Geriatric Update Nov 3, 2025
Tirzepatide showed superiority over semaglutide in reducing body weight and cardiometabolic risk factors in adults with obesity without diabetes, and tirzepatide was associated with fewer gastrointestinal side effects than semaglutide, possibly owing to the counterregulatory role of glucose-dependent insulinotropic polypeptide (GIP) in modulating emetic pathways.2
Over a 10-year follow-up glucagon-like peptide-1 receptor agonists (GLP-1) users had a significantly lower risk of lung cancer than did dipeptidyl peptidase-4 inhibitor (DPP4i) users (hazard ratios [HR] 0.86; 95% confidence interval [CI] 0.80–0.94), reduced risk of influenza and pneumonia (HR 0.94; 95% CI 0.92–0.96) and pulmonary fibrosis (HR 0.92; 95% CI 0.87–0.98) in an observational study that 1:1 propensity score matched GLP-1 and DPP4i (n = 158,224) users. While it does not meet the HR of 2.0 for an observational study, it would support further study and use if indicated.
Several viral infections increase the risk of cardiovascular events:
SARS‐CoV‐2 infection increased risk of CHD (RR, 1.74 [95% CI, 1.44–2.11]) and stroke (RR, 1.69 [95% CI, 1.23–2.31]).
Influenza infection and myocardial infarction (pooled incidence rate ratio, 4.01 [95% CI, 2.66–6.05]) and stroke during the first 1 month (incidence rate ratio, 5.01 [95% CI, 3.41–7.37]).
Herpes zoster, in addition to dementia, was also associated with an elevated risk of CHD (RR, 1.12 [95% CI, 1.08–1.15]) and stroke (RR, 1.18 [95% CI, 1.09–1.27]).
The hugely increased risk with influenza is a good starting point in discussing the respiratory vaccines this fall. And the Shingles shot decreasing dementia risk as another argument.
Pneumococcal capsular polysaccharides are protein-conjugated vaccines (PCVs) to prevent pneumonia hospitalization and death. PCV20 covers 54% to 58% of serotypes that cause adult IPD compared to 81% to 84% for PCV21, which does not cover serotype 4 that affects mostly younger adults age <65 yo. As of August 2025, the Centers for Disease Control and Prevention (CDC) recommends that all pneumococcal vaccine–naive adults with an age or risk indication for vaccination be vaccinated with PCV21, preferentially.
Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalization during 2 seasons was 58%. Vaccine effectiveness was 69% when vaccination occurred in the same season before illness onset and 48% when vaccination occurred in the prior season; these estimates were not statistically significantly different. Estimated vaccine effectiveness during 2 seasons was significantly lower among immunocompromised adults (30%; 95% CI, −9% to 55%) than immunocompetent adults (67%; 95% CI, 53%-77%; P = .02) and among those with cardiovascular disease (56%; 95% CI, 32%-72%) vs without (80%; 95% CI, 62%-90%; P = .03).
The Advisory Committee on Immunization Practices (ACIP) has used a process that evaluates the evidence: Grading of Recommendations Assessment, Development and Evaluation (GRADE). in 2019 it added, an Evidence to Recommendation (ETR) process that included, in addition to the GRADE tables on efficacy and safety, consideration of a number of other important variables including the magnitude of the public health problem being addressed, costs vs benefits, feasibility of the intervention, views of community and professional stakeholders, and effects on equity. Documents for the evidence and the process were posted on the ACIP website. Even though the new ACIP members have access to the GRADE and ETR documents and received training, of the 4 major decisions made in the 2 meetings held, 2 did not involve any work group deliberations, 2 were not accompanied by a description of the methods used to gather and assess the information presented, no ETR documents were provided at the meetings or in advance for committee and public consideration, and only 2 decisions were based on a GRADE assessment of the quality of the evidence.
Ensitrelvir is an oral antiviral treatment for COVID-19 with the same molecular target (the main protease) as ritonavir-boosted nirmatrelvir, the current oral first-line treatment. Median estimated SARS-CoV-2 clearance half-lives were 5.9 h with ensitrelvir, 5.2 h with nirmatrelvir, and 11.6 h with no study drug. Viral rebound occurred in 10 (5%) of 202 in the ensitrelvir and 15 (7%) of 207 patients in the nirmatrelvir group group (p=0.45). In the meta-analysis of all unblinded small molecule drugs evaluated in the platform trial, nirmatrelvir and ensitrelvir had the largest antiviral effects (1157 patients).
Bronchiectasis is a widening of the airway that causes cough and lung infections, neither hypertonic saline nor carbocisteine, a mucolytic that makes phlegm less thick and sticky, significantly reduced the mean incidence of pulmonary exacerbations over a period of 52 weeks.
Colchicine for long COVID did not improve functional capacity, respiratory function, mental states, constitutional symptoms, or inflammatory markers at 52 weeks vs. placebo in a randomized clinical trial including 346 adults.
Of almost half a million nursing home patients, 61% had a drug-drug interactions (DDIs). The 12 most prevalent DDIs involved central nervous system (CNS)-active drugs, anticholinergics, antihypertensives, opioids, and diuretics. Of these DDIs, concurrent use of acetylcholinesterase inhibitors and heart rate-reducing drugs had the longest median exposure duration (81 days; Q1–Q3, 24–235). The most prevalent DDI, concomitant use of ≥ 3 CNS-active drugs, was observed in 27.1% (95% CLs, 27.0%, 27.2%) of residents.
