7.8), corticosteroids (aOR=2.4, 95% CI 2.3 to 2.5), and proton-pump inhibitors (PPIs) (aOR=1.8, 95% CI 1.7 to 1.8).

Urinary antimicrobial peptides (AMPs) are part of the innate immune system and are active in both preventing and responding to acute bacterial infection. Baseline levels of several AMPs (human neutrophil peptides 1–3 (HNP 1–3), human alpha-defensin-5 (HD-5) and cathelicidin (LL-37) did not vary by age, but older adults had lower baseline human beta-defensin-2 (hBD-2) levels. 

Of 162 older adult patients, 18 (11%) had asymptomatic bacteriuria. Urinalysis results varied between asymptomatic older adult patients with positive asymptomatic bacteriuria and negative cultures, but AMP values did not differ: all 4 AMPs were low and may be able to distinguish asymptomatic bacteriuria from true infection where urinalysis cannot.

Rapid antimicrobial susceptibility testing (RAST) showed no difference in 30-day mortality (rapid, 24%; standard, 23%) or length of stay compared to routine culture that takes 3-5 days. However, rapid testing led to quicker changes in antibiotic therapy (median 22 vs 36 hours) and in patients with carbapenem-resistant infections (median 9.5 vs 28 hours), and could lead to lower resistance to antibiotics. In another study:

pid microcapillary direct-from-urine (RMD) provides rapid bacteriuria and antibiotic susceptibility testing (AST) results for five antibiotics and showed a concordance with the reference method of agar plated >105 colony count, 572/590 bacteria/antibiotic combinations (96.95%) for urine samples containing a single organism. The mean time to AST result was 5.85 hours, compared with several days for culture. When duplicate samples with or without boric acid were directly compared there was a categorical agreement of 158/160 (98.75%), important when sample has to be stored until test can be done, or until lab pick-up.

The effect of amyloid‐beta‐targeting monoclonal antibodies on cognitive function and dementia severity at 18 months in people with mild cognitive impairment or mild dementia due to Alzheimer’s disease is trivial and the effect on functional ability is small at best. There is also increased risk of amyloid‐related imaging abnormalities. Since removal of amyloid from the brain does not seem to be associated with clinically meaningful effects, this Cochrane review of 17 randomized controlled trials with 20,342 participants calls for research to focus on other mechanisms of action.

21 sessions of internet-based cognitive behavioral therapy (ICBT) for tinnitus were associated with significant improvements in ringing in the ear at 6-year postintervention assessment in 49 of 136 participants (35.5%), age 54 years, based on a 23.86 point (95% CI, 7.96-39.76) score improvement. Small effects were found on measures of anxiety, depression, insomnia, and satisfaction with life, but not on auditory-related effects of hearing disability.  

251 patients (age 72) with atrial fibrillation (on EKG), history of stroke within 1 to 6 months, and on edoxaban anticoagulation, were randomized to medical therapy and catheter ablation with medical therapy. No difference was seen between the groups for recurrent ischemic stroke, systemic embolism, all-cause death, and hospitalization for heart failure (hazard ratio, 1.11; 95% CI, 0.62-2.01), nor was a significant difference seen for death (1.0 and 2.8 per 100 person-years). 

Stroke was associated with double the risk of dementia, depending on stroke severity, in a cohort study of 42,342 participants, age 62, over 11 years. Compared with participants with no stroke, adjusted hazard ratios for incident dementia were 1.93 (95% CI, 1.52-2.45) for National Institutes of Health Stroke Scale (NIHSS) 0-5, 3.26 (95% CI, 1.93-5.53) for NIHSS 6 to 10, and 5.06 (95% CI, 2.71-9.45) for NIHSS 11 or higher. Controlling systolic BP to <120 is the best way to prevent stroke, and with adequate hydration older adults can prevent side effects from orthostatic hypotension, such as dizziness and falls.

The chair of the American College of Cardiology (ACC) annual flagship meeting summarized the most pertinent take-aways:

• benefit of intensive lipid-lowering therapy in high-risk patients without atherosclerotic heart disease,

• glucagon-like peptide-1 (GLP-1) receptor agonists’ cardiorenal benefits,

• discontinuing β-blockers a year after myocardial infarction (MI),

• treatment for post–COVID-19 postural orthostatic tachycardia syndrome (POTS), and

• a possible cardioprotective role of shingles vaccination.

