Geriatric Update Jan 20, 2024

The Centers for Disease Control and Prevention (CDC) recommends a shortened timeline for subtyping all influenza A specimens among hospitalized patients to identify avian influenza A (H5N1) viruses and expedite treatment, which is oseltamivir, as is for any other influenza A.

Office or tele- visits within 7 days of hospital discharge were not associated with reductions in 30-day emergency department use or readmissions compared with usual care, based on a meta-analysis of  13 studies (11 randomized trials, 12 delivered visits via telephone). Three of 11 RTs were rated as having low risk of bias , with 1 rated high. Most PDC interventions (n = 10) consisted of single telephone contacts, often within 3 days. The study did not identify if visits were with the patient’s primary care physician.

Zoledronic acid, or zoledronate is a long acting bisphosphonate for osteoporosis that reduced fractures for 10 years in 1054 women with a mean age of 56.0 years at baseline. A new morphometric (on x-ray) fracture occurred in 22 women (6.3%) in the group that received zoledronate at baseline and 5 years, in 23 women (6.6%) in the group that received zoledronate at baseline and placebo at 5 years, and in 39 women (11.1%) in the placebo only group. The relative risk of fractures were reduced between 21% and 44% compared to placebo, depending how they are measured, with little difference between 5 or 10 year intervals since administration.  

Participants who eat processed red meat ≥0.25 servings per day (1 serving is 3 ounces), compared with <0.10 serving per day, had a 13% higher risk of dementia (hazard ratio [HR] 1.13; 95% CI 1.08–1.19) and a 14% higher risk of subjective cognitive decline (SCD) (relative risk [RR] 1.14; 95% CI 1.04–1.25). Higher processed red meat intake was associated with accelerated aging in global cognition (1.61 years per 1 serving per day increment) and in verbal memory (1.69 years per 1 serving per day increment). Unprocessed red meat intake of ≥1.00 serving per day, compared with <0.50 serving per day, was associated with a 16% higher risk of SCD (RR 1.16; 95% CI 1.03–1.30). Replacing 1 serving per day of nuts and legumes for processed red meat was associated with a 19% lower risk of dementia (HR 0.81, 95% CI 0.75–0.86), 1.37 fewer years of cognitive aging (95% CI −2.49 to −0.25), and a 21% lower risk of SCD (RR 0.79, 95% CI 0.68–0.92). The mechanism is through inflammation, reduced short chain fatty acids, a leaky mucosa, and gut microbiome production of trimethylamine N-oxide (TMAO) that has been associated with cardiovascular disease. 

Among 901 patients with asymptomatic severe aortic stenosis, age 75.8 years, early transcatheter aortic-valve replacement (TAVR) was superior to clinical surveillance in reducing the incidence of death 8.4% vs. 9.2%, stroke 4.2% vs. 6.7%, or unplanned hospitalization for cardiovascular causes 20.9% vs. 41.7%. Over 3.8 years, 87.0% of patients in the clinical surveillance group underwent aortic-valve replacement. 

The U.S. Food and Drug Administration (FDA) approved generic Victoza (liraglutide injection) 18 milligram/3 milliliter, a glucagon-like peptide-1 (GLP-1) receptor agonist. Last month the GLP-1 exanatide was the first generic in class to get approved. 

The FDA has issued a proposed rule on a front-of-package nutrition labeling that could help consumers quickly and easily identify how foods can be part of a healthy diet with information on saturated fat, sodium, and added sugar content of a food as “Low,” “Med,” or “High.”

Synovial fluid dual‐biomarker algorithm, using cartilage oligomeric matrix protein and Interleukin-8 concentrations, accurately differentiates osteoarthritis from inflammatory arthritis.

Although women are 6 times more likely to develop gliomas than men, there does not appear to be an association between glioma and hormone therapy use in postmenopausal women, (hazard ratio [HR] = 1.16; 95% confidence interval [CI], 0.75-1.81) or duration of use.

Compared with children without obesity at the time of initial cancer diagnosis, those with obesity had lower rates of 5-year event-free survival (77.5% vs 79.6%) and overall survival (83.0% vs 85.9%). Adverse prognostic impact of obesity was particularly notable for acute lymphoblastic leukemia (ALL) event survival (aHR = 1.55; P = .002) and overall survival (aHR = 1.75; P = .002) and central nervous system (CNS) tumors, event-free survival (aHR = 1.38; P = .008) and overall survival (aHR = 1.47; P = .004).

The root of joy is gratefulness. It is not joy that makes us grateful, it is gratitude that makes us joyful. (Father David Steindl-Rast)