Geriatric Update Nov 10, 2025
More than half of Americans 54%, dislike time changes in the spring and fall. While some studies have shown an increase in cardiovascular events, this new study showed no increase in myocardial infarction.
Individuals with the brightest light exposure at night, 91st-100th percentiles vs. 0-50th percentile, had significantly higher risks of developing coronary artery disease (adjusted HR [aHR], 1.32; 95% CI, 1.18-1.46), myocardial infarction (aHR, 1.47; 95% CI, 1.26-1.71), heart failure (aHR, 1.56; 95% CI, 1.34-1.81), atrial fibrillation (aHR, 1.32; 95% CI, 1.18-1.46), and stroke (aHR, 1.28; 95% CI, 1.06-1.55). These associations were robust after adjusting for established cardiovascular risk factors, including physical activity, smoking, alcohol, diet, sleep duration, socioeconomic status, and polygenic risk. The authors explain the mechanism of night light's disruptive effect on circadian rhythms with:
Dysregulation of various cardiovascular and metabolic mechanisms: impaired glucose tolerance and type 2 diabetes, which are significant risk factors for endothelial dysfunction and atherosclerosis.
Hypercoagulability increasing risks of thromboembolic events and subsequent ischemia, particularly in people with atherosclerosis or atrial fibrillation.
Higher average 24-hour blood pressure, leading to vascular endothelial damage and myocardial hypertrophy.
Cardiac arrhythmia, due to conflicting inputs to the sinoatrial and atrioventricular nodes from the central circadian clock and cardiomyocyte clocks.
In patients with diabetes, providing educational materials (EM) alone increased healthy eating days by 0.67 day/week, health coaching (HC)+EM by 0.99 day/week, and text messaging (TM)+EM by 1.36 day/week, all arms similarly increased exercise and reduced HbA1c by 0.76% and 90 of 349 participants (25.8%) with complete data for HbA1c achieved reductions below 8%.
In patients with diabetes, the risk of dementia decreased with sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), thiazolidinediones (TZD) and dipeptidyl peptidase-4 inhibitors (DPP4i) compared with placebo, no use of antidiabetic agents or other antidiabetic agents. Insulin was associated with an increased risk of dementia, whereas no significant association was found with the use of metformin, sulfonylureas, glinides and a-glucosidase inhibitors. My theory is the sodium excretion of SGLT2i and the anti-inflammatory effects of the others.
The GLP-1 med liraglutide halved stroke recurrence when started within 24 hours of stroke. In 90 days, 25 patients (7.9%) in the liraglutide group and 44 (13.8%) in the control group experienced stroke recurrence (hazard ratio, 0.56; 95% CI, 0.34-0.91; P = .02). And more patients in the liraglutide group (274 [87.3%]) than in the control group (246 [77.8%]) achieved excellent functional outcomes (odds ratio, 1.95; 95% CI, 1.28-3.00; P = .002), with similar, low rates of symptomatic intracranial hemorrhage and all-cause mortality.
Late onset epilepsy (LOE) occurred at a rate of 7.02 cases per 1,000 person-years (PYs) after incident MI compared with 2.49 per 1,000 PYs without MI (adjusted hazard ratio [aHR] 2.12; 95% CI 1.06–4.25; p = 0.035), in 3174 participants free of a history of stroke, MI, or epilepsy at enrollment, followed prospectively for up to 30 years (mean 14 years). Incident MI occurred at a rate of 17.68 cases per 1,000 PYs after incident LOE compared with 6.46 per 1,000 PYs without LOE (aHR 1.99; 95% CI 0.98–4.05; p = 0.059). Nonstroke vascular death occurred at a rate of 99.24 deaths per 1,000 PYs after incident LOE compared with 16.29 per 1,000 PYs without LOE (aHR 2.82; 96% CI 2.09–3.80; p < 0.001).
