Geriatric Update Nov 17, 2025
In 5,291 patients with prior ischemic stroke, reducing low density lipoprotein (LDL) cholesterol levels to <40 mg/dL vs ≥70 mg/dL experienced a 27% reduction in all strokes and a 25% reduction in subsequent ischemic strokes. Why wait until after a stroke? I would like to prevent all strokes. Vitamin D deficiency can contribute to muscle aches with statins, and supplementing vitamin D allowed me to restart statins after 3 months in my patients.
Thinking of vascular changes in coronary and carotid arteries has evolved from narrowing to factors like plaque morphology, composition, and inflammation, which predict embolic risk better than stenosis severity alone. A standardized 4-point scoring system from 1 (minimal risk) to 4 (high risk), intended to harmonize reporting across computed tomography (CT), magnetic resonance (MR), and ultrasound and to correlate directly with escalating stroke risk and improved prediction by 63.8% for first strokes and 47.8% for recurrent strokes.
Blood vessel wall appearance also mattered in intracranial aneurysms. The cumulative risk of instability at 4 years was 36.8% (95% CI, 30.7%-43.0%) in unruptured intracranial aneurysms (UIAs) with circumferential aneurysmal wall enhancement (AWE), 17.2% (95% CI, 13.4%-21.1%) in UIAs with focal AWE, and 11.4% (95% CI, 11.9%-16.1%) in UIAs with no AWE.
In a young cohort, age 26, of 1770 patients with unruptured arteriovenous malformations (AVMs), interventional treatment was associated with significantly higher estimated hemorrhage-free survival at 5 years (96% vs 89%) and 10 years (84% vs 76%) compared with conservative management.
Patients who participated in a personalized prehabilitation program of twice-weekly coaching were better prepped for a major surgery than those offered standard pre-surgery advice without any direct guidance. They improved significantly on every test of physical and mental fitness prior to their procedure and showed changes in their immune system that aided their post-surgery recovery and wound up with fewer complications. The mechanism seems to be that immune cells are less likely to overreact and also lowered the patient’s baseline level of inflammation prior to surgery, reducing post-surgical cognitive decline, which affects up to half of patients after major surgery.
Atrial fibrillation (A-fib) or atrial flutter recurrence was less in the 100 patients, age 69, randomized to 7 cups caffeinated coffee consumption (47%) than the 100 in the coffee abstinence (64%) group (hazard ratio, 0.61 [95% CI, 0.42-0.89]; P = .01).
In 3961 patients (mean [SD] age, 76.8 with subclinical atrial fibrillation (SCAF), lasting 6 minutes to 24 hours with stroke risk factors (CHA2DS2-VASc score ≥3) or prior stroke, were randomized to apixaban, 5 mg, twice daily (2.5 mg twice daily when indicated) or aspirin, 81 mg, once daily. The rates of intracranial and fatal bleeding were similar in the apixaban and aspirin groups, whereas the rate of gastrointestinal bleeding was higher in the apixaban group (0.89% vs 0.40% per 100 patient-years; HR, 2.23). Factors that increased risk were nonsteroidal anti-inflammatory drug (NSAID) use (HR, 10.25), cancer (HR, 2.87), and age (HR, 1.47; 95% CI, 1.28-1.67, per 5-year increase).
Vascular dysfunction contributes to dementia and this study showed, stronger platelet clumping/ aggregation, measured by light transmission aggregometry, goes hand-in-hand with more amyloid and tau on PET and MRI brain scans in middle age, avg 56 years. I suspect that the underlying inflammation drives platelet aggregation and dementia because years of use of the antiplatelet aspirin that we physicians recommended to millions of people, did not reduce dementia.
Training 52 home health aides (HHAs), age 54, in the care of adults with heart failure (HF) improved knowledge and self-efficacy, the ability to message nurses was associated with fewer preventable 911 calls among HHAs in the intervention group, but did not reduce emergency room visits or hospitalizations compared to the 50 HHA randomized to usual care.
A new dementia diagnoses was 31% higher in the primary care clinics randomized to combining the artificial intelligence (AI) assisted Quick Dementia Rating System (QDRS) with a Passive Digital Marker (PDM), with 5325 patients, age 71.
