Geriatric Update Feb 10, 2025

The most common symptom of avian influenza A(H5N1) was conjunctivitis (93%), followed by fever (49%) and respiratory symptoms (36%). Of 46 case patients, 20 were exposed to infected poultry, 25 were exposed to infected dairy cows, and 1 had no identified exposure; illness was mild and lasted about 4 days, no deaths so far.

Six dairy herds in Nevada have tested positive for a newer variant of the H5N1 bird flu virus that’s been associated with severe infections in humans. Until now, humans infected had mild infections. Influenza virus mutates more dramatically than SARS-CoV-2 did, but is not airborne transmitted. Droplet and contact transmission is easier to control with standard masks and hand washing.

SGLT2i use was associated with reduced stroke risk in patients aged < 75 years (HR 0.71, 95% CI 0.50–1.00), a neutral effect in those aged 75–89 years (HR 1.11, 95% CI 0.71–1.74), and an increased risk in patients aged ≥ 90 years (HR 4.96, 95% CI 1.19–20.7, P < 0.05). The mechanism is likely due to dehydration. We have shown an increased risk of stroke with dehydration in older adults (unpublished data).

Treatment with GLP-1 RAs was associated with a reduced risk for incident diabetic macular edema (DME) (HR, 0.77; 95% CI, 0.70-0.85), as was treatment with fenofibrates (HR, 0.83; 95% CI, 0.68-0.98). Calcium channel blocker use showed an increased risk for this eye disease (hazard ratio [HR], 1.66; 95% CI, 1.54-1.78) compared with control individuals.

Use of GLP1-RA relative to use of DPP-4i was not associated with an increased risk of thyroid cancer (pooled weighted HR 0.81, CI 0.59–1.12), based on database of 2.6 million users of multiple countries up to 3 years.

Mandated reductions in sodium content in processed products were associated with a reduction in urinary sodium excretion and blood pressure, in a cohort of rural South African adults aged >40 years. Every gram of sodium reduction was associated with a −1.30 mm Hg reduction (95% CI, 0.65-1.96; P = .00) in systolic blood pressure. The proportion of the study population that achieved ideal sodium consumption (<2 g per day or <5 g of salt) increased from 7% to 17%.

Higher intake of ultraprocessed foods based on questionnaires, was associated with accelerated biological aging, based on 36 biomarkers, compared with the lowest intake, with a mean difference between the biological and chronological ages of −4.1 years in the lowest and 1.6 years in those with the highest intakes.

Increasing neurofilament light chain and glial fibrillary acidic protein levels, but not change in the amyloid-β42/40 ratio or phosphorylated tau 181, were associated with worsening cognitive function and incident cognitive impairment in 758 individuals with type 2 diabetes and overweight or obesity, over 12 years.

Carbonated water may indirectly promote weight loss by enhancing anaerobic glycolysis and glucose utilization. The amount is small, 9.5 g glucose (2 tsp or 33 kcal) over 4 hours, but may help.

Continuing anticoagulation compared to giving the last dose of factor Xa inhibitor (ie, apixaban, edoxaban, or rivaroxaban) 24 hours before the procedure (ie, endoscopy, dental procedure, or ocular surgery) and restarting treatment with the inhibitor the next day, showed negligible 0.1% higher risk of bleeding, and no blood clots.

Hospitalization for or death from heart failure (HF) within 12 months was significantly more likely to occur in individuals diagnosed as inpatients (in hospital) than outpatients (809 vs 384 events; adjusted HR: 1.62 (1.39-1.89), p<0.001), and this was consistent regardless of ejection fraction (EF). For HF with reduced EF, patients first diagnosed as inpatients, discharged on 2 guideline recommended meds (GRM) had a reduced incidence of the primary outcome compared with those discharged on <2 GRM (303 vs 175 events; adjusted HR: 0.72 (0.55-0.94), p=0.016). GRMs: beta blockers, angiotensin receptor-neprilysin inhibitors (ARNIs), angiotensin receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACE), mineralcorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter 2 Inhibitors (SGLT2i).

Treatment for rheumatoid arthritis and MRI-detected subclinical joint inflammation with methotrexate resulted in better work productivity, lower healthcare costs and improved quality of life over the course of 2 years vs. placebo; with the largest gain in productivity costs, €-4809, and Healthcare cost €-418.

Central obesity measures of waist circumference and waist-to-hip ratio appear to be more accurate and consistent indicators of colorectal cancer incidence than BMI. This would put some patients at risk, who may not be overweight or obese. 

In patients with cancer, muscle strength and cardiorespiratory fitness (CRF) is inversely associated with all-cause and cancer-specific mortality: a systematic review with meta-analysis of 42 studies with 46,694 patients. Cancer patients with high muscle strength or CRF levels had a significant reduction in risk of all-cause mortality by 31–46% compared with those with low physical fitness levels and a 11% reduction with each unit increment in muscle strength.

In this cohort study of 11.6 million Canadians, individuals with incident hospital-based care for a Cannabis use disorder (CUD) were at a 2.8-fold increased risk of death within 5 years relative to the general population, [aHR], 2.79 [95% CI, 2.62-2.97]). The highest was risk of death by suicide (aHR, 9.70 [95% CI, 6.04-15.57]), trauma (aHR, 4.55 [95% CI, 3.55-5.82]), opioid poisoning (aHR, 5.03 [95% CI, 2.86-8.84]), other drug poisonings (aHR, 4.56 [95% CI, 3.11-6.68]), and lung cancer (aHR, 3.81 [95% CI, 2.39-6.07]) relative to the general population.

Schizophrenia increased significantly from 3.7% in the cannabis prelegalization period to 10.3% during the postlegalization period in Ontario, based on 13.6 million people aged 14 to 65 years without a history of schizophrenia.

The US leads reporting countries in overdose deaths, no reports from China or Russia. Over the last year, since Jan 2024, the rate has dropped sharply, by 21.7% in the US, with the greatest drop in NC by 51%.

The GLP-1 meds seem to help a lot of diseases, however, the GLP-1 exenatide was not effective to prevent progression in Parkinson’s disease. 

Drugs that may slow aging are metformin, rapamycin and dicetin in addition to quercetin from dietary flavonoids, found in colored vegetables.

Cardiovascular risk and obesity (visceral and subcutaneous fat) were most strongly linked to brain volume loss on MRI, especially in the temporal lobe, between ages 55 and 74 years in men, and in women, between 65 and 74 years, regardless of apolipoprotein ε4 status.

Drinking alcohol increases the risk of serious liver damage even more if you have cardiometabolic risk factors (CMRF). A large belly, diabetes, or high blood pressure double the risk, but hyperlipidemia does not: High Waist Circumference Adjusted Odds Ratio (aOR) (95% CI) 1.8 (1.0-3.0); Hypertension aOR 2.4 (1.3-4.3); Diabetes aOR 2.4 (1.4-4.2); Hypertriglyceridemia aOR 0.8 (0.5-1.2); Low HDL aOR 1.3 (0.8-2.2).

Many people use a juice cleanse to "detoxify" the body, but they do more harm than good. A diet of only vegetable and fruit juice, even for just three days with little fiber, can lead to shifts in gut microbiome and oral bacteria linked to inflammation. Our bodies do an excellent job continually clearing out waste products that we do not need to “detoxify.”

This 3 min news clip describes that wearing socks may help with sleep by allowing lower room temperature at night and core body temperature drop, which helps with sleep.