Geriatric Update Sep 22, 2025

The CDC reports 1,491 , confirmed measles cases in 42 states, up from 1,454 in 42 states 1 week ago. Now that the disease has become endemic, I will report it toward the end of the update.

Chagas disease is caused by the parasitic protozoan Trypanosoma cruzi, affects 60 million people worldwide in 21 countries, and 280,000 Americans, mostly in 12 southern states, and only rare cases so far in Ohio It is transmitted by the kissing bug, causes fever that may last for weeks, affects the heart and can lead to heart failure. Antiparasitic drugs are 100% effective if taken early.

High-dose influenza vaccine, compared to standard dose, in patients aged 72.3 years, led to lower pneumonia or hospitalization in 174 of 67,093 participants (absolute risk, 0.26%) in the group randomized to high-dose and in 227 of 66,789 (absolute risk, 0.34%) in the standard-dose group (relative vaccine effectiveness, 23.7%; 95% confidence interval [CI], 6.6 to 37.7). Hospitalization for influenza occurred in 63 of 67,093 participants (absolute risk, 0.09%) in the high-dose group and in 92 of 66,789 (absolute risk, 0.14%) in the standard-dose group (relative vaccine effectiveness, 31.8%; 95% CI, 5.0 to 51.3), with similar serious adverse events.

In this video I explain the reason for high dose or enhanced Flu Vaccines: Strengthening Protection in Older Adults. ReachMD sadly cut out my explanation of the mechanism how high dose with 4 times the antigen and enhanced flu vaccines, with aluminum or an inactivated or attenuated virus attached to the antigen, such as adenovirus, to increase the immune system stimulation (immunogenicity). 

Vaccine effectiveness against respiratory syncytial virus (RSV) infection declined from 71% at 4 months post-vaccination to 40% by 19 months. RSV positivity during the 2024/2025 season was 3.9% among those never vaccinated, 1.1% among individuals who had the RSV vaccine in the past 6 months, 1.1% among those vaccinated 6 to 12 months prior, and 2.8% among those vaccinated 12 to 18 months prior. RSV-related emergency department (ED) visit and hospitalization rates were twice as high for patients vaccinated 12 to 18 months prior, compared to those vaccinated within the year prior. Those who have never received the RSV vaccine had ED visits 3 times more often than the recently vaccinated groups.

Sequential administration of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent polysaccharide vaccine (PPSV23) led to nonsignificant increases in memory B cells by week 28 in older adults; however, it elicited more sustained long-term immune responses against key pneumococcal serotypes, memory B-cell counts and serotype-specific immunoglobulin G levels over 2 years, than either the simultaneous or single-dose schedule. All regimens were safe and well tolerated.

This BBC Inside Science podcast describes vaccine science well.

Telomeres are the ends of the chromosome strands that protect the DNA from degradation by preventing DNA repair systems from mistaking the very ends of the DNA strand for a double-strand break. Telomeres shorten as we age, one theory is to protect us from cancer. Pregnancy, healthy diet and exercise have been known to prevent shortening of telomeres and are associated with longevity. This study showed that 2000 IU vitamin D daily significantly reduced telomere shortening over four years compared to a placebo, thus preventing nearly three years' worth of cellular aging, while omega 3 fatty acids had no effect. Leukocyte telomere length (LTL) attrition significantly decreased by 0.14 kilo base pairs (kb) (95%CI: 0.007, 0.27) over 4 years (p = 0.039) in 1039 randomized participants ≥50 years of age. Watch my Vitamin D and Calcium presentation about dosing, risk and benefits of vitamin D and its role in immunity.

Compared with standard blood pressure control, intensive blood pressure control <120 or <130 mmHg was associated with a 1.73% absolute risk reduction (95% CrI 1.65-1.81) in cardiovascular disease (number needed to treat 58 [95% CrI 55-61]) and a 1.82% absolute risk increase (95% CrI 1.63-2.01) for adverse events of interest (number needed to harm 55 [95% CrI 49-61]), in 80,220 Chinese participants of randomized controlled trials, median age 64. Overall, intensive blood pressure control showed a favorable benefit-harm profile, with a net benefit of 1.14 (95% CrI 1.03-1.25), using adjudicated weighting. The net benefit remained positive when considering kidney-related adverse events (1.13 [95% CrI 1.01-1.24]).

The U.S. Food and Drug Administration (FDA) has cleared Apple to roll out a hypertension detection feature on some of its smartwatches.

