Geriatric Update Jan 1, 2024
The live-attenuated influenza virus vector-based intranasal vaccine reduced the incidence of confirmed symptomatic SARS-CoV-2 infection caused by omicron variants regardless of immunization history to 1.6% in the vaccine group and 2.3% in the placebo group, resulting in an overall vaccine efficacy of 28.2% (95% CI 3·4–46·6), with a median follow-up duration of 161 days. ☹
In Geriatric and Other News,
Following the current CDC guidance for influenza outbreaks in nursing homes was most effective and reduced symptomatic illnesses by 12% and hospitalizations by 36%: start prophylaxis of non-ill residents with oseltamivir once an influenza outbreak is detected and continue on it for at least 14 days, and until seven days after the last laboratory-confirmed influenza case is identified.
In a meta-analysis of 15 randomized controlled trials involving 598 patients with mild to moderate Alzheimer’s, light therapy significantly improved sleep efficiency, agitation, depression, severity of psychobehavioral symptoms and caregiver burden, but not cognition based on MMSE.
Treating residents in the nursing home improved outcomes over ED and hospitalization for the 6 conditions tested under a CMS initiative: pneumonia, congestive heart failure, chronic obstructive pulmonary disease/asthma, skin infection, fluid/electrolyte disorder or dehydration, and urinary tract infections. 13.6% were subsequently hospitalized and 7.8% died, within 30 days, compared to 26.5% and 17.0%, respectively, among those treated in the hospital, and those treated in the hospital were more likely to be readmitted (OR = 1.666, P < .001) or to die (OR = 2.251, P < .001).
Perioperative Optimization of Senior Health (POSH) Initiative vs. a comparison group showed
fewer complications, (0.9 vs 1.4; P < .001; 95%CI, –0.13 to –0.89),
shorter hospitalizations (4 days vs 6 days; P < .001; 95%CI, –1.06 to –4.21),
more frequent discharge to home, (114 of 183 [62.3%] vs 73 of 143 [51.1%]; P = .04; 95%CI, 1.02 to 2.47),
fewer readmissions
7 days (5 of 180 [2.8%] vs 14 of 142 [9.9%];P = .007; 95%CI, 0.09 to 0.74) and
30 days (14 of 180 [7.8%] vs 26 of 142 [18.3%]
Folate/folic acid supplementation alone increased the risk of Alzheimer's disease (hazard ratio [HR] =1.34, 95% confidence interval [CI] =1.06 to 1.69, p=0.015) and vascular dementia (HR=1.61, 95% CI=1.21 to 2.13, p=0.001) in 466,224 UK Biobank participants but not when taken in combination with other B vitamins, possibly because of depletion of vitamin B-12. I usually recommend all patients >50 take a multivitamin for seniors a day to prevent B-12 and D from drifting into the deficiency range.
Clinically apparent Helicobacter pylori infection (HPI) increased the risk of incident Alzheimer's disease by 11%, based on a population-based nested case-control study of >4million Brits age ≥50 years (1988–2017). No data was reported on asymptomatic HPI. Not sure that it would change my mgmt. because I am investigating and treating symptomatic HPI anyway. Moreover, the association is weak with OR 1.11, while an OR of >2 is considered significant in observational studies as this.
This study used simulation and modeling in vitro and estimated the risk of arrhythmias with escitalopram and citalopram 10 mg in older adults >65 to be 20% and for 20 mg to be 60%. This was based on serum concentrations that should be kept below 100 nM of the active drugs and was not associated with metabolites. I have not seen arrhythmias in my patients on these meds, and previous studies have shown that citalopram reduced events compared to Zoloft: Ventricular arrhythmias (HR =0.68, 95% CI=0.61–0.76) All cause mortality (HR=0.94, 95% CI=0.90–0.99). And compared to placebo: Major acute coronary events 40.9% vs. 53.6% (HR, 0.69; 95% CI, 0.49-0.96; P = .03) and MI, 8.7% vs 15.2% (HR, 0.54; 95% CI, 0.27-0.96; P = .04). The mechanism is theorized to be due to serotonin promoting clot formation and SSRIs block the pump that the platelet needs to collect serotonin. We should treat depression, but use the lowest dose necessary.
This Cochrane review about the effects of corticosteroids given orally during an acute herpes zoster infection on preventing postherpetic neuralgia found little to no difference but follow up was short. Future trials should include measurements of function and quality of life, as well as updated measures of pain and long-term follow up.
A meta-analysis of 7 randomized controlled trials (RCT) showed an 11% decrease in the death risk at 1 month after tranexamic acid use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84 to 0.95) with a number needed to treat of 61 to avoid 1 additional death. It reduced 24-hour mortality (OR 0.76, 95% CI 0.65 to 0.88) without increased vascular occlusive events (OR 0.96, 95% CI 0.73 to 1.27). Subgroup analyses showed TXA's effectiveness in general trauma versus traumatic brain injury and survival advantages when administered out-of-hospital versus inhospital.
Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, the postmenopausal women who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years aHR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years aHR, 1.68 [95% CI, 1.03-2.75]; P = .04) over 20 years in. No statistical difference was found for artificially sweetened beverages.
Among individuals living alone, pet ownership was associated with slower rates of decline for composite verbal cognition (β = 0.023 SD/year), verbal memory (β = 0.021 SD/year), and verbal fluency (β = 0.018 SD/year). But associations did not persist among those living with others.
Private equity acquisition of hospitals was associated with increased hospital-acquired adverse events, including falls, central line–associated bloodstream infections and much more.
