Geriatric Update Feb 24, 2025

Home ambient temperature of 20 °C to 24 °C (68 °F-75 °F) was optimal for cognitive function in older adults >65. The likelihood of cognitive difficulties doubled with a 4 °C (7 °F) increase or decrease from this range. 

Higher lithium exposure in drinking groundwater was associated with reduced risk of all cancer types (breast, prostate, bladder and urinary tract, CNS, colorectal, kidney, leukemia, lymphoma, thyroid) overall and stratified by females and males. Compared with the first (lowest) quintile of lithium exposure, the HR for all cancers was 0.49 (95% CI, 0.31-0.78) for the fourth quintile and 0.29 (0.15-0.55) for the fifth quintile. The western US has higher levels of lithium and lower cancer rates HR 0.1 (0.00-0.09), vs. eastern US 0.34 (0.21-0.57).

Massage and touch can be used as complementary treatments for agitation in people with dementia and could benefit nursing staff and caregivers to better cope with the agitated behavior of older adults with dementia, based on a review of 17 randomized control trials with 980 patients. Another study has shown worsening agitation with massage. We have to assess the situation and individualize based on patient's response.

A mobile cognitive self-assessment scale (CogSAS) is a 15 minute online tool that measures sentence memory, visual memory and executive function with computer analysis of the selections and recorded story repeat. Internal consistency is 0.81, and test–retest reliability 0.82 and validity 0.74. The sensitivity and specificity for discriminating clinically diagnosed from cognitively unimpaired were 0.90 and 0.67, respectively and for discriminating biologically diagnosed MCI and dementia due to AD from cognitively unimpaired, 1.00 and 0.78, respectively.

People with type 2 diabetes who take GLP-1 have shown lower dementia rates, but also metformin is linked to a lower incidence of all-cause dementia compared to non-user (n = 17, HR = 0.76, 95% CI = 0.65–0.91, p = 0.002, I2 = 98.9%) and sulfonylureas (n = 5, HR = 0.88, 95% CI = 0.85–0.90, p < 0.001, I2 = 9.7%), but not to thiazolidinedione (n = 2, HR = 0.53, 95% CI = 0.08–3.41, p = 0.503, I2 = 92.7%).

Only 3.7% of 68,126 hospitalized adults with type 2 diabetes received an SGLT2 inhibitor or GLP-1 before being discharged. Yet, 46.8 % of hospitalized patients with T2DM would potentially benefit from an SGLT2 inhibitor and probably more from a GLP-1 agonist. Instead, 17.2% were discharged on sulfonylureas, which cause hypoglycemia, weight gain, and do not improve cardiovascular outcomes.

Two weeks ago I mentioned that GLP-1RA did not increase risk for thyroid cancer. This study also showed GLP-1RA did not increase overall risk for thyroid cancer compared to 3 other diabetes drugs (HR, 1.24; 95% CI, 0.88-1.76). However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08), probably because of greater awareness and investigation.

Greater weight loss after initiating antiobesity medications within 1 year was associated with a lower risk of 5-year and 10-year revision among patients with obesity undergoing hip or knee replacement. The HRs for revision were 0.55 (95% CI, 0.32-0.93) for small-to-moderate weight loss and 0.49 (95% CI, 0.25-0.97) for large weight loss groups compared with the weight gain or stable group for knee replacement; the corresponding HRs for revision were 0.82 (95% CI, 0.54-1.25) and 0.53 (95% CI, 0.30-0.93) in patients undergoing hip replacement.

A salt alternative with 25% potassium reduced the risk for recurrent stroke over 4.7 years by 14%, major cardiovascular events by 13% and death by 12%. Adverse events, such as hyperkalemia were the same compared to 100% sodium salt.

Stroke is devastating and in addition to hemiparesis, the most prevalent adverse nonmotor outcomes across 10 domains were,  sleep disturbance, sexual dysfunction, constipation, reduced social participation, bladder dysfunction, and fatigue, in a meta-analysis, including 279 studies with 117,440 patients.

Intravenous iron therapy with ferric derisomaltose (FDI) improved outcomes in heart failure with reduced ejection fraction (HFrEF) and iron deficiency. The IRONMAN trial randomized 1137 patients (median age 73 years) and showed benefit in older adults as well as in other ages.

