Geriatric Update Sep 29, 2025

Subthalamic stimulation in 137 patients with moderate to advanced Parkinson’s disease in a randomized, double-blinded trial, led to significant improvements in motor function, suppression of dyskinesia, improvements in activities of daily living, and a reduction in anti-parkinsonian medications that were sustained over the 5-year follow-up period compared to the 122 sham-controlled subjects.

Hypoglycemia is the leading cause of iatrogenic (caused by healthcare) complications among older adults with type 2 diabetes. Doctors of patients aged >75 with hemoglobin A1C levels of <8.0%, treated with insulin and/or sulfonylureas received a previsit activation deprescribing handout, vs an attention control healthy lifestyle handout. At 6 and 12 months, the intervention group showed higher deprescribing rates compared to the control group, but no significant difference in severe hypoglycemia. With 450 patients, age 80, the study may have been underpowered to show a difference.

Metabolic surgery showed better outcomes than GLP-1 meds on: major adverse cardiovascular events (MACE), nephropathy and retinopathy, weight loss, HbA1c and all-cause mortality. The study did not mention side effects: chronic diarrhea, food intolerance, peripheral neuropathy, osteoporosis, etc., which I have seen in patients who stopped taking their supplements, such as vitamin B-12, vitamin D and calcium, that surgery patients have to take lifelong. Only healthier patients underwent surgery, and 7% of them had complications, it is unclear if they were included, also unclear is if patients requiring GLP-1 after surgery were included. The study included older GLP-1 meds liraglutide (65.4%) and dulaglutide (48.6%), which were less potent than newer ones. Longer follow up than the 5.9 years may show if several curves that were converging, would actually cross, and include neuropathy, osteoporotic fractures and other symptoms that may not develop for several years.

In 2019 oral semaglutide was approved by the FDA as the first (and still only) commercially available oral GLP-1 RA but must be taken on an empty stomach at least 30 min before any other food, drink, or medication and with no more than 120 mL of water to maximize absorption and bioavailability, or the stomach acid would break down the complex that hides, and breaks apart the peptide before it could be absorbed. Orforglipron is a small-molecule, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist in clinical development that led to weight loss and hemoglobin A1c reduction in a dose dependent fashion. Adverse events were mild-to-moderate gastrointestinal events in 4.4 to 7.8%, most of which occurred during dose escalation, and no severe hypoglycemia or liver toxicity occurred.

Elinzanetant is a neurokinin receptor antagonist that works by blocking signals in the brain responsible for temperature control, providing non-hormonal treatment of menopausal hot flashes. It is approved in Canada and the UK but not the US yet. In this randomized trial of 353 women, age 54, moderate to severe vasomotor symptoms frequency on the 29 item Menopause-Specific Quality Of Life (MENQOL) questionnaire was −5.4 (95% CI, −6.3 to −4.5) for elinzanetant and −3.5 (95% CI, −4.1 to −2.9) for placebo. Most frequent adverse effects were somnolence, fatigue, and headache, but not hepatotoxic effects, endometrial hyperplasia, or meaningful changes in bone density or bone turnover markers.

Nicotinamide (Niacin or vitamin B3) 500 mg twice daily for more than 30 days after a skin cancer diagnosis was associated with a 14% reduction in the subsequent rate of skin cancers, increasing to 54% in patients who started nicotinamide after a first skin cancer. Niacin deficiency causes pellagra, which is diarrhea, dementia and dermatitis, if high doses can contribute to dementia is not tested.  We only recently learned that thiamine excess can cause dementia and have known for years that vitamin B-6 excess can. 

There was no difference in Urogenital Distress Inventory (UDI, a 300 point scale) total score improvement at 6 months between the onabotulinumtoxinA (Botox) and midurethral sling (surgery) groups in 137 females, age 59, with moderate to severe mixed urinary incontinence who previously did not respond to conservative treatments.

Underinsured patients, those living in rural areas, and patients from underrepresented races and ethnicities, even insured patients face obstacles to receiving stroke rehabilitation because of the prior authorization process.

Significant contributors to post-stroke dementia (PSD) included age ≥ 74 years (adjusted hazard ratio [aHR], 4.76), higher stroke severity at admission (aHR, 2.68), acute phase cognitive impairment (aHR, 5.86), presence of diabetes (aHR, 2.28), metabolic syndrome (aHR, 2.05), reduced HDL-C levels (aHR, 2.61), and stroke recurrence (aHR, 2.36), over 5 years of follow up, avg age 68.

Among participants with idiopathic normal-pressure hydrocephalus (NPH) who had a response to temporary CSF drainage, shunting resulted in significant improvements at 3 months in gait velocity and a measure of gait, falls and balance but not in measures of cognition or incontinence.

Older adults with chronic insomnia experienced faster cognitive decline and a 40% higher risk of developing cognitive impairment over 5.6 years of follow-up. But I am not sure if the underlying neurodegenerative disease is the cause of both, and if treating chronic insomnia, not just to improve sleep quality but potentially to protect brain health as we age.