In 66 952 women with breast cancer, age 50-59, who were randomized to statins, the 10-year risk of mortality was 11.8% among statin initiators and 13.5% among noninitiators, corresponding to a risk difference of 1.7% HR of 0.90 (95% CI, 0.85 to 0.95). A similar difference was observed for all-cause mortality (23.3% vs 24.5%; 0.92 (95% CI, 0.85 to 1.00), with 59 patients needing treatment (NNT) to prevent 1 additional breast cancer death at 10 years.
The European prostate cancer screening study, reduced prostate cancer mortality by 13% in the screening group (rate ratio, 0.87; 95% confidence interval [CI], 0.80 to 0.95), and the absolute risk reduction was 0.22% (95% CI, 0.10 to 0.34). Over 23 years of follow-up, 1 death from prostate cancer was prevented for every 456 men (95% CI, 306 to 943) who were invited for screening, and one death from prostate cancer was averted for every 12 men (95% CI, 8 to 26) in whom prostate cancer was diagnosed. At 16 years of follow-up 1 death from prostate cancer prevented for every 628 men (95% CI, 419 to 1481) and one death averted for every 18 men (95% CI, 12 to 45).
Among US adults surveyed, 37.1% believed alcohol increases cancer risk, 9.1% believed it has no effect, 1.0% believed it decreases risk, and 52.9% were uncertain about alcohol’s effect on cancer risk.
Poor olfaction was associated with a higher risk of coronary heart disease (CHD) risk that attenuated over time and was not significant after 8 years: adjusted risk ratio of CHD was 2.06 (95% CI, 1.04-4.53) at year 2, 2.02 (95% CI, 1.27-3.29) at year 4, 1.59 (95% CI, 1.13-2.35) at year 6, 1.22 (95% CI, 0.88-1.70) at year 8, and 1.08 (95% CI, 0.78-1.44) at year 9. Loss of sense of smell is also associated with dementia, and what’s good for the heart is good for the brain.
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.
The Mediterranean diet (MD), grains, pulses/ legumes, fruits, and vegetables reduced symptoms of irritable bowel syndrome (IBS) by more than 50%, in 62% (95% CI, 50% to 73%) versus 42% (CI, 31% to 55%) following traditional diet advice (TDA). Reduction in the mean IBS Symptom Severity Scale after MD was −101.2 vs. −64.5 for TDA.
The incremental cost-effectiveness ratio of automated external defibrillations (AEDs) in private homes was $4,481,659 per quality adjusted life year (QALY) gained. At a willingness-to-pay threshold of $200 000 (horizontal dotted line), the annual AED cost would have to be below approximately $9 for AEDs to be cost-effective if cost of bystander training was not included. With bystander training included, AEDs would not be considered cost-effective at any AED cost.
Among patients with documented absence of atrial arrhythmia recurrence 1 year after catheter ablation for atrial fibrillation (A-fib), discontinuing oral anticoagulant therapy resulted in a lower risk for the composite outcome of stroke, systemic embolism, and major bleeding vs continuing direct oral anticoagulant therapy at 2 years. Of 840 patients, age 64, the primary outcome occurred in 1 patient (0.3%) in the discontinue oral anticoagulant therapy group vs 8 patients (2.2%) in the continue oral anticoagulant therapy group (absolute difference, –1.9 percentage points [95% CI, −3.5 to −0.3]; P = .02), driven mostly by bleeds.
Ultraprocessed food (UPF) consumption, in the highest quintile had an increased risk of depression, noted for both strict definition (n= 2122) (HR, 1.49; 95% CI, 1.26-1.76; P < .001) and broad definition (n= 4840) (HR, 1.34; 95% CI, 1.20-1.50; P < .001) (Table). Models were not materially altered after inclusion of potential confounders. We did not observe differential associations in subgroups defined by age, BMI, physical activity, or smoking. In a 4-year lag analysis, associations were not materially altered (strict definition: HR, 1.32; 95% CI, 1.13-1.54; P < .001), arguing against reverse causation.
