Geriatric Update Feb 17, 2025

Sodium-glucose cotransporter 2 (SGLT2), inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1) lowered the risk for COPD exacerbation in adults with the disease and type 2 diabetes, (2.2 and 1.6 fewer events per 100 person-years, respectively) compared to DPP-4 inhibitors.

The GLP-1 semaglutide significantly reduced alcoholic drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04), weekly alcohol craving (β, −0.39; 95% CI, −0.73 to −0.06; P = .01), and heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). Semaglutide also reduced cigarette use per day in a subsample of individuals with current cigarette use (β, −0.10; 95% CI, −0.16 to −0.03; P = .005).

Currently 6 studies are under way to test nasal COVID-19 vaccines, the CDC and NIH sites that used to carry this information are no longer available.

A database review identified 16 preventive measures, both nonpharmacologic (eg, staffing, visitor restrictions) and pharmacologic (eg, vaccines, antivirals) interventions for COVID-19 used in nursing homes. Nonpharmacologic measures were widely implemented but lacked evidence for effectiveness, whereas vaccinations and antivirals showed substantial benefits but were underutilized; up-to-date vaccination status was suboptimal in residents and staff and only a minority of infected residents received antiviral treatment.

COVID-19 vaccination lowered the risk for hyperthyroidism but the risk of hypothyroidism significantly increased from 6 to 12 months after vaccination (HR: 1.14–1.30), especially in older adults and groups vaccinated with the mRNA vaccines vs. the unvaccinated group. No difference in the risk was noted in the group vaccinated with Ad26.COV2, based on a TriNetX analysis of 2.3 million patients.

Only 2.4% of individuals born before 1968 had protective antibodies against H5N1 before vaccination, while antibodies against H7N9, also avian influenza virus, were absent across all vaccinated groups. 1 month after seasonal vaccination, H5N1 antibody response was greatest in young adults (15%), born after 1977, followed by middle aged (12.2%), but no response in those born before 1968, and responses to H7N9 were minimal. After 6 months, seroprotection against AIV remained 2% or lower in all cases. As I explained with COVID-19, seroprotection is one arm of immunity, cellular is the other, involving T-cells that learn quickly when exposed to infection after vaccination.

Exergaming is comparable to conventional physical exercises on frailty. Participants appeared to have better adherence to exergaming, based on 5 studies with 391 participants. Exergaming, delivered in 20–36 sessions over 8–12 weeks, resulted in improvements in frailty scores and indices, frailty status, and frailty phenotypes, including exhaustion, low physical activity levels, gait speed, and muscle weakness over time, without unintentional weight loss.

Cognition significantly declined after a stroke (−0.14; 95% CI, −0.21 to −0.07) compared with that of the group with transient ischemic attach (TIA) (0.01; 95% CI, −0.10 to 0.12; P = .02) and controls (−0.03; 95% CI, −0.05 to −0.01; P = .003). However, the annual decline after the index event was faster (P = .001) in the group with TIA (−0.05; 95% CI, −0.06 to −0.03) than that for asymptomatic controls (−0.02; 95% CI, −0.02 to −0.02) but not different from the group with stroke (−0.04; 95% CI, −0.05 to −0.03; P = .43). The cognitive impairment observed in patients with TIA was primarily driven by declines in immediate and delayed memory recall, rather than verbal fluency.

New in the American Stroke Association's 2024 Guideline for the Primary Prevention of Stroke is: physical activity is essential for stroke prevention and cardiovascular health, and robust data support the use of GLP-1 receptor agonists for patients with diabetes at high cardiovascular risk.

Systematic reviews and/or meta-analyses (based on large epidemiological studies) have demonstrated a dose–response inverse relationship between physical activity and premature mortality and the primary and secondary prevention of several chronic medical conditions.  Even minor volumes of physical activity show health benefits.

This meta-analysis found a significant association between physical activity (high versus low) and academic performance (high versus low performers) (odds ratio = 3.04; 95% CI = 1.84-5.02; P ≤ 0.001; I2 = 49.62). I wonder if the underlying determinant is discipline and motivation. I would like to see a randomized trial, using objective measurements of physical activity.

People who exercise regularly before the age of 50 experience slower shrinkage in the hippocampus, a brain region critical for learning and memory and neurodegenerative markers (Aβ status; hippocampal and whole-brain volume; cortical thickness in Alzheimer’s disease regions) (all P < 0.05). 

And individuals with all-cause dementia who remained physically active both before and after dementia diagnosis had the lowest mortality risk after adjusting for confounders compared with those who have never engaged in regular exercise (hazard ratio, 0.71; 95% CI, 0.65-0.79).

