Geriatric Update Dec 2, 2024

NSAID use in 51,794 patients on anticoagulation increased bleeding per 100 person-years: 3.5 [during periods without NSAID use and 6.3 during periods with NSAID use (number needed to harm = 36 patients treated for 1 year). Compared with non-use, the adjusted hazard ratios for any bleeding associated with NSAID use were 2.09 (95% CI, 1.67-2.62) overall, 1.79 (95% CI, 1.36-2.36) for ibuprofen, 3.30 (95% CI, 1.82-5.97) for diclofenac, and 4.10 (95% CI, 2.13-7.91) for naproxen. Prostaglandins are vasodilators and NSAIDs are prostaglandin inhibitors that can lead to heart failure, kidney failure, stroke and MI in older adults due to vasoconstriction and are on the Beers list.

Patients with sciatica, avg. age 42 were randomized to receive either naproxen 500 mg or a placebo twice daily for 10 days. The primary outcome, daily leg pain intensity measured on a 0 to 10 numeric rating scale throughout the treatment period, revealed a statistically significant difference in favor of naproxen, with an adjusted mean difference of -0.5 (95% CI -0.8 to -0.1, P = 0.015), which is thought to be clinically non-significant. No differences were found for sciatica bothersomeness or consumption of rescue medication or opioids.

Consuming additional water was associated with greater weight loss (range, 44%-100% more than control conditions) and fewer nephrolithiasis events (15 fewer events per 100 participants over 5 years). Single studies suggested benefits related to migraine prevention, urinary tract infection, diabetes control, and hypotension.

Two low-calorie high-protein diets were compared: 35% of total calories from protein, in which 75% of the protein was from either plant-based sources or animal sources. For both diets, 30% of total calories from fat and 35% from carbohydrates. Both diets had a similar beneficial effect on glucose metabolism, including fasting glucose, insulin, homeostasis model assessment of insulin resistance index, glycated hemoglobin, lipid profiles, liver enzymes, adipokines and inflammatory biomarkers. Fasting incretins, mainly glucagon-like peptide 1, decreased significantly in both groups, and this effect correlated with weight loss, (-8.05 ± 5.12 kg for the animal protein diet and -7.70 ± 5.47 kg for the plant protein diet at 6 months) and fat mass, mainly visceral fat.

In the Dutch population, a vegan diet fell below estimated average requirement in in 83% in quality and quantity protein, compared to vegetarian, flexitarian, or pescetarian diet. The loss in protein intake (quantity) in all scenarios was mainly observed at dinner; the loss in protein quality was greatest at breakfast and lunch, especially in lysine (found in beans or soy milk). In a different culture where legumes are more often used, e.g. Hispanic, this would not be a problem, possibly explaining the Hispanic paradox, longer life expectancy despite of poverty and life stressors.

62 people, age, 57.4 years, 23% men, were randomized to start a vegan (n = 30) or Mediterranean (n = 32) diet for 32 weeks. Food costs decreased on the vegan diet by 19% (−$1.8/d [95% CI, −$2.6/d to −$1.0/d]; P < .001), without significant change on the Mediterranean diet. This decrease in costs on the vegan diet was mainly associated with savings on meat (−$2.9/d), dairy (−$0.5/d), and added fats (−$0.5/d). These savings outweighed the increased spending on vegetables ($0.5/d), grains (95% CI, $0.3/d), and meat alternatives ($0.5/d) on the vegan diet. 

The secondary infection risk of influenza infection among household contacts was 18.8% (95% CI, 15.9% to 22.0%), and influenza vaccines prevented secondary infections among household contacts by 21.0% (95% CI, 1.4% to 36.7%).

Poor sleepers had a higher risk of incident Motoric Cognitive Risk (MCR) syndrome (HR = 2.7 [1.2; 5.2]) compared with good sleepers, but excessive sleepiness and lower enthusiasm for activities, were the only sleep components linked to a significant risk for MCR in fully adjusted models (aHR, 3.3; 95% CI, 1.5-7.4; P < .05). The relationship is unidirectional, MCR did not cause poor sleep. The mechanism may be from sleep apnea, but glymphatics also clean the brain more effectively during nighttime sleep than during daytime naps.

Of 3612 Medicare beneficiaries with dementia receiving cholinesterase inhibitors (e.g. donepezil) who initiated memantine, those who discontinued the cholinesterase inhibitor had similar 1-year mean long-term care institutionalization-free days and all-cause mortality, but had a lower risk of fall-related injury compared with those who continued the cholinesterase inhibitor (0.9 vs 2.0 per 100 person-years; hazard ratio [HR], 0.47 [95% CI, 0.25 to 0.88]).

Veterans on avg 68.9 years old with COVID-19, before vaccines were available, had more deficits compared with uninfected controls: Median (IQR) number of new deficits at 1 year was 1 (0-2) for infected and 0 (0-1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52-1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%). This is not surprising to us geriatricians, we know that any major stressor, infection, new environment, trauma or loss, leads to a decline in function. 

Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism in those perpetrating it, was found across the age, sex, and race/ethnicity.

Meta-analyses showed that resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week. Walking 3.0 mph (4.8 km/h) burns 3 MET per minute, and 22 minutes a day, 6 days a week, amounts to 390 MET.