Geriatric Update Oct 20, 2025

This article explains the mechanism of the immune system’s role on longevity and chronic diseases via DNA sensor cyclic guanosine monophosphate–adenosine monophosphate synthase (cGAS) in the naked mole rat, which has an unusually long life span.

Combining tramadol with CYP2D6-inhibiting antidepressants  may increase seizure risk for older adults. In >70,000 nursing home residents, on tramadol had a 9% higher seizure risk compared with adding CYP2D6-neutral antidepressants. Conversely, seizure risk was 6% higher among those who added tramadol onto an existing CYP2D6-inhibiting antidepressant.

Teladoc’s hospital and health system platform uses AI-enabled cameras and ambient listening capabilities to analyze facial expressions, threatening gestures and aggressive language from patients, to curb the increasing violence against clinicians. In addition to keeping clinicians safe, the violence prevention tool can help chief financial officers justify their investment into smart room technology.

CAPABLE uses 10 home visits over 5 months with an occupational therapist, a registered nurse and a handyworker to address an older adult's self-identified functional goals. participants with > 4 co-morbidities at baseline showed significantly improved ADL independence: improvement in difficulty with and assistance needed for 10 activities of daily living (range 10-50); (2) five instrumental activities of daily living and mobility: walking up a set of stairs and walking a block compared to control participants. The difference in healthier patients was not statistically or clinically significant.

In nursing home residents in hospice for dementia (n= 105,372, age 87.6 years), initiation of benzodiazepine use was associated with higher 180-day mortality compared with nonuse (HR, 1.41; 95% CI, 1.38-1.44), as was initiation of antipsychotic use (HR, 1.16; 95% CI, 1.12-1.20).

The best evidence on dementia care content is summarized in 28 guidelines, focusing on five key areas: dementia-friendly environment, knowledge, skill, attitude and behavior, traits and motive, with a total of 140 pieces of best evidence.

Changes in tau PET uptake in frontoparietal regions were strongly associated with concurrent changes in cognition. Changes in plasma p-tau217, which was recently FDA approved, were more modestly associated with concurrent cognitive changes.

Creutzfeldt-Jakob disease (CJD) is a rare, 1-2 in a million, neurodegenerative disorder caused by accumulation of misfolded prion proteins. It leads to death in a median of 12 weeks, and life expectancy that declined with increasing age: 22.0 weeks at age 65 years, 18.7 weeks at age 75 years, and 15.9 weeks at age 85 years that has not changed in the past 30 years.  

The PREVENT calculator was better at discriminating who will and won’t have an event, and less prone to overestimating risk than the 2013 Pooled Cohort Equation (PCE) calculator. In the 2787 participants >80 years, 355 atherosclerotic cardiovascular (ASCVD) events occurred over 7.4 years follow-up; PCE predicted 1067 events while PREVENT predicted 350 events. 

The blood thinner, inhaled nebulized unfractionated heparin (UFH) 225,000 IU, reduced the odds of intubation or death in 478 patients, 54 years old, hospitalized with COVID compared with standard care only.

Patients with detectable microplastics in excised carotid artery plaque had a 4.5 times higher risk (20.0%; 30/150 patients) of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom microplastics were not detected (7.5%; 8/107 patients). A postmortem study reported that brain tissue obtained from 12 patients with dementia had higher levels of microplastics than those obtained from 52 individuals without dementia (26 076 μg g−1 vs 4131 μg g−1; P < .001). The article addresses policy approaches.

In a comparative effectiveness study of 21,790 veterans with type 2 diabetes and without end-stage kidney disease, outcomes for kidney and cardiovascular events were similar among liraglutide, semaglutide, and dulaglutide initiators.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors were associated with reduced risk of composite outcome (HR: 0.75, 95% CI: 0.67-0.83, I2 = 51%), all-cause mortality (HR: 0.80, 95% CI: 0.66-0.97, I2 = 68%), CVD (HR: 0.78, 95% CI: 0.65-0.94, I2 = 61%), and HHF (HR: 0.73, 95% CI: 0.65-0.83, I2 = 0%). Benefits were consistent in subgroups of HF only, T2DM only, and those aged ≥75 years.

The new obesity definition increased the rate of obesity from 42.9% to 68.6% by basing the classification on any of the following criteria: (1) elevated BMI plus at least 1 elevated anthropometric measure (eg, waist circumference, waist-to-hip ratio, and/or waist-to-height ratio) or BMI greater than 40; (2) at least 2 elevated anthropometric measures, irrespective of BMI; or (3) excess body fat as assessed by dual-energy x-ray absorptiometry or similar modalities. In longitudinal analyses, clinical obesity conferred elevated risks of incident diabetes (adjusted hazard ratio [AHR], 6.11; 95% CI, 5.67-6.60), cardiovascular events (AHR, 5.88; 95% CI, 5.38-6.43), and all-cause mortality (AHR, 2.71; 95% CI, 2.41-3.05) compared with no obesity or organ dysfunction.

Digital tools/ apps to access tobacco-cessation treatment are growing and at $0.10 are much cheaper than the $100 average cost for a provider to administer tobacco cessation counseling to a patient.  Germany’s private health insurance system includes 2 apps in its digital directory and allows its practitioners to prescribe them.

Of 12 children with congenital deafness due to the otoferlin (OTOF) gene variants, were able to hear for the first time, using the DB-OTO, a dual adeno-associated virus 1 gene therapy that delivers human OTOF complementary DNA, encoding otoferlin, the mechanism is by a (ear) hair cell–specific promoter. Some children were as old as 16 and went from not hearing a lawn mower to some hearing a whisper. While not directly relevant to geriatrics, it may advance knowledge and science of hair cell damage and loss in presbycusis, the most common hearing loss in older adults. 

Nonantibiotic medications (NAMs), such as diuretics, statins, and proton pump inhibitors, contribute to antimicrobial resistance (AMR) ibuprofen and acetaminophen lead to an increased number of bacterial mutants in the gut. Diclofenac and furosemide, also increased mutation frequency compared with the control group. The increase in resistance was particularly marked for ciprofloxacin, reaching up to 32-fold in some cases but also included beta-lactam antibiotics such as amoxicillin, ceftazidime, and meropenem, as well as to levofloxacin and minocycline.

Rosacea improved with transcutaneous auricular vagus nerve stimulation (taVNS) for 3 weeks and reduced facial erythema, flushing, anxiety, depression, and fatigue compared with sham stimulation, with effects lasting 24 weeks after treatment.

Of 23 protein supplements tested by Consumer Reports, 70% contained more lead in a single serving than is safe to have in a day. Naked Nutrition’s Mass Gainer powder contained 7.7 micrograms of lead per serving, which is roughly 1,570 %, and Huel’s Black Edition powder contained 6.3 micrograms of lead, or about 1,290 % of daily lead limit of 0.5 micrograms. Two others had 400- 600% of that level per daily serving and recommended limiting these to once a week. Cadmium and arsenic levels were also above recommended levels.

The CDC reports 1,573 , confirmed measles cases in 42 states, up from 1,454 in 42 states 1 week ago.

The OMDA call on Thu Oct 23rd at 8 am is: Nutrition and Weight Loss in Post-Acute and Long-Term Care, by Suzanne Cryst, RDN, CSG, LD

Today the only thing that is permanent is change.

Dr. Charles H. Mayo