In Alzheimer’s disease (AD) mouse models, Lithium deficiency resulted in elevated levels of phosphorylated tau protein and two-fold greater Aβ plaque deposition than control mice. The mechanism may be through an enzyme called glycogen synthase kinase 3β (GSK3β) as a key mediator of the negative effects of lithium deficiency, demonstrating that administration of a GSK3β inhibitor blocked many of the cell- and tissue-level changes observed in lithium-deprived animals. Lithium orotate (LiO) supplementation raised lithium concentrations specifically in non-plaque areas of the mouse brain and exhibited significantly lower affinity for Aβ plaques, without requiring extreme doses or raising lithium levels elsewhere in the body above normal physiological ranges, which can occur with lithium carbonate, used for bipolar disorder.

A blood test for phosphorylated tau 217 (p-tau217) achieved a positive predictive value (PPV) of 79% and an overall accuracy of 81% in detecting amyloid. In a 2-step workflow, adding PET scan or cerebrospinal fluid significantly increased accuracy and the PPV to 91%.

Delphi study including 70 invited participants and experts, added biomarkers to update the diagnostic criteria for vascular cognitive impairment and dementia (VCID) primarily as features that may suggest an alternative or concomitant etiology (cause) to vascular disease. We should control our patients’ blood pressure (BP) well to prevent stroke, MI, and dementia, and with adequate hydration, I am able to control my patient's BP well, the main driver of vascular disease. 

In 662 frail patients with atrial fibrillation (AF) switched from a vitamin K antagonist (VKA, warfarin) to an non–vitamin K oral anticoagulant (NOAC), was associated with more bleeding complications and no reduction in thromboembolic complications compared to 661 patients who continued VKAs.

Patients with frailty undergoing surgery for nonmetastatic breast cancer had higher complications if they had frailty than if they did not: systemic (4.8% vs 2.7%; P = .009) and local (15.1% vs 10.8%; P = .006) complication rates. In adjusted analyses, frailty was associated with a 76% higher likelihood of systemic and 48% higher local complications, but chronological age was not.

Sarcopenia at baseline may significantly elevate the risk for radiographic and symptomatic progression of knee osteoarthritis (OA), and the need for future total knee replacement (TKR). Screened sarcopenia (Scre-S) was identified with the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) questionnaire and probable sarcopenia (Prob-S) with the 5-times chair-stand test. Over 48 months both Scre-S and Prob-S participants were significantly associated with worsening knee OA on radiographic measures, joint space narrowing, and sclerosis. Over 92 months the risk for total knee replacement was nearly 4-times higher among the Scre-S group and more than twice as high among the Prob-S group, compared against participants without sarcopenia.

The risk of vertebral fractures was 55% higher in the 1,915 people with chronic hypoparathyroidism than in the general Swedish population, and femur fractures were 30% lower. Patients were matched with 15,838 controls by sex, year of birth, and county of residence.

Dry eyes are common after cataract surgery and 89 patients, age 74 years, received either periocular low-level light therapy (LLLT), using a specialized device at specific wavelengths (633 ± 10 nm) or sham treatment of low light that was too low to be therapeutic, 7 days before and 7 days after surgery. The group randomized to intervention had significantly better outcomes on Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (BUT), tear osmolarity but not Schirmer test.

Lyme tests look for antibodies, which usually only appear in the blood several weeks after an infection. If the test is given too early, it will come back negative because antibodies haven't yet been built to a detectable amount. Any Lyme test available for sale at a drugstore or website is unapproved, another red flag is the use of saliva, urine or other bodily fluids besides blood to detect Lyme. Patients spend hundreds or thousands of dollars on bogus tests, which aren't covered by insurance, and unreliable.

60 Minutes on 9/20/2025 had a report on genetically changed mice to fight Lyme disease as the rodent is the reservoir of the tick borne bacterium .

Nearly 120 clinics across the U.S. offering unproven Lyme treatments, some with consultation fees as high as $3,000. These unproven treatments include electrical stimulation, ozone-based therapy and hyperbaric oxygen therapy, which aren't covered by insurance and can carry price tags as high as $6,000, and longterm antibiotics that may affect the biome and have no evidence of improving outcomes.

The CDC reports 1,493 , confirmed measles cases in 42 states, up from 1,454 in 43 states 1 week ago.

The OMDA call on Thu Oct 2nd at 8 am is: Nutrition and Weight Loss in Post-Acute and Long-Term Care, by Suzanne Cryst, RDN, CSG, LD

Aging is not for the faint of heart. One day you wake up and realize youth has quietly slipped away, but it didn't leave alone. It took with it insecurities, the rush to please, and the fear of not being enough. In return, it left something stronger: a slower pace, but a steadier step, the wisdom to say goodbye without fear, the grace to cherish those who choose to stay, and the power to be yourself unapologetically. Aging isn't about losing. It's about letting go. It's learning to accept to release and to truly see that beauty was never just in the mirror, it lived in every story, scar, and strength carried within. Aging is a gift- wear it with dignity. 

Meryl Streep