An online intervention targeting modifiable dementia risk factors (physical activity, nutrition, cognitive activity and depression or anxiety) improved cognition over 3 years, in a randomized controlled trial of dementia-free community-dwelling 6,100 Australians aged 55–77 years. The mean changes in z scores in global cognitive composite were 0.28 (95% confidence interval (CI): 0.25–0.32) for intervention, 0.10 (95% CI: 0.07–0.13) for control.

Middle-aged women who practiced self-compassion had lower risk of developing cardiovascular disease, as measured by thinner carotid artery walls and less plaque buildup, irrespective of other traditional risk factors such as high blood pressure, insulin resistance and cholesterol levels.

People who flossed their teeth regularly had 22% lower risk of an ischemic stroke, a 44% lower risk of a cardioembolic stroke, and a 12% lower risk of A-fib, but no association with thrombotic or lacunar strokes, over 25 years.

Black participants with the highest accessibility to rivers had 32% lower odds of coronary artery calcification (CAC), an early sign of heart disease, compared to those with the lowest accessibility. Those with greater access to green spaces had up to 35% lower odds of CAC.

An 8-hour time-restricted eating schedule had a 91% higher risk of death from cardiovascular disease than a standard schedule of eating across 12-16 hours per day.

Vaccination reduces dementia and other neurodegenerative diseases (adjusted hazard ratio: 0.72; 95% confidence interval: 0.69 to 0.75). The mechanism is thought to be: protection against bacterial and viral infection is beneficial to the brain since these infections may activate dormant herpes viruses in the nerves. Embryologic reactivation and gene un-silencing is increased by herpes viruses, such as herpes zoster (shingles) and herpes simplex (cold sores).

The Parkinson’s med entacapone can significantly disrupt the gut microbiome by sequestering iron, leading to iron deficiency for beneficial bacteria and selecting for E.coli.  

Effect on aging was measured for Vitamin D (2,000 IU per day) and/or omega-3 (1 g per day) and/or a home exercise program, based on on four next-generation DNA methylation (DNAm) measures of biological aging (PhenoAge, GrimAge, GrimAge2 and DunedinPACE) over 3 years. Omega-3 alone slowed the DNAm clocks PhenoAge, GrimAge2 and DunedinPACE, and all three treatments had additive benefits on PhenoAge. Overall, from baseline to year 3, standardized effects ranged from 0.16 to 0.32 units (2.9–3.8 months).

A meta-analysis of 38,565 patients with Barrett’s Esophagus (BE), of whom 1684 were diagnosed with high grade dysplasia or cancer, found that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. Each 5-kg/m2 increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted odds ratio, 1.06; 95% CI, 1.02–1.10; P < .001; I2= 0%).

Eating >2 servings of yogurt per week for years had 20% lower odds for an aggressive type of colon cancer, typically found on the right side of the colon (HR 0.80, 0.50–1.28). Although the HR crosses 1, yogurt is beneficial for a number of reasons, but be careful of the amount of sugar or artificial sweetener often included.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors increase the risk for amputation compared to placebo. This study compared SGLT2 with DPP-4 inhibitors and found again higher risk of amputation (aHR, 1.15) and revascularization (aHR, 1.25) with SGLT2,  11.2 vs 10.0 per 1000 person-years (adjusted hazard ratio [aHR], 1.18). At 4 years 4.0% SGLT2 inhibitor users and 2.8% of DPP-4 inhibitor users had vascular surgery.

A blood test for early-stage pancreatic cancer achieved 98% specificity and 73% sensitivity across all stages of pancreatic ductal adenocarcinoma (PDAC), and adding CA 19-9 cancer biomarker increased the sensitivity to 85% with a specificity of 96%. The test also distinguished PDAC from non-cancer pancreatic conditions with 100% accuracy.

In a systematic review and meta-analysis of 27 randomized controlled trials, exercise interventions were found to be associated with significantly reduced levels of depression (SMD = -0.53; 95% CI, -0.79 to -0.28) and anxiety (SMD = -0.39; 95% CI, -0.66 to -0.12) and improvements in overall HRQOL (SMD = 0.63; 95% CI, 0.10 to 1.17) in older adults with cancer. Mind-body exercise was better than conventional exercise. Mind-body exercises are physical activities that integrate body movement, mental focus, and controlled breathing to improve strength, balance, flexibility, and overall health, e.g. yoga, tai chi, etc.

4 weeks of oral vancomycin induces remission in primary sclerosing cholangitis- inflammatory bowel disease (PSC-IBD), associated with a reduction in gut bacterial diversity and compositional changes relating to bile acid and short chain fatty acid homeostasis, in 12 of 15 patients.

The Food and Drug Administration (FDA) is advising consumers not to purchase or use Advance King, sold for joint pain. FDA laboratory analysis confirmed that it contains dexamethasone, diclofenac, and methocarbamol not listed on the product label. These are prescription meds can lead to withdrawal symptoms for dexamethasone and methocarbamol, and cardiovascular events for diclofenac.