Geriatric Update April 1, 2024

The FDA approved the monoclonal antibody pemivibart (Pemgarda, Invivyd) for the pre-exposure prophylaxis of COVID-19 in the 6.6% of Americans who are immunocompromised.

When pregnant women received a COVID vaccine, their babies were 56% less likely to acquire infection in the first 6 months.

Virus-induced acute respiratory distress syndrome causes cardiomyopathy through macrophages eliciting inflammatory responses in the heart.

Sarcopenia and sarcopenic obesity (SO) increase mortality over 10-year follow-up (HRs 1.29, 1.93, respectively) in 5888 participants, age, 69.5. Body composition (BC) by DXA (high fat percentage and/or low appendicular skeletal muscle index) in addition to sarcopenia by low handgrip strength further increased risk: Participants with SO and one BC component, all-cause mortality (HR, 1.94; 95% CI, 1.60-2.33) and those with SO and both components of BC had almost three times the risk for mortality as those without (HR, 2.84; 95% CI, 1.97-4.11).

In ~40,000 UK Biobank participants, genome-wide associations between higher-order brain regions particularly vulnerable to the ageing process and 9 genetic clusters implicated in cardiovascular deaths, schizophrenia, Alzheimer’s and Parkinson’s disease. Of 12, the most deleterious modifiable risk factors for this vulnerable brain network are diabetes, nitrogen dioxide – a proxy for traffic-related air pollution – and alcohol intake frequency.  

The new ACC/AHA guidelines for heart failure with reduced ejection fraction (HFrEF) recommend: valsartan/sacubitril first line, then sodium-glucose cotransporter 1 and/or 2 (SGLT1/2) inhibitor.

Treatment for gastroesophageal reflux includes weight loss, and in terms of diet, the culprit is carbohydrates. Carbohydrates produce effects on esophagogastric motility that are mediated by their fermentation products, especially short-chain fatty acids, which are synthesized in the colon and lead to fundus relaxation, reduced lower esophageal sphincter tone, and increased reflux.

In ~12,000 Chinese patients age 64, on dual antiplatelet treatment and monitored for 3 months after stroke, the risk of any bleeding was increased at lower LDL cholesterol <70 levels in the ticagrelor-aspirin group (aHR, 1.71; CI, 1.08-2.72), but not in the clopidogrel-aspirin group (aHR, 1.30; CI, 0.73-2.30).

The study evaluated the difference between brain age and chronological age, termed ‘predicted age difference’ (PAD), across several common types of chronic musculoskeletal pain (CMP) (N = 2,427), and found significantly increased PAD in knee osteoarthritis (KOA) cohorts versus healthy controls, and validates it in an independent dataset (N = 192), suggesting a pattern of brain-aging acceleration in KOA. This acceleration was contributed by the hippocampus in both datasets and predicted memory decline and dementia incidents during follow-up. I would like to see if lack of physical activity is the reason for both.

In 1991 Dr. McGeer published the McGeer criteria, a validated tool to evaluate patients symptoms for pneumonia and UTI before ordering tests. Yet, inappropriate diagnosis of UTI (43%) and pneumonia (12%) persists, especially in patients with dementia  (AOR, 1.79; 95% CI, 1.55-2.08).  In my experience the most common reason for mental status changes is dehydration. 

The use of ginseng as a nutritional supplement acts on the central nervous system and has antioxidant and anti-inflammatory properties, also can help muscle regeneration and renewal.  

Older men >50 with history of melanoma have an increased risk for second primary invasive melanoma (SPIM): the first year the risk is 16.5 per 1000, within 5 years  8.1 of 1000 patients, and 6.4 per 1000 within 10 years.

Red flags symptoms for ovarian cancer from the UK's National Institute for Health and Care Excellence (NICE) are, persistently/ frequently (particularly more than 12 times per month and especially if the woman is 50 years or older):

• Early satiety and/or loss of appetite

• Abdominal bloating

• Pelvic or abdominal pain

• Urinary urgency/frequency

• Other symptoms could include:

• Changes in bowel habits (eg, diarrhea or constipation)

• Extreme fatigue

• Unexplained weight loss

Depo-Provera, or medroxyprogesterone acetate, increased the risk of intracranial meningioma 5.6-fold if used for longer than a year. And the menopausal hormone therapy drugs medrogestone and promegestone increased the risk of intracranial meningiomas by 4.1-fold and 2.7-fold, respectively. The national case control study was based on 18,061 French women who underwent meningioma surgery, matched 1:5 with controls. This sounds very high but is due to the low incidence rate of 8.6/100,000 in the US.

Yoga has been shown to help with memory and falls. This website has free on-line yoga classes in various languages. 

For alcohol intake, less is better:

• Among women, those who reported high alcohol intake >2 drinks per day had a 45% higher risk of heart disease compared with those reporting low intake 1-2 drinks per week, and had a 29% higher risk compared with those reporting moderate intake 1-2 drinks per day.

• Men with high overall intake were 33% more likely to develop heart disease compared with men who had moderate intake.

• Individuals in the binge drinking category had the highest risk; women in this category were 68% more likely to develop heart disease compared with women reporting moderate intake.

This perspective makes a case for disaggregating Asian data because of great diversity between populations.

This podcast closes out women’s month of March: Why are women still taken less seriously than men?  Men are assumed to be competent until proven otherwise and women are assumed incompetent until assumed otherwise. When hiring, 70% of men will rate men higher than women for the same qualification, and 30% of women also rate men higher. Leaders don’t like women who are self confident and consider them as pushy. Greater gender equality makes also men happier, healthier, and more satisfied, with less alcohol and drug abuse, and more sex.