Geriatric Update Sep 8, 2025

The CDC reports 1,431, confirmed measles cases in 43 states, up from 1,375 in 42 states 1 week ago.

Recombinant quadrivalent influenza vaccine (RIV4) and standard egg-based quadrivalent inactivated IV (IIV4) show comparable effectiveness in reducing influenza-related hospitalization among older adult nursing home residents studied across two influenza seasons (2019-2020 and 2020-2021). cluster randomized trial of 144,565 person observations at 1078 nursing homes.

In a comparison of high-dose (HD), adjuvanted (ADJ), and recombinant (RIV) influenza vaccines ("enhanced influenza vaccines") vs. standard-dose unadjuvanted influenza vaccines (SD) with one another for prevention of influenza-associated hospitalizations among 71,459,918 vaccinated participants aged ≥65 years, relative vaccine effectiveness (rVE) of enhanced vaccines, HD, ADJ, and RIV vs. SD was 18% (95% CI 3 to 32) from 5 randomized and 11% (95% CI 8 to 14) from 27 observational studies, by meta-analysis and meta-regression.

The incidence of hospitalization for any cardiovascular (CV) disease was lower in the high dose inactivated influenza vaccine (HD-IIV) group than the standard dose (SD-IIV) group (rVE, 5.7% [95% CI, 1.4% to 9.9%]; absolute difference, −0.13 [95% CI, −0.24 to −0.03] percentage points), and relative vaccine efficacy (rVE) did not differ by history of CV disease compared with no CV disease at baseline. Hospitalization for any CV disease occurred in fewer participants in the HD-IIV group than the SD-IIV group (rVE, 7.5% [95% CI, 1.5% to 12.5%]; absolute difference, −0.10 [95% CI, −0.18 to −0.02] percentage points) as did hospitalization for heart failure (rVE, 19.5% [95% CI, 3.3% to 33.1%]; absolute difference, −0.03% [95% CI, −0.06% to −0.01%]).

The risk of incident myocarditis or pericarditis was lower among individuals randomized to HD-IIV vs SD-IIV. Probably because the risk is higher with illness than vaccine and older adults are less likely than younger adults to develop myocarditis.

Last year the U.S. Food and Drug Administration approved FluMist for self- or caregiver-administration provides a new option for getting influenza vaccine with greater convenience, flexibility and accessibility for those aged 2-49 years.

In a review of 28 studies of 4315 patients with egg allergy who received egg-based Influenza vaccine, including 656 patients with a history of anaphylaxis to egg, none developed a serious reaction when they received influenza vaccine.

RSV vaccine is safe and well tolerated among older adults >65 when coadministered with the high-dose seasonal influenza vaccine Fluzone-HD,  but has higher adverse (AE) effects, mostly arm pain. AEs were more frequently reported in participants receiving concomitant Fluzone-HD and Ad26.RSV.preF/RSV preF protein (76.8%) compared with those receiving Ad26.RSV.preF/RSV preF protein (63.6%), Fluzone-HD (48.5%), or placebo alone (23.5%).

Cardiorespiratory hospitalization was significantly lower in the respiratory syncytial virus (RSV) group compared with the control group (26.3 vs 29.2 events per 1000 participant-years), among 131,276 adults >60 years, but all-cause cardiovascular hospitalization was 16.4 vs 17.7 events per 1000 participant-years, a nonsignificant difference.

Another RSV study of 6958 adults, estimated 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. While these studies showed only slight reduction in cardiorespiratory hospitalization, given the millions of patients infected each year, the individual and healthcare system effects are large. 

The American College of Cardiology, recommends people with cardiovascular disease receive vaccines against influenza, COVID-19, and respiratory syncytial virus (RSV), as this population is at greater risk for respiratory infections and subsequent adverse events, including hospitalization and death. The guidance also recommends other vaccines, such as those against shingles and pneumococcal disease, where vaccination appears to offer cardiovascular protection. Our Dr. Eugene Chung was on the study's oversight committee, thank you!  

The phase 1 dose finding study investigated the investigational vaccine, ELI-002 that is designed to train the immune system to recognize and attack tumor cells harboring mutant KRAS, which is present in roughly 93% of pancreatic ductal adenocarcinoma (PDAC) and 50% of colorectal cancer (CRC). The 2 highest of the 5 tested doses showed tumor response.

