Geriatric Update Jan 27, 2025

COVID is associated with an increased risk of diabetes. The mechanism is thought to be due to islet vascular dysfunction. 

The US Food and Drug Administration (FDA) declined to approve sotagliflozin (Zynquista) as an adjunct to insulin therapy for people with type 1 diabetes (T1D) and chronic kidney disease (CKD).

The FDA expanded approval for ketamine nasal spray (Spravato), to allow it to be used as a standalone treatment for patients with severe depression.

Based on claims data of an increased risk of Guillain-Barré Syndrome during the 42 days following RSV vaccination, the FDA added a warning. An estimated 9 excess cases of GBS per million doses of Abrysvo, and an estimated 7 excess cases of GBS per million doses of Arexvy administered to individuals aged 65 years and older.

Antivirals for influenza had little effect. In a systematic review and network meta-analysis of 73 trials involving 34 332 participants, baloxavir has not reduced the risk of admission to hospital for high-risk patients (RD, −1.6%; 95% CI, −2.0 to 0.4; low certainty), probably reduced time to alleviation of symptoms  (mean difference [MD], −1.02 days; 95% CI, −1.41 to −0.63, and did not increase adverse events related to treatment, but might have increased emergence of resistance. Oseltamivir had little or no effect on mortality and admission to hospital (risk difference [RD], −0.4%; 95% CI, −1.0 to 0.4; high certainty), likely had no important effect on time to alleviation of symptoms, and likely increased adverse events related to treatments.

Cases of dementia will double by 2060 because of longevity and risk factors (obesity, diabetes, hypertension, inactivity…), and triple for Blacks. With lifetime risks ranging from approximately 45% to 60%.

Mild and reversible acute kidney injury (AKI) was tied to an increased risk for probable dementia (hazard ratio, 1.72; 95% CI, 1.07-2.75) and mild cognitive impairment in 8148 older adults with high cardiovascular risk and mild cognitive impairment (1.43 [1.01-2.04]) in the SPRINT trial. Dehydration is the most common cause of AKI, especially in older adults.

The MIND study showed benefit from mild cognitive impairment with BP control of <120 mmHg vs. <140 mmHg but was stopped early because of overwhelming benefit. This follow-up study of 7 years, 248 participants of the intensive treatment group (8.5 per 1,000 person-years) were adjudicated with probable dementia, compared with 293 participants (10.2 per 1,000 person-years) in the standard treatment group (hazard ratio [HR] = 0.86; 95% confidence interval [CI], 0.72-1.02). Consistent with earlier results from the trial, the rate of both mild cognitive impairment (HR = 0.87; 95% CI, 0.76-1.00) and a composite of mild cognitive impairment or probable dementia was lower with intensive treatment (HR = 0.89; 95% CI, 0.79-0.99).

Antimicrobials, vaccinations, and anti-inflammatories were associated with reduced dementia risk, whereas vitamins, supplements, and antipsychotics were associated with an increased risk (Vitamin B-12 may have been found deficient and started during dementia work-up). Medications linked to an increased dementia risk were intended to treat conditions of cardiovascular disease, diabetes, depression, neurodegenerative diseases, dementia symptoms, dyspepsia and gastroesophageal reflux disease, nausea and vertigo, laxatives, proton pump inhibitors, hypnotics, anxiolytics, analgesics, anticonvulsants, drugs used in substance abuse, and drugs for genitourinary disorders.

After embolic stroke, Intra-arterial tenecteplase after endovascular thrombectomy showed no difference in freedom from disability (a modified Rankin Scale score of 0 or 1) at 90 days in 49.1% of 540 patients compared with 44.1% of patients not treated with intra-arterial thrombolysis (adjusted risk ratio, 1.15 [95% CI, 0.97-1.36]; P = .11).

Similar results were found for urokinase administered after near-complete to complete reperfusion by endovascular thrombectomy, with 45.1% of 534 patients in the intra-arterial urokinase group and 40.2% in the control group that did not receive intra-arterial thrombolysis (adjusted risk ratio, 1.13 [95% CI, 0.94-1.36]; P = .19).

Of 7 frailty screening instruments, none exceeded the areas under the receiver operating characteristic curve (AUC) of 0.61 for adverse postoperative outcomes in patients aged >70 years undergoing colorectal surgery. Frailty screening cannot be used in isolation as risk predictor for adverse postoperative outcomes. (An AUC of 0.5 is like a coin toss, and 1.0 is perfect predictability).

The Walter Index includes ADLs, CHF, albumin and creatinine, and has higher net benefit than the Charlson Comorbidity Index by more correctly identifying hospitalized patients at risk of mortality while minimizing unnecessary interventions for those not at risk. Adding delirium to the Walter Index, which was not accounted for in the original model, marginally yet significantly improved 12-month mortality discrimination.

After hospitalization for COVID, Black individuals were more likely to experience long-term nursing home stay or death (adjusted odds ratio [aOR], 1.33; 95% CI, 1.30-1.37; P < .001) than non-Hispanic White individuals (72 years old), while Asian or Pacific Islander (aOR, 0.79; 95% CI, 0.75-0.83; P < .001), Hispanic (aOR, 0.72; 95% CI, 0.70-0.74; P < .001), and American Indian or Alaska Native (aOR, 0.79; 95% CI, 0.72-0.87; P < .001) individuals were less likely to experience long-term NH stay or death.

This NY Times article describes human metapneumovirus, one of the respiratory viruses transmitted by droplet and contact, like flu. However, it causes milder infections that do not usually lead to death, and it currently has no treatment or vaccine. 

In a new scientific statement, the American Heart Association endorses palliative care to aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. Although, such care is often underused, it can help in all stages of stroke and should include strategies to improve communication about prognosis and goals of care, address psychosocial needs such as coping with loss, navigating complex health care systems, and preparing for death when necessary.

Patients with low-risk differentiated thyroid cancer show similar outcomes after 5 years regardless of whether they received radioactive iodine following total thyroidectomy. The proportions of the 776 patients, age 53, without events were 93.2% in the no-radioiodine group and 94.8% in the radioiodine group, for a difference of –1.6% (90% CI –4.5 to 1.4). 

Veterans Affairs study looked for a relationship between GLP-1 weight-loss drugs and 175 diseases and conditions, in the analysis of medical records from about 2.5 million veterans with diabetes. GLP-1 drugs support benefits in Alzheimer’s disease, schizophrenia and substance abuse involving alcohol, cannabis and narcotics.

Today is the 80th anniversary of the liberation of Auschwitz concentration camp.  May we learn from history and never repeat atrocities against any fellow human being.