Geriatric Update Oct 27, 2025
In patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.
A minimum threshold of 336 Metabolic Equivalent of Task minutes per week was required to yield cognitive benefits, while 934 Metabolic Equivalent of Task minutes per week was the minimum dose for clinically meaningful improvements. The dose-response relationship varied by exercise modalities, with some modalities showing significant effects at lower doses. Aerobic exercise combined with resistance training exhibited superior efficacy compared to other modalities.
High-dose inactivated influenza vaccine (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) demonstrated superior protection against hospitalization for influenza or pneumonia and also reduced the incidence of the secondary endpoints of cardiorespiratory hospitalization, laboratory-confirmed influenza hospitalization, and all-cause hospitalization.
Pneumococcal vaccine (PV) uptake rate was higher in a chatbot intervention group than in the standard group, 29.4% vs 18.7% of 374 Hong Kong participants age 69.6. More participants in the chatbot group than in the standard intervention group completed at least 1 intervention session (79.7% vs 57.8%; P < .001).
The vaccine efficacy (VE) of the recombinant herpes zoster vaccine (RZV) against any herpes zoster (HZ) or shingles outcome was 56.1% (95% CI, 53.1% to 59.0%), with similar VE between immunocompetent (56.5%) and immunocompromised (54.2%) individuals. Individuals vaccinated with the previous vaccine in the past 10 years benefited from RZV. A second RZV dose conferred an additional 67.9% effectiveness against any HZ outcome.
Sultiame improves the ventilatory response and upper airway muscle activity by inhibiting carbonic anhydrase and improved obstructive sleep apnea (OSA) consistently and dose-dependent, nocturnal hypoxia, sleep quality, and excessive daytime sleepiness.
Intensive blood pressure (BP) treatment initiating from randomization (0 month) yielded the greatest benefit (relative risk [RR]: 0.83; 95% CI: 0.70-0.96), with an attenuated cardiovascular benefit for later initiation from 12 months (RR: 0.88; 95% CI: 0.76-0.99). While the difference was small, the difference in BP of 127 vs. 129 was also small. I tend to treat BP aggressively, even in frail older adults and suggest to stop medication if lifestyle changes succeeded in controlling BP, and I make sure patients drink enough fluids to prevent orthostasis and falls with BP control.
Intensive BP treatment, targeting office SBP to <120 mm Hg vs. <140, produced modest benefits to health-related quality of life (HRQoL) among hypertensive patients with high cardiovascular risk.
This NY Times article on longevity supplements summarized well that there is no evidence for their use and quotes Eric Topol: “If you really want to know something that’s proven to change biologic aging and epigenetic aging,” Dr. Topol said, “it’s exercise.” I agree with him. I want to add that I also recommend losing weight if the waist circumference is elevated, and I recommend a multivitamin for seniors to all >50 years to prevent vitamin D and B-12 deficiency. Absorption of these vitamins decreases with age, and the additional thiamine and B-6 assure adequate supply without toxicity to prevent dementia.
White matter hyperintensities (WMH) predict an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7).. Therefore, WMH should prompt interventions to prevent 80% of cerebrovascular events by controlling risk factors:
history of hypertension (OR 2·64, 99% CI 2·26–3·08; PAR 34·6%, 99% CI 30·4–39·1);
current smoking (2·09, 1·75–2·51; 18·9%, 15·3–23·1);
cardiac causes (2·38, 1·77–3·20; 6·7%, 4·8–9·1);
regular physical activity (0·69, 0·53–0·90; 28·5%, 14·5–48·5);
waist-to-hip ratio (1·65, 1·36–1·99 for highest vs lowest tertile; 26·5%, 18·8–36·0);
diet risk score (1·35, 1·11–1·64 for highest vs lowest tertile; 18·8%, 11·2–29·7);
diabetes mellitus (1·36, 1·10–1·68; 5·0%, 2·6–9·5);
alcohol intake (1·51, 1·18–1·92 for more than 30 drinks per month or binge drinking; 3·8%, 0·9–14·4);
psychosocial stress (1·30, 1·06–1·60; 4·6%, 2·1–9·6)
depression (1·35, 1·10–1·66; 5·2%, 2·7–9·8);
ratio of apolipoproteins B to A1 (1·89, 1·49–2·40 for highest vs lowest tertile; 24·9%, 15·7–37·1).