Transcranial direct current stimulation (HD-tDCS)  helped people, age 34, with moderate to severe depression significantly more than a sham treatment for 20 minutes a day over 12 working days. 

A 12-session smartphone-based digital cognitive behavior therapy (CBT) reduced recurrent suicide attempts in the long term over 24 weeks but in the first 12 weeks the control group a smartphone-based application that delivers safety planning and psychoeducation about suicide showed lower suicidal ideation, and after 12 weeks was worse than the CBT app. In older men suicide risk increases with age, especially after bad news, and they are often resistant to psychology referral. Some resistant patients may be willing to talk to a religious minister and now we also have a digital option. 

Coffee and energy drinks have opposing effects on suicide risk. High coffee consumption, >60 cups per month, was linked to significantly reduced suicide attempts.

A single can of an energy drink per month was observed to increase the risk for suicidal thoughts and attempts, with a dose-dependent effect that can triple the risk at higher consumption levels.

Esketamine reduced treatment resistant depression within 24 hours of 1st dose −3.8 for 56 mg and −3.4 for 84 mg on the 10 item, up to 54 point Montgomery-Åsberg Depression Rating Scale (MADRS). Adverse events were nausea (56 participants [24.8%]), dissociation (55 [24.3%]), dizziness (49 [21.7%]), and headache (43 [19.0%]). 

While ketamine and other N-methyl-D-aspartate (NMDA) receptor agonists are often prescribed off-label to manage chronic pain for fibromyalgia, nerve pain, and complex regional pain syndrome, etc. A Cochrane review found no clear evidence supporting the use of ketamine for chronic pain, and side effects include: delusions, delirium, paranoia, nausea, and vomiting.

In 120 older adults >60 years with chronic non-specific low back pain (CNSLBP) group-based exercise reduced pain intensity on a 0-to-10 scale (MD -2.0, 95% CI -2.8 to -1.3) and disability on the 0-to-24 Roland-Morris Disability Questionnaire (MD -3.4, 95% CI -4.7 to -2.1),  led to higher ratings of global perceived effect sustained through to 12 months and higher levels of physical activity at week 8, but had negligible effect on fear of falling.

FDA laboratory analysis confirmed that PAIN FLEX, a supplement promoted and sold for joint pain, contains dexamethasone and methocarbamol not listed on the product label, and is advising consumers not to purchase or use PAIN FLEX because of risk to patients.

Carpal tunnel syndrome (CTS) may occur more than 2 years before rheumatoid arthritis (RA) diagnosis, particularly among patients with seronegative disease. During a median follow-up of more than 12 years, the cumulative incidence of CTS was 9.6% among patients with RA compared with 4.5% among the non-RA group. After excluding individuals with pre-existing CTS, patients with RA had a 78% higher risk of developing CTS. Furthermore, after RA diagnosis, patients were more than twice as likely to receive carpal tunnel release surgery or injection compared with their non-RA counterparts.

September is international and US pain awareness month and pain management has recently made great gains with the approval of suzetrigine. This interview between Drs. Topol and Gupta delves into the latest pain research.

Stapokibart is a novel anti–interleukin 4Rα monoclonal antibody, decreases nasal polyps and reduce symptoms of nasal congestion in this randomized clinical trial over 24 weeks in 179 Chinese patients with severe chronic rhinosinusitis with nasal polyps.

After a single session of exercise, particularly high-intensity interval training (HIT) or weightlifting, the blood contained higher levels of certain molecules that helped slow the growth of laboratory-grown breast cancer cells.  The cancer-fighting impacts were greatest with the blood drawn after interval training, showing the highest concentrations of certain, beneficial myokines, especially IL-6.

In patients with cerebellar ataxias, home HIT aerobic training was safe and effective in improving ataxia symptoms in 62 patients, age 54, randomized to training. Improvements in ataxia symptoms, fitness, fatigue, balance, and gait were maintained for individuals in the aerobic group who continued to meet training goals at 1 year, but trended back to baseline for those who did not.

Falls Prevention Awareness Week is September 22nd-26th The Falls Free CheckUp from the National Council on Aging is a free, evidence-based tool that takes only minutes to complete. Older adults can use the Falls Free CheckUp to regularly check their risk of falling, discuss the results with a healthcare professional and then use the falls prevention education resources on the website. Also, People Working Cooperatively supports the Greater Cincinnati Falls Prevention Task Force with a website that provides falls prevention classes information on a calendar and map.

The OMDA call on Thu Sep 25th at 8 am is: State Budget, One Big Beautiful Bill, Trump Administration, Pete Van Runkle