Geriatric Update Feb 3, 2025

The Food and Drug Administration (FDA) approved Journavx (suzetrigine) 50 milligram oral tablets twice daily, a first-in-class non-opioid analgesic, to treat moderate to severe acute pain in adults. Suzetrigine reduces pain by targeting a pain-signaling pathway involving sodium channels  Nav1.8-dependent pain-signaling pathways in the peripheral nervous system, before pain signals reach the brain. Side effects include: itching, muscle spasms, increased blood level of creatine phosphokinase, and rash. Cost is $15.50 per 50mg pill.

This novel biomarker is an objective way of predicting pain sensitivity: brain sensorimotor peak alpha frequency (PAF) and corticomotor excitability (CME), with accuracy, reproducibility, and reliability, and an outstanding area under the curve (AUC = 1.00). The study was done on 150 Australians age 25, I would like to see older adults included.

Meter dose inhalers for asthma and chronic obstructive pulmonary disease were switched on VA formulary to dry powder inhaler (DPI) for environmental and carbon footprint reason. Of 347,486 veterans, age 65.8 years, who were dispensed a combination inhaler before and after the formulary transition, 260,268 (74.9%) were switched to the fluticasone-salmeterol DPI. Of these 14.2% were subsequently prescribed a non–fluticasone-salmeterol combination inhaler. 

Patients with atrial fibrillation (A-fib) and rapid heartrate (n=149), mean age of 76 years over 12-month follow-up, treatment with digoxin was significantly less costly than beta blockers for heart rate control, £530.41 per patient per year. Mainly due to lower rates of adverse events, with less primary and secondary healthcare utilization than with beta-blocker therapy. There was no significant difference in Quality-Adjusted Life Years.

In a review of 13 studies with 1660 patients with A-fib and rapid heart rate, those treated with metoprolol had lower rates of bradycardia and/or hypotension compared to those treated with diltiazem (RR 0.74, 95 % CI 0.56-0.98, p = 0.034).

In emergency department (ED) patients with chest pain, neither the History, Electrocardiogram, and Troponin (HET) score, a simplified alternative to the HEART score, which also includes age and risk factors, achieved a safe negative predictive value or efficacy in 1460 patients, mean age 57.6 years. 

Public-loud and public-quiet blood pressure measurements (BPs) had minimal, non-clinically important different readings from private quiet BPs, and was consistent across subgroups among the 108 patients, avg age 56.

Compared with usual care before surgery, a combination of exercise, nutrition, and psychosocial prehabilitation was most likely to improve health-related quality of life (mean difference on Short Form-36 physical component scale, 3.48) and physical recovery (mean difference in meters on the 6-minute walk test, 43). Exercise alone (odds ratio [OR], 0.50), nutrition alone (OR, 0.62), and combined exercise, nutrition, plus psychosocial prehabilitation (OR, 0.64) were most likely to reduce the risk for complications compared with usual care. Combined exercise and psychosocial support was associated with 2.44 fewer days in the hospital, whereas combined exercise and nutritional support was associated with 1.22 fewer days. Individually, exercise and nutrition were associated with 0.93 and 0.99 fewer days, respectively. Based on a systematic review of 186 randomized controlled trials with 15,684 participants (mean age, 62 years) that held after removing studies with higher risk of bias.

Physically active members showed lower rates of cancer progression with baseline low vs. no physical activity HR 0.84 (95% CI 0.79 to 0.89), and with medium to high physical activity vs. none HR 0.73 (95% CI 0.70 to 0.77). The HR for all cause mortality for low vs. no activity was 0.67 (95% CI 0.61 to 0.74), and for medium to high physical activity 0.53 (95% CI 0.50 to 0.58) compared with no physical activity in 28,248 South African cancer patients.

Risk factors of experiencing post-acute sequelae of COVID-19 (PASC) are: multiple SARS-COV-2 infections (RR = 1.41 [1.14–1.74]), severe COVID-19 (RR = 3.17 [2.41–4.16]), and being unvaccinated at first infection (RR = 3.29 [2.46–4.41]). Older women with baseline elevated leukocyte (white blood cell) counts, indicating inflammation, have more severe symptoms of long COVID.