The US Department of Health and Human Services (HHS) has stopped messenger RNA (mRNA) vaccine development under the Biomedical Advanced Research and Development Authority (BARDA). The decision included the cancellation of 22 mRNA vaccine research investments worth nearly $500 million.

The CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) tracked Campylobacter, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E.Coli (STEC),  Shigella, Vibrio, and Yersinia infections. It has scaled down to track only Salmonella and Shiga toxin-producing Escherichia coli (STEC), as of July 1st.

Thank you, Joe for sending this: Azelastine, 0.1%, nasal spray 3 times daily for 56 days showed lower incidence of PCR-confirmed SARS-CoV-2 infection than placebo, 5 vs. 15 (OR, 0.31; 95% CI, 0.11-0.87).  

Germicidal UV light (GUV) was used in common areas of long-term care facilities (LTCFs) for 6-week cycles and then crossed over. During the 6-week cycles no decrease in acute respiratory infections (ARI) was seen in the short term but after 30 weeks for units of cognitively intact participants and after 50 weeks in all units, including memory units, GUV lowered ARIs by 12%. While 20% is considered significant, the study did not use GUV in HVAC systems or include patient rooms or bathrooms, and occurred during COVID-19 with staff and PPE shortage.

Stopping oral anticoagulation after successful ablation for atrial fibrillation improved bleeding rates (0.3% vs 2.2%, [95% CI, −3.5 to −0.3]) without significantly raising stroke rates, in 840 patients age 64, randomized to stop or continue anticoagulation over 2 years.

Compared with systolic blood pressure (BP) targeting <140 mm Hg, targeting <120 mm Hg halved the risk of hemorrhagic stroke 23 (0.4%) vs 45 (0.8%) (HR: 0.51; 95% CI: 0.31-0.85; P = 0.009). and did not increase that of ischemic stroke.

Risks for developing dementia  after a stroke 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; P ≤ .05 for all).

Among patients without prior diagnosis of sleep disordered breathing (SDB), 154 with hypertrophic cardiomyopathy underwent criterion-standard polysomnography. Previously undiagnosed SDB was identified in 59% of patients and was associated with significantly increased left ventricular mass, diastolic dysfunction, and elevated troponin-T levels.

Baxdrostat, an aldosterone synthase inhibitor was associated with a reduction in blood pressure of 14.5 mm Hg with the 1 mg dose, and 15.7 mm Hg with the 2-mg dose, vs. placebo 5.8 mm Hg over 12 weeks. The 794 patients randomized, had uncontrolled (27%) or resistant (73%) hypertension despite already taking 3 antihypertensive medications, including a diuretic. At baseline, their median office blood pressure was 149/87 mm Hg. The most common side effect was hyperkalemia.

Among patients discharged after invasive care for a myocardial infarction with a left ventricular ejection fraction above 40%, beta-blocker therapy appeared to have no effect on the incidence of death from any cause, reinfarction, or hospitalization for heart failure, in a randomized trial of 316 in the beta-blocker group and in 307 patients (21.7 events per 1000 patient-years) in the no-beta-blocker group (hazard ratio, 1.04; 95% confidence interval [CI], 0.89 to 1.22; P=0.63).

A randomized clinical trial of 267 patients with brain bleeds, age 60, minimally invasive surgery within 72 hours did not significantly reduce 30-day mortality or improve 180-day disability compared to medical management alone.

This study evaluated the effect of an electric fan in extreme heat in 20 adults, age 28, and found cardiac strain and discomfort in those with limited fluid intake, leading to dehydration and no adverse effects if euhydrated.

This Cochrane review of reducing falls in care facilities tiered findings by: probably, may, and little or no effect. Interventions that probably reduce falls are: Exercise (must be sustained), Multifactorial interventions, Vitamin D (>800 IU). May decrease falls: Dairy. Little or no effect: Medication review and deprescribing. (Possibly because of low rates because of resistance to stop meds from patients, families and prescribers). 

The FDA approved generic liraglutide, the first GLP-1 for the treatment of overweight and obesity. In 2024 it approved generic liraglutide for diabetes.

We might get better outcomes if we make our goals FAST (frequently discussed, ambitious, specific and transparent) not Smart (specific, measurable, achievable, realistic, time-bound

CMS is planning to cut nursing home codes PCOS 31 by 7% in 2026. Consider using this link to edit and send the prepared letter to Mehmet Oz.