Participants who received intranasal insulin (160 IU daily through a cartridge pump system) showed measurable improvements in cognitive performance, as assessed by the modified Preclinical Alzheimer’s Cognitive Composite (mPACC5), along with favorable changes in brain blood flow and reductions in inflammatory biomarkers. Empagliflozin 10 mg daily, lowered cerebrospinal fluid tau levels and improved vascular and inflammatory markers. Over 4 weeks both agents moderated immune/inflammatory/neurovascular markers in this phase 2 randomized trial.
Ventromedial nucleus of the hypothalamus that express the cholecystokinin b receptor (VMHCckbr neurons) support glucose homeostasis during short fasts and contribute to gluconeogenic substrate mobilization and lipolysis. VMHCckbr neurons mobilize glucose without depleting hepatic glycogen or increasing gluconeogenic gene expression, but instead mobilize glycerol in a β3-adrenergic receptor (β3-AR)-dependent manner. Restoring glycerol availability following VMHCckbr neuron silencing restores glucose, and acute activation of VMHCckbr neurons mobilizes additional gluconeogenic substrates beyond glycerol.
Agitation and aggression occur in up to half of people living with dementia over the course of the disease and medications are sometimes needed for management. Risperidone is often used and associated with increased risk of stroke (adjusted hazard ratio: 1.28; 95% CI: 1.20–1.37) in a propensity matched study. It was about twice as high in those with a prior history of stroke (incidence rate: 222 per 1000 person-years) and CVD (incidence rate: 94.1 per 1000 person-years) than in the overall cohort (incidence rate: 53.3 per 1000 person-years).
Thank you, Dr. Tobias for pointing out that the link to last week’s dementia guideline study did not work. Here is the updated link in context: 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. As always, if you want an article but don’t have access, let me know, and I will send it to you.
Among patients with chronic coronary syndrome at high atherothrombotic risk who were receiving an oral anticoagulant, the addition of aspirin led to a higher risk of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia than placebo, as well as higher risks of death from any cause and major bleeding.
In recurrent prostate cancer, the 8-year overall survival was higher, 78.9% (95% confidence interval [CI], 73.9 to 83.1) in the combination group enzalutamide plus leuprolide than 69.5% (95% CI, 64.0 to 74.3) in the leuprolide-alone group; the hazard ratio for death was 0.60 (95% CI, 0.44 to 0.80; P<0.001). The 8-year overall survival with monotherapy was 73.1% (95% CI, 67.6 to 77.9), which did not differ significantly from that with leuprolide alone (hazard ratio, 0.83; 95% CI, 0.63 to 1.10; P=0.19). This trial was drug company sponsored.
Patients with previously untreated, locally advanced, unresectable or metastatic triple-negative breast cancer who are not candidates for inhibitors of programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) have limited treatment options. Progression-free survival was 9.7 months (95% confidence interval [CI], 8.1 to 11.1) with sacituzumab govitecan and 6.9 months (95% CI, 5.6 to 8.2) with chemotherapy (paclitaxel, nanoparticle albumin-bound paclitaxel, or gemcitabine plus carboplatin) (stratified hazard ratio for disease progression or death, 0.62; 95% CI, 0.50 to 0.77; P<0.001), in 558 patients of this drug company sponsored open label randomized trial.
Transcutaneous peripheral nerve stimulation (TPNS) improved essential tremor by 6.9 points, on the max 48 point ADL scale, in the TPNS group vs 2.7 points (95% CI, 1.3-4.0) in the sham group over 90 days in 125 patients, age 65.
The CDC reports 1,595 confirmed measles cases in 42 states, up from 1,573 in 42 states 1 week ago.
The OMDA call on Thu Oct 30th at 8 am is: Wound Care Clinical Management, by Kristy Leininger, APRN, CWCN
Always laugh when you can, it is cheap medicine.
Lord Byron