Women have a 31% or higher risk for symptoms of long COVID compared with men. The sex-based difference in long COVID risk was age, pregnancy, and menopause dependent, with the highest risk among females aged 40 to 55 years.

In a cross-sectional study of 1003 young adults, heavy lifetime cannabis use was associated with lower brain activation during a working memory task, involving the anterior insula, medial prefrontal cortex, and dorsolateral prefrontal cortex (Cohen d = −0.28 [95% CI, −0.50 to −0.06]). This association remained after removing individuals with recent cannabis use, and were not explained by differences in demographic variables, age at first cannabis use, alcohol use, or nicotine use.

Each additional cup of coffee consumed without additives was associated with a 10% lower risk for type 2 diabetes (HR, 0.90; 95% CI, 0.89-0.92). Cream use showed no significant impact on the protection. Adding sugar to coffee reduced protection to 5% lower risk for T2D (HR, 0.95; 95% CI, 0.93-0.97); and artificial sweetener (HR, 0.93; 95% CI, 0.90-0.96). Decaffeinated coffee showed similar protective association as caffeinated coffee. 

Bisphosphonate users had a higher risk for acute angle closure glaucoma than nonusers (adjusted incidence rate ratio [aIRR], 1.78; 95% CI, 1.05-3.01), but not open angle glaucoma. Risedronate had a higher risk than others (aIRR, 2.76; 95% CI, 1.11-6.90). The prevalence of closed angle glaucoma in the US is 0.1% and open angle glaucoma is 1.86%.

Women, avg age 58, taking 2,000 IU/d Vitamin D compared to other doses performed better in learning and memory tests (p < .05). However, the 4,000 IU/d group had a slower reaction time compared to the 600 IU/d group, which may explain the higher risk of falls found with high doses.

Brain accumulation of microplastics is much higher in people with dementia, including Alzheimer’s disease, and 7-30 times greater than other organs (liver and kidney).

Microplastics have also been shown in carotid artery plaques. Patients in whom microplastics were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27). Anywhere there is inflammation there is accumulation of calcium, microplastics, and a number of metals, however:

Lowering brain iron elevation in Alzheimer disease using the iron chelator deferiprone 15 mg/kg twice a day for 12 months decreased brain iron accumulation but accelerated cognitive deterioration. The lack of benefit from removing iron may be due to the small molecule having little impact but inflammation being the culprit. While we cannot remove microplastics, it is probably best to avoid them in our environment and reduce our plastic purchase and use. 

Intranasal oxytocin given every 3rd day was well tolerated and was associated with a small reduction in apathy in patients with frontotemporal dementia. The greater problem for family is usually the disinhibition and outbursts that can be improved with serotonin selective reuptake inhibitors (SSRI).

Over about 5 years, fluctuations in cholesterol levels were associated with dementia and cognitive impairment with no dementia (CIND). The hazard ratios (95% CI) comparing the highest and lowest quartiles of total cholesterol and LDL-c variability were 1.60 (1.23–2.08) and 1.48 (1.15–1.91) for dementia and 1.23 (1.08–1.41) and 1.27 (1.11–1.46) for CIND, based on the analysis of the ASPREE trial including 9,846 individuals age 73.9 years. Weight loss, as frequently occurs in dementia, is associated with a 10% to 30% reduction in cholesterol. And weight gain, as is common in frontotemporal dementia, would raise cholesterol, contributing to fluctuations.

Among adults aged ≥65 years, with and without chronic kidney disease (CKD), statin therapy was not associated with improved or worsened kidney function.

The Chinese visceral adiposity index (CVAI) was associated with diabetic kidney disease (DKD). Compared to low CVAI level, the high baseline CVAI level was positively associated with the risk of DKD (HR: 1.24, 95% CI: 1.09-1.42), as well as the high cumulative CVAI level (HR: 1.62, 95% CI: 1.29-2.04).

This GeriPal podcast addresses coping with difficult illness.