Medetomidine is increasing in the illegal drug supply. It lowers heart rate, similar to clonidine, which can help differentiate between sedation from medetomidine toxicity and overdose (associated with bradycardia) and decreased alertness from medetomidine withdrawal (associated with tachycardia and hypertension). Dexmedetomidine is approved for procedural sedation in humans and has been found effective and well-tolerated in sublingual form for the treatment of agitation associated with schizophrenia and bipolar disorder. IV titration by 0.1 mcg/kg/h, for an average dose of 0.36 mcg/kg/h, lowered postoperative ICU delirium by ½ (relative risk, 0.44; 95% confidence interval, 0.23–0.82) in 100 randomized Canadian and US adults, age 62 years.

Physio-cognitive dual-task training (PCDT), combining physical and cognitive tasks with higher weekly frequency showed greater benefits. Participants with dementia benefited less than those with mild cognitive impairment and age did not affect results. It seems that the earlier we practice dual tasking, the better.

The loss of the involuntary blink response and corneal reflex can predict death within 24 hours (OR 5.48, p<0.001), with a 24-hour mortality rate of 70.7%. It showed high specificity (85.0%) and positive predictive value (70.7%) in 665 Korean hospice patients with cancer.

Chlorthalidone is more potent in lowering BP and longer lasting than hydrochlorothiazide and has shown more hypokalemia. With a healthy diet high in vegetables, fruits, nuts and legumes that contain lots of potassium, magnesium and other minerals (unlike a diet high in meat, rice or pasta), hypokalemia will not be a problem for older adults. Make sure to limit salt as the kidneys use water to wash out excess sodium and then take potassium and other minerals out with it.

Tonlamarsen is an investigational antisense oligonucleotide directed against hepatic angiotensinogen synthesis. 198 participants randomized to 90 mg Tonlamarsen once vs monthly led to 6.7 mmHg lower BP in both groups for the 16 weeks of the trial, even though angiotensinogen levels were −67.2% lower with monthly vs −23.0% with a single dose of tonlamarsen and subsequent placebo.

Influenza vaccination may offer cardiovascular protection even when it does not prevent infection. Of 1,221 individuals (age >40 years) with a first-ever hospital admission for acute myocardial infarction (AMI) or stroke within 365 days of a polymerase chain reaction-confirmed influenza infection, 50% were vaccinated. After adjusting for calendar month, risk for cardiovascular events was elevated with overall incidence rate ratio [IRR], 3.5, particularly for AMI (IRR, 4.7) and stroke (IRR, 2.9). There was significant reduction in the excess risk for AMI or stroke associated with influenza infection for those with prior influenza vaccination during the same influenza season.

The high-dose influenza vaccination is associated with 55% lower dementia risk in adults ≥65 years, with a stronger effect among women. A previous study showed a 40% risk reduction among those who received the standard dose.

The FluScoreVax screening risk score with 6 items (subjective fever, interfered with usual activity, headache, wheeze, phlegm, and recent flu vaccine) and a range from -5 to +6 points showed good specificity and sensitivity with a good AUC of 0.75, and in a validation it classified 61% of patients as low risk, of whom only 7% had influenza when the prevalence of influenza was 15%. 

A few weeks ago, John F. Kennedy, Jr. testified in congress that the measles vaccine is safe and effective “for most people” and agreed it was safer than getting measles. The vaccine is live and should not be given to pregnant women, individuals with significant immune system compromise or active, untreated tuberculosis. This coincided with Trump picking Dr. Erica Schwartz, a Navy officer and former deputy surgeon general who supports vaccines, to be the next head of the C.D.C.

The CDC reports 1,782 confirmed measles cases in 37 states vs 1,782 cases in 37 states last week.

The OMDA call on Thu May 4 is on: Medical School Admissions by Doug Moses, MD, FAAP

Think of exercise as medicine and take your daily prescription. Steven Magee (Author of Toxic Electricity)