Geriatric Update Jan 6, 2024
A breakfast containing 20−30% of total caloric intake was linked to lower values of body mass index, waist circumference, triglycerides, and higher HDL-C concentrations, and a high-quality breakfast was associated with healthier values of the same and kidney function.
Metered-dose inhaler budesonide-glycopyrrolate-formoterol (Breztri Aerosphere) was associated with a higher risk of a first moderate or severe COPD exacerbation...compared with the dry-powder competitor fluticasone-umeclidinium-vilanterol (Trelegy Ellipta) over median follow-ups of 88 and 113 days, respectively, in a propensity score-matched analysis of claims data from the US in moderate and severe COPD exacerbations.
Procalcitonin (PCT) reduced the need for antibiotic use from 10.7 [SD, 7.6] days to 9.8 [SD, 7.2] days for hospitalized critically ill adults with suspected sepsis, but monitoring C-reactive protein (CRP) had no effect.
People with severe, treatment-resistant depression who received electrical vagus nerve-stimulating therapy showed significant improvement in depressive symptoms, quality of life, and ability to complete everyday tasks after 1 year. The device used: output current (minimum 1.0 mA), frequency (20 Hz), pulse width (250 μs), ON time (30 s), OFF time (5 min), and magnet output current (0 mA). I would like to see a study of vagus nerve stimulation with deep breathing exercises as part of mindfulness.
Metformin reduced infarct size in stroke with use, especially when administered early in patients with pre-diabetes or diabetes. The mechanism of action involves the inhibition of complex I of the mitochondrial respiratory chain, which indirectly activates adenosine monophosphate–activated protein kinase. This, in turn, results in a reduction of intestinal glucose absorption, inhibition of hepatic glucose production, and an increase in insulin sensitivity.
A Cochrane review showed that a lower BP target in older adults to <140 mmHg reduces stroke, and serious cardiovascular events compared to <150 to 160/95 to 105 mmHg.
A meta-analysis showed no benefit of aortic valve replacement versus clinical surveillance in patients with asymptomatic severe aortic stenosis, in cardiovascular and all-cause mortality; however, early aortic valve replacement was associated with a reduced risk of cardiovascular-related or heart failure hospitalization (HR, 0.40) and stroke (HR, 0.62).
Increasing exercise frequency and duration were associated with a decreased risk of accelerated aging, with the greatest benefit observed in individuals who exercised for 5 days per week for a total of at least 3 hours per week.
Among healthy, physically active older adults, age 75 years, appendicular lean muscle mass index and incidence of sarcopenia were not improved by treatment of daily 2000 IU vitamin D, daily 1 g omega-3s, or a simple home exercise program compared with control over 3 years.
Weekly moderate and long-duration exercise were negatively associated with accelerated aging. The mechanism of action is through: anti-inflammatory response, primarily mediated through IL-6 produced by muscles. Furthermore, changes in the DNA methylation patterns of skeletal muscle in the elderly due to lifelong exercise may enhance energy metabolism and muscle function, revealing the molecular mechanisms which exercise promotes healthy aging. The enhanced antioxidant capacity due to exercise helps neutralize age-related oxidative stress and reduce inflammation, further blocking key pathological pathways in the aging process.
Among adults with overweight or obesity, each 30 minutes per week of aerobic exercise was associated with reduced body weight (0.52 kg), waist circumference (0.56 cm), body fat percentage (0.37 percent), and the areas of visceral and adipose subcutaneous tissues (mean differences, −1.60 and −1.37 cm2, respectively) in a meta-analysis of randomized clinical trials.
Plasma proteins were used to monitor organ health. Organ age estimates are associated with future onset of heart failure (heart age HR=1.83), chronic obstructive pulmonary disease (lung age HR=1.39), type II diabetes (kidney age HR=1.58), and Alzheimer’s disease (brain age HR=1.81) and sensitive to lifestyle factors such as smoking and exercise, hormone replacement therapy, or supplements. Remarkably, the accrual of aged organs progressively increases mortality risk while a youthful brain and immune system are uniquely associated with disease-free longevity.
6-month sedentary behavior reduction intervention prevented worsening of back pain and related disability outcomes, and improved paraspinal muscles (ie, erector spinae and transversospinales separately) insulin sensitivity, glucose uptake, and muscle fat fraction compared to controls who worsened.
Surgeon General Murthy said in an advisory: Alcohol consumption contributes to 100,000 cancer cases and 20,000 related deaths each year.
My Top Story of 2024 in Primary Care addresses that altered mental status in older adults is not always a urinary tract infection (UTI) and discusses approaches with families and patients.
Irene