PancreaSure is a blood test for pancreatic cancer that combines the biomarkers: ICAM-1, THSB1, CTSD, TIMP1, and CA19-9, with a sensitivity of 78% and specificity of 92% in detecting early-stage pancreatic cancer, and an area under the receiver operating curve (AUC) of 0.84.
Knee pain attributed to a degenerative meniscal tear improved equally with exercise, with or without physical therapist (PT) involvement. The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore (range, 0 to 100, with higher scores indicating more pain) improved 2.5 points over 3 months in both randomized groups of 879 participants age, 59.2 years. Saving PT for patients who need motivation or instruction will save healthcare costs.
Tai chi in an unsupervised multimodal online intervention over 12 weeks, improved knee pain and function compared with a website containing information about osteoarthritis and exercise benefits in a randomized clinical trial of 178 participants, age 61.
Walking for more than 100 minutes per day was associated with a 23% lower risk of chronic low back pain compared with walking less than 78 minutes per day; walking intensity was also associated with risk of chronic low back pain but to a lesser degree than walking volume. The population-based cohort study included 11,194 participants, age 55.3, without chronic back pain at the start of the study, over 6 years.
Longer walks has more health benefits than taking the same number of steps a day over multiple short walks. Hundreds of studies have shown that higher step counts are tied to lower risk of dementia, Type 2 diabetes and other health issues. Those who regularly walked longer than 15 minutes were 80 percent less likely to die from any cause and nearly 70 percent less likely to develop cardiovascular disease over a 9.5-year period, compared with those who got most of their steps in walks of five minutes or less. The average age of the participants was 62.
The incidence of hearing loss over 25-years (among 436 at-risk participants, avg age 52) was 56.2% (246 participants) and the mean hearing loss progression was 15.1 dB. Factors associated with incident hearing loss included older age, lower education, and high noise exposure, and, among participants aged more than 50 years, hypertension and higher Framingham Stroke Risk Profile (FSRP). Progression of hearing loss was associated with included older age, female sex, lower education, and among participants aged more than 50 years, hypertension and higher diastolic blood pressure.
Disease-specific shift in a subpopulation of nanoscale assemblies of alpha-synuclein that represent an early feature of the proteinopathy that underlies Parkinson's disease.
Heart rate variability biofeedback (HRVB) is an effective intervention for reducing the effects of acute psychological stress on myocardial blood flow by increasing myocardial flow reserve (MFR). Dr. Lawson Wulsin, the author of “Toxic Stress” wrote an excellent commentary to the article.
This study applied HRVB to substance use disorder (SUD) treatment, and showed improved negative affect, craving, and alcohol and other drug (AOD) use in 260 adults, age 46 with SUD over 8 weeks.
Dangerous alcohol consumption at baseline, in caregivers of patients with dementia, was associated with a higher likelihood of negligent behaviors (odds ratio [OR] 2.89; 95% confidence interval [CI] 1.74 to 4.80; P < 0.001) and psychologically aggressive behaviors (OR 2.32; 95% CI 1.28 to 4.19; P = 0.006).
Anxiety was significantly improved with a single treatment of lysergic acid diethylamide (LSD) at a one time dose of 100 µg or 200 µg in a controlled environment of 198 participants, age 41, based on the Hamilton Anxiety Rating Scale.
Psychotherapy via a weekly video session has previously shown to be as effective as in person therapy, a new study showed that unlimited, as-needed messaging or emailing with a therapist over 12 weeks, showed similar improvement in depression symptoms in a randomized trial of 850 adults, age 34, as video sessions.
Machine learning (ML) increased delirium detection rates of inpatients assessed for delirium with the Confusion Assessment Method from 4.42% (95% CI, 3.70%-5.14%) in the pre-ML cohort to 17.17% (95% CI, 15.54%-18.80%) in the post-ML cohort (P < .001). This reduced the use of benzodiazepines and antipsychotics.
This New York Times article gives 5 Tips when Consulting ‘Dr.’ ChatGPT:
Use AI chatbots to prepare for your doctor visit, be informed and help you ask questions.
Practice when stakes are low. Ask open ended rather than validating questions as AI is agreeable.
Give chatbots as much context as you’re comfortable sharing to increase the chance of getting a more personalized answer, but keep in mind that you are putting your information on the internet.
AI chatbots can sometimes forget or confuse critical details, particularly with free versions or during a long conversation.
AI chatbots are far better at offering answers than asking questions, so ask it: “Ask me any additional questions you need to reason safely.”
Ask AI for sources and verify their information with reputable health resources and, of course, your doctor.
Of 982 social media posts about medical tests, with more than 194 million total followers, 87.1% mentioned benefits, 14.7% mentioned potential harms, 6.1% mentioned overdiagnosis, and 6.4% included scientific evidence. Posts from physicians were more likely to mention harms and less likely to promote the test.
Health insurance premiums nationwide are set to rise by 18% on average. The average marketplace consumer will pay $1,904 in annual premiums next year, up from $888 in 2025, the worst year-over-year price hikes in the 12 years since the marketplaces launched.
Financial hardship – including poverty, food insecurity, and housing instability – was found to be common among U.S. health care workers, particularly those in direct care and support roles
The CDC reports 1,625, confirmed measles cases in 42 states, up from 1,595 in 42 states 1 week ago.
The OMDA call on Thu Nov 6th at 8 am is: Cognitive Compass: Proactive Pathways to Assessing Brain Health, Clinical Education Alliance, LLC. This session will provide free CME in addition to CMD credit.
Thank you, Irene, for this quote: The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated Communist, but people for whom the distinction between fact and fiction, true and false no longer exists.
Hannah Arendt (1906-1976), The Origins of Totalitarianism.