Of 96 patients with hip fractures undergoing surgery with general anesthesia who were randomized to intranasal insulin (INI) showed a significantly lower incidence of postoperative delirium (POD) within the 5-day postoperative period (10.9% vs. 30.4%, P = 0.020) than the normal saline group. On postoperative day 3, the incidence of POD was 2.2% in the insulin group vs. 19.6% in the NS group. No significant differences in POD incidence were observed on postoperative days 1 or 5.
A 24-week multicomponent frailty prevention program including structured exercise and nutrition, with depression management, deprescribing, and home hazard reduction, had longer composite outcome-free survival at 66 months (mean difference, 6.53 [95% CI, 1.38-11.68] months) among 119 matched pairs of Koreans, aged ≥75 years.
Iron deficiency anemia was significantly lower in the group taking sodium–glucose cotransporter-2 inhibitors (SGLT2i) than in the DPP-4 inhibitor cohort (6.9% vs 11.3%; HR: 0.67; 95% CI: 0.58–0.78) in men >60 years old, not in women or younger folks. The mechanism is that SGLT2i modulate erythropoiesis and iron metabolism. the protective effect was limited to metformin use under 3 years, possibly because metformin blocks vitamin B-12 absorption, necessary for erythropoiesis.
Eating ultraprocessed foods may significantly raise the odds of developing early-age noncancerous colorectal adenomas – growths, or polyps, in the colon and rectum that can lead to cancer (highest vs lowest intake: AOR, 1.45; 95% CI, 1.19-1.77; overall P < .001).
In 110 out of 182 Italians with chronic kidney disease (CKD), who chose to follow low-protein diets (LPDs), 0.6-0.7 g/kg/day, delayed the need for kidney replacement therapy (KRT) After a median follow-up of 18 months: the diet group had an 84% lower risk of requiring dialysis (crude hazard ratio [HR], 0.16; 95% CI, 0.07-0.39), a 78% lower risk for all-cause mortality (crude HR, 0.22; 95% CI, 0.06-0.72), an 81% lower risk for the composite outcome of dialysis, mortality, or non-fatal cardiovascular events (crude HR, 0.19; 95% CI, 0.09-0.38) and a significantly slower annual decline in the estimated glomerular filtration rate (eGFR) than the no-diet group (-0.89 vs -2.65 mL/min/1.73 m2 per year; P = .0004).
In this podcast on thyroid function and hypothyroidism, Dr. Antonio Bianco describes the higher than normal levels of thyroid stimulating hormone (TSH) levels (0.5-5.0 mIU/L) in older adults: for every decade >50, add 1 point, for example an 80 year old would have a normal TSH with 7.5.
The U.S. and New Zealand are the only two countries that currently allow direct-to-consumer (DTC) advertising of prescription drugs, and a growing number of voices, including public officials from across the political spectrum and the American Medical Association, have called for banning it. 43% of DTC television advertisements reviewed were objectively true, 2% were false, and 55% were potentially misleading. Potential benefits of DTC advertising, include enhanced information seeking by patients, increased appropriate prescription requests, and increased and improved patient perceptions of physician interactions, who often steer patients to more appropriate or lower-cost alternatives. The article did not state the cost of television advertising, but 18-25% of budget is for promotion, with 13.5% going to television advertising, a small fraction compared to cost of CEO salaries and stock buyouts, and more than research and development.
Fall migratory patterns are again spurring seasonal outbreaks of bird flu, H5N1, particularly among geese and swans at public parks. Since September, 42 US states have confirmed wild bird flu cases. Nearly 4 million commercial poultry were culled in September, plus another 4 million in October due to flock outbreaks. Influenza vaccination protects us.
A new influenza strain, a version of H3N2, is causing outbreaks in Canada and the U.K., where health officials are warning about the early wave that’s sending people to the hospital. According to the UK Health Security Agency (UKHSA), almost all recent cases (98%) have been influenza A, and among those subtyped, around 84% are H3N2. Of these, around 87% are subclade K. The CDC also reports H3N2 as the most frequent flu virus.
The CDC reports 1,700, confirmed measles cases in 42 states, up from 1,658 in 42 states 1 week ago.
Long ago I learned from my father to put old people to bed only for as short a time as was absolutely necessary, for they were like a foundered horse; if they got down it was difficult for them to get up and their strength ebbed away very rapidly while in bed. Dr. Charles H. Mayo
