Geriatric Update Aug 12, 2024

COVID-19 Patients (n=728) with residual lung abnormalities at 3 years more commonly had respiratory symptoms (32% versus 16%; p<0.001), lower 6-minute walk distance (494 vs 510 m; p=0.003) and abnormal carbon monoxide diffusion impairment (DLCO) (57% versus 27%; p<0.001) compared with those with complete resolution. Compared with controls (n=792), who did not have COVID, the proportions of DLCO (38% vs 17%; p<0.001) and respiratory symptoms (23% vs 2.2%; p<0.001) were significantly higher in the matched COVID-19 survivors at the 3-year follow-up.

Many diseases were shifted downward when COVID-19 became a leading cause of death but are rebounding, see graph.

Compared to the 2020 report, the updated report on dementia adds that in adults over age 65 high LDL cholesterol is a risk factor for dementia, and those who experience vision loss have a nearly 50% increased risk of developing dementia. When vision problems are corrected, that risk drops dramatically, by 30% for cataract surgery. The 2020 report already showed the following risk factors:  less education, hearing loss (37% increased risk, and hearing aids slow the decline), hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury, air pollution, and social isolation.

Lifestyle interventions including diet, exercise, stress mgmt., support, and supplements including magnesium, curcumin, vitamin B-12, lions mane, etc. improved cognition, microbiome, function, and amyloid over 20 weeks. The interview with Dean Ornish includes a compelling patient interview.

Benzgalantamine is a prodrug of the acetylcholinesterase inhibitor galantamine, that remains inert as it passes through the stomach, was just approved by the FDA.  It is touted to prevent side effects such as nausea, vomiting and decreased appetite. I would like to see outcomes and side effects of a head to head study with acetylcholinesterase inhibitors because the GI side effects are from the systemic acetylcholine effect and less from contact with the stomach.

This British study calculated the cost-effectiveness of population-level interventions for addressing dementia risk factors: increases in tobacco pricing, minimum pricing for alcohol, raising alcohol price, salt and sugar reduction policies, low emission zones, and compulsory helmet use for cycling by children.

In 90 patients, age 76.6, with percutaneous left atrial appendage occlusion (LAAO) for A-fib, low-dose oral anticoagulant, apixaban 2.5 mg bid compared with dual antiplatelet therapy over 3 months, exhibited a lower rate of device related thrombosis (0% vs 6 [8.7%]; P = .04) and tended to have a lower incidence of major bleeding events (2 [4.6%] vs 6 [13.0%]; P = .17), with no differences in thromboembolic events such as stroke and systemic embolism between groups (none).

Visceral fat index, identified on CT scan, showed the highest predictive performance for prevalent and incident diabetes, yielding area under the curve (AUC) (sensitivity / specificity) of 0.70 (95% CI: 0.68, 0.71) for men and 0.82 (95% CI: 0.78, 0.85) for women. Combining visceral fat, muscle area, liver fat fraction, and aortic calcification improved predictive performance. The AUC for visceral fat index in identifying metabolic syndrome was 0.81 (95% CI: 0.80, 0.81) for men and 0.90 (95% CI: 0.88, 0.91) for women.

In both humans and mice, gut microbiome suggested possible non-beneficial effects of bacteria in the Proteobacteria phylum and potential protective effects of Actinobacteria against the development of food addiction. A decrease of the species Blautia wexlerae was observed in addicted humans and of Blautia genus in addicted mice. Administration of the non-digestible carbohydrates, lactulose and rhamnose, known to favor Blautia growth, led to increased relative abundance of Blautia in mice feces in parallel with dramatic improvements in food addiction. Changing our diet to high fiber plant diet may help with food addiction.

A randomized clinical trial of 22 healthy, adult, identical twin pairs, showed that consuming a healthy vegan diet over 8 weeks (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds), significantly improved low-density lipoprotein cholesterol concentration, fasting insulin level, and weight loss compared with twins consuming a healthy omnivorous diet.

Plant lignans , including flaxseed products and whole grains, are beneficial factors for lowering T2D risk, and including lignin-rich foods into diets can prevent T2D.

The biological age gap (BAG) is the difference between machine learning-predicted age and chronological age, across nine human organ systems in 377,028 participants of European ancestry from the UK Biobank. The BAGs were computed using cross-validated support vector machines, incorporating imaging, physical traits and physiological measures, and identified 393 genomic loci-BAG pairs (P < 5 × 10–8) linked to the brain, eye, cardiovascular, hepatic, immune, metabolic, musculoskeletal, pulmonary and renal systems.

Compared with the reference level heart rate < 70/min group, the adjusted hazard ratios (HRs) for all-cause mortality were 1.74 (1.05–2.89) for the heart rate ≥ 80 and < 90/min group and 2.61 (1.59–4.29) for heart rate ≥ 90/min, in 1353 Japanese patients, median age 65, with chronic kidney disease not on dialysis. I wonder how much of a role dehydration played, which is so common in older adults with diminished thirst sensation.

Weight-bearing activity is associated with incident knee osteoarthritis in people with low levels of lower-limb muscle mass (OR, 1.53; 95% CI, 1.15-2.04; P = .003) but not in people with medium or high lower-limb muscle mass.

Systematic reviews of studies between 2018-2023 rated as moderate certainty showed that massage therapy had a beneficial effect on pain.

The GLP-1 tirzepatide was associated with reduced blood pressure, 6.8 mm Hg systolic and 4.2 mm Hg diastolic, over 72 weeks, consistently across participant groups primarily via weight loss.

A multidisciplinary deprescribing intervention reduced the number of inappropriate medications but did not reduce death, unscheduled hospital visits, or rehospitalization

within 12 months in 442 Japanese participants, age 81.8, randomly assigned to receive either an intervention for medication optimization using the STOPP (Screening Tool of Older Persons' Prescriptions) criteria or usual care including medication reconciliation.

Shorter visit length was associated with a higher likelihood of inappropriate antibiotic prescribing for patients with upper respiratory tract infections and co-prescribing of opioids and benzodiazepines for patients with painful conditions. For each additional minute of visit length, the likelihood that a visit resulted in an inappropriate antibiotic prescription changed by −0.11% (95% CI, −0.14 to −0.09 percentage points) and the likelihood of opioid and benzodiazepine co-prescribing changed by −0.01% (95% CI, −0.01 to −0.009 percentage points).

In 2020, 136,762 Medicare beneficiaries, age of 68.2, experienced a nonfatal drug overdose, and in the 12 months after their overdose, 23,815 beneficiaries (17.4%) experienced at least 1 subsequent nonfatal drug overdose. However, in the following 12 months, only 6.2% filled a naltrexone prescription and only 4.1% received meds for opioid use disorder: buprenorphine (3.0%), methadone (1.2%) and ER naltrexone (0.2%).

This review article on frailty in older adults is excellent. Let me know if you want the article and don’t have access to the NEJM.

Ohio Department of Aging will host statewide series of Assisted Living Feedback Forums Aug 7th through Sep 5th. The Cincinnati session is Aug 14th.

A fascinating and encouraging TedTalk on artificial intelligence (AI).

Irene