A systemic review and meta-analysis of 153 trials showed that combining pharmacologic and nonpharmacologic interventions are associated with the best outcomes for patients with Alzheimer disease (AD), such as: rivastigmine plus cognitive rehabilitation and donepezil plus cognitive therapy yielded the greatest improvements in the 30 point Mini-Mental State Examination scores of >3.5 points, and ranked highest in surface under the cumulative ranking analysis. exercise, cognitive training, and brain stimulation also improved cognition compared with placebo. Behavioral symptoms, measured by the Neuropsychiatric Inventory, improved best with brain stimulation plus exercise and rivastigmine plus cognitive stimulation, both surpassing the 8-point minimal clinically important difference on the max 144 point scale. I would be cautious as prior studies have not shown benefits from cognitive training unless the training is based on what's tested.
The KÜLKUF wrist cooling device (cooling to 47°F via a porcelain plate in direct contact with the skin) vs. an identical sham device (fan only) randomized for 2 weeks, followed by crossover to the alternative device for 2 additional weeks produced a 46% reduction in severe hot flash episodes in 27 patients with prostate or breast cancer undergoing hormone deprivation therapy and in postmenopausal women, with no adverse events reported.
In patients hospitalized with community acquired pneumonia, those who had dementia had a higher mortality rate at 30 days (26.3%) than control individuals (7.1%), hazard ratio [HR], 2.28). Patients with dementia presented with significantly lower leukocyte, hemoglobin, hematocrit, and platelet levels coupled with higher sodium and blood urea nitrogen levels. The latter 2 are associated with dehydration, common in dementia and leading to mortality.
In 2180 patients, age 53, with community acquired pneumonia in 18 Kenyan hospitals, randomized to low-dose glucocorticoids for 10 days in addition to standard care, led to fewer deaths at 30 days: 246 patients (22.6%) in the glucocorticoid group and 284 patients (26.0%) in the standard-care group (hazard ratio, 0.84; 95% confidence interval, 0.73 to 0.97; P=0.02). Most common adverse effect of glucocorticoid (dose was not given) was hyperglycemia, and in both groups, tuberculosis.
Among 9289 critically ill patients undergoing mechanical ventilation, selective decontamination of the digestive tract did not result in a lower incidence of in-hospital death than standard care.
Peritoneal dialysis (PD) and hemodialysis (HD) have equivalent survival benefits for patients with end-stage renal disease (ESRD). PD was associated with a lower mortality rate when compared to HD in patients <65 years of age. The study did not show the statistical calculation for patients >65, and with the low- or no- glucose peritoneal dialysates potentially decreasing infections, I would like to see data in older adults.
Morphine did not improve breathlessness in chronic conditions at day 28 vs. placebo, in a randomized trial of 143 participants, age 70.5 and 93% male.
The article: “What the Trump Administration Can Do in the Short-Term to Address the Long-Term Care Crisis” suggests:
Legislation, encourage congress to: reauthorize the Older Americans Act; approve the bipartisan WISH Act (Well-Being Insurance for Seniors to be at Home Act, HR 2082)
Staffing: Temporary H2B visas that the President has suggested for hotel and farm workers; Improve licensing and training standards for care workers; Innovative staffing models such as “Green House” nursing homes; Support family caregivers and use REACH and GUIDE models, and other federal initiatives to assist informal caregivers.
Housing: the OBBBA supports state access to 1915(c) Medicaid waivers; multiage housing like student-senior housing.
Leverage Federally Qualified Health Centers (FQHCs) to support seniors in clinics.
Most, 80% of international students, study science, technology, engineering, and math (STEM). The drop of international students affects mostly small arts and design schools, Christian colleges, music conservatories and large state colleges, where international students pay higher tuition and subsidize domestic students.
The CDC reports 1,658, confirmed measles cases in 42 states, up from 1,625 in 42 states 1 week ago.
The OMDA call on Thu Nov 13th at 8 am is: Health Care Power of Attorney, Jason Chen, PhD, HEC-C
Long ago I learned from my father to put old people to bed only for as short a time as was absolutely necessary, for they were like a foundered horse; if they got down it was difficult for them to get up and their strength ebbed away very rapidly while in bed. Dr. Charles H. Mayo
