Geriatric Update Feb 19, 2024

In 2000 I started the update to provide COVID information and later added pertinent geriatric topics.  As the news about COVID is dwindling, I will no longer separate my update into COVID and other sections. 

The collection of throat swabs showed higher sensitivity than nasal swabs for of COVID-19 rapid antigen tests for both self-collected and healthcare worker–collected specimens.

According to the CDC 15% of all US adults had experienced >1 symptoms of post–COVID-19 conditions (PCC). This study looked at fatigue after COVID and found compared with non–COVID-19 controls, the hazard ratios were 1.68 (95% CI 1.48–1.92) for fatigue and 4.32 (95% CI 2.90–6.43) for chronic fatigue. We should strive to prevent COVID with vaccine boosters and treat it with Paxlovid to reduce PCC.

Of 196,470 newborn infants (48.0%) were exposed to COVID-19 vaccination during pregnancy. Exposed infants exhibited no increased odds of adverse neonatal outcomes, and had lower odds for neonatal nontraumatic intracranial hemorrhage (event rate, 1.7 vs 3.2/1000; adjusted odds ratio [aOR], 0.78 [95% CI, 0.61-0.99]), hypoxic-ischemic encephalopathy (1.8 vs 2.7/1000; aOR, 0.73 [95% CI, 0.55-0.96]), and neonatal mortality (0.9 vs 1.8/1000; aOR, 0.68 [95% CI, 0.50-0.91]).

The CDC is considering to update isolation guidelines. Peter Hotez does not want to end isolation early because COVID-19 is more severe than flu or other viral infections. He advocates antigen testing after fever has resolved and if negative to end isolation.

The American Heart Association has issued a new calculator, PREVENT that includes a more diverse sample and other health conditions, such as kidney and metabolic diseases, over the previous version from 2013.

Playing a musical instrument was associated with better cognition with statistically significant effect sizes that ranged from 0.15 to 0.24 for improving: executive function, working memory, digit span, and verbal reasoning. Singing showed better verbal reasoning.

Zilebesiran is an investigational RNA interference therapeutic that targets hepatic angiotensinogen synthesis. In 377 patients, age 57, 1 injection of zilebesiran lowered blood pressure:

• 150 mg every 3 months reduced BP by −7.3 mm Hg  

• 300 mg once every 6 months by −10.0 mm Hg

• 600 mg once every 3 months or every 6 months by −8.9 mm Hg

• vs. +6.8 mm Hg with placebo.

48 Chinese nursing homes with 1612 participants, age 71, were randomized to replacing regular salt over 2 years. The salt substitute, with 62.5% sodium chloride, 25% potassium chloride, and 12.5% dried food ingredients, reduced mean systolic blood pressure by 7.14 (95% CI, 3.79-10.48) mm Hg, hypertension prevalence by 5.09%, and cumulative MACEs by 2.27%. At the end of the 2-year intervention, the mean cost was $25.95 less per participant for the salt substitute group than the regular salt group due to substantial savings in health care costs for MACEs ($72.88 vs $111.18).

A plant-based diet, low in dairy and meat but rich in fruits, vegetables, whole grains, legumes and nuts, can improve sexual and urinary health in patients treated for local prostate cancer, and quality of life.

280 participants were assigned to receive 2.24 g oral intragastric expandable capsules twice a day that expand to 1/3 of the stomach volume, or placebo.  At 24 weeks, weight loss exceeding 5% was 45.0% in the intragastric expandable capsule group versus 19.7% in the placebo group. I wonder if a high fiber diet would have similar effects.

A pill of the antimuscarinic aroxybutynin and the noradrenergic atomoxetine was trialed in 176 patients with obstructive sleep apnea age 5-57, over 4-weeks: participants in the first and second arms received containing doses of 2.5 mg/75 mg and 5 mg/75 mg of aroxybutynin and atomoxetine, respectively. The 3rd arm received atomoxetine alone (75 mg), and the 4th placebo. The apnea-hypopnea index improved in the respective arms: 1) 20.5 to 10.8 2) 19.4 to 9.5  3) 19.0 to 11.8. Nocturnal desaturation (in percentage per hour) 1) -12.7, 2) -16.6, and 3) -5.2. The mechanism of action is: increased activity of the dilator muscles in the upper airways by activating the genioglossus muscle with a synergic effect on the upper respiratory tract during sleep.  Aroxybutynin is on the Beers list. If we offer this, we need to make our patients aware of the cumulative risk of dementia with the antimuscarinic med, and we don’t know the effects on sleep architecture.

A UK Biobank study of 434,374 examined the association of calcium supplements with CVD events and mortality in individuals with and without diabetes in a prospective observational study over 10 years. Calcium supplementation was associated with a higher risk of CVD incidence (HR, 1.34), CVD mortality (HR, 1.67), and all-cause mortality (HR, 1.44) in participants with diabetes. No significant association was observed in participants without diabetes. Keep in mind that calcium absorption sharply drops at >500 mg, so if supplementing, use smaller doses. 

Multivitamin supplements (MVI) have been associated with lower incidence of colorectal cancer (CRC). This study looked at effect on 2424 patients with stage I–III CRC over 11 years. At a moderate dose (3-5 per week) MVI appear to lower the risk for both all-cause and cancer-related mortality in patients with CRC by 45%; however, high doses of MVI >10 pills a week may increase the risk for CRC-specific mortality by 60%. It was not clear which vitamins or what amount was used in this prospective cohort study.

Last month I wrote about helicobacter pylori and dementia, and was not convinced of the weak correlation.  Here is another study showing H. pylori infection was associated with an increased risk of incident dementia (HR, 1.70) over 7 years, with the association more pronounced for Alzheimer's disease (HR, 2.85).

Individuals, age 74, with cataract, age-related macular degeneration, or glaucoma have about a third higher risk of falls and fractures.  A now 10 year old study showed that cataract surgery increased the risk of falls for 6 months and the older the person, the higher the risk: 85+ year olds have a 6.8 fold higher risk. 

This summary of best evidence for prevention and management of frailty recommends exercise and protein, particularly the essential amino acids, valine, leucine, isoleucine and lysine, found in legumes, seeds, nuts and whole grains.

Thank you, Dr. Barrett for sharing this excellent podcast:  Why are people asking me if my mother recognizes me, when it’s totally beside the point? (14 minutes)

Even low intensity activities such as walking or yoga are beneficial for improving depression. (Shorter summary and comment)

Despite being the leading cause of death among U.S. children, funding for research on firearm mortality lags behind about $600 per life lost, auto accidents received about $26,000 of research funding per death, pediatric cancer, the third leading cause of death, topped $195,000 per death.

The FDA approved iloprost for severe frostbite, based on a study in a Grenoble hospital randomized 47 adults with severe frostbite, into one of three treatment groups, all received aspirin by vein and standard of care (risk of amputation): 1. Iloprost alone (0 amputations of 15), 2. 400 mg of buflomedil (used in Europe for claudication) (9 of 15 patients), 3. Iloprost and plus recombinant tissue plasminogen activator [rt-PA] (3 of 16 patients). I would like to see a comparison with other prostaglandins: misoprostol and lubiprostone.

The city of Cincinnati in collaboration with Hamilton County and the Council on Aging has reopened the senior home repair and utility assistance program and is now accepting new applications.