Concomitant use of statins improved survival among people with cancer treated with immune checkpoint inhibitors, according to results of a meta-analysis of 25 studies, involving 46,154 patients with cancer. Overall survival (OS) (HR, 0.80 [95% CI, 0.71 to 0.92]) and/or progression-free survival (PFS) (HR, 0.80 [95% CI, 0.69 to 0.92]) were benefitted in Europe, but a sub analysis showed no benefit in the US and Asian populations. 

Nirmatrelvir-ritonavir (Paxlovid) prescriptions (n = 19 868) increased with age, among patients 70-74 years 227.9 prescriptions per 100 000 patients per month vs. 65-70 years, 106.0. Although hospitalization and mortality outcomes also rose with age, there were no significant differences just below vs just above age 70 years for COVID-19–related or all cause hospitalizations, or mortality, or with the use of Paxlovid. This may be because at the time, April to Nov 2022, population immunity from vaccine or infection was >95%.

For hip pain, resistance exercise with or without aerobic physical activity, at 3 months, showed similar mean improvements in patients’ pain (2.4 vs 2.2) and function (7.0 vs 8.9). The Functional Scale and 30-second sit-to-stand test showed greater improvement in the aerobic physical activity and resistance exercise group than in the resistance exercise-only group, with mean differences of −1.2 (P = .001) and −2.7 (P < .0001), respectively.

Of 9 muscle relaxant medications, baclofen, orphenadrine, carisoprodol, and methocarbamol improved cramp frequency, use of eperisone improved neck pain and chlormezanone enhanced the quality of sleep in those with neck osteoarthritis. But for fibromyalgia, low back pain, headaches and other syndromes, these 6, as well as tizanidine, cyclobenzaprine and quinine were not beneficial, in a systematic review of 44 studies including 2482 participants. Adverse effects: somnolence, dry mouth, vomiting, diarrhea, nausea, weakness, and constipation, and all muscle relaxants are on the Beers list.

People with narcissistic personality traits feel more excluded and ostracized than their peers and stuck in a behavioral doom loop they can’t easily escape. Narcissists tend to view social cues as negative, even when they’re not intended to be. However, they are also more likely to be excluded from groups because of their strong personality types, especially narcissistic rivalry, this exclusion can exacerbate narcissistic traits further, creating a self-perpetuating cycle.

Red meat was a strong driver of microbes that are negatively correlated with host cardiometabolic health. What seems to be more important is the diversity of healthy plant-based foods that is consumed. Whether this comes within a vegan or an omnivore diet is less crucial, as long as there is no specific overconsumption of unhealthy food categories, such as red meat.

I recently mentioned coffee reducing mortality and diabetes, this new study may explain the mechanism through the microbiome: L asaccharolyticus is highly prevalent, with about fourfold higher average abundance in coffee drinkers, and its growth is stimulated in vitro by coffee supplementation. Plasma metabolomics on 438 samples identified several metabolites enriched among coffee drinkers, with quinic acid and its potential derivatives associated with both coffee and L asaccharolyticus. The link between coffee consumption and the microbiome was highly reproducible across different populations (area under the curve, 0.89) from 25 countries.

In Serbian women aged ≥ 70 years with luminal A–like early breast cancer who had undergone breast-conserving surgery, radiotherapy (5-15 fractions) compared with endocrine therapy (aromatase inhibitors or tamoxifen) is associated with better health-related quality-of-life (global health status score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and a more favorable safety profile, with no differences in recurrence at 24 months. Physical functioning declined significantly in the endocrine therapy group (−6.90; P = .0006), while role functioning (ability to perform daily and leisure time activities, and/or work) declined significantly in the radiotherapy group (−4.88; P = .030); both groups also experienced cognitive decline (−7.55 for endocrine vs −5.49 for radiotherapy), but the between-group difference was not statistically significant. Treatment-related adverse event rates were higher in the endocrine group 85% vs 65% for radiotherapy.

A hydroablation device (Aquablation, using a water jet to reduce prostate tissue), developed for benign prostatic hyperplasia (BPH) showed promise as a potential treatment aid for early prostate cancer.  Men in active surveillance for prostate cancer with symptomatic lower urinary tract symptoms had an early spike in circulating tumors cells after treatment, followed by a decrease to below baseline levels. MRI-detected prostate lesions had disappeared 6 months after Aquablation treatment with improved prostate symptoms and sexual function.