Geriatric Update July 22, 2024

Postexposure prophylaxis with nirmatrelvir–ritonavir (Paxlovid) for 5 or 10 days did not significantly reduce the risk of symptomatic SARS-CoV-2 infection, in this placebo-controlled trial of 2736 participants: COVID developed by day 14 in 2.6% of the participants in the 5-day nirmatrelvir–ritonavir group, 2.4% of those in the 10-day group, and 3.9% in the placebo group. 

A pro-fibrotic monocyte-derived macrophage response seems to be responsible for long COVID in respiratory post-acute sequellae of COVID (PASC).  As well as abnormal interactions between pulmonary macrophages and respiratory resident T cells, in both humans and mice. Interferon-γ (IFN-γ) emerged as a key node mediating the immune anomalies in respiratory PASC. Neutralizing IFN-γ after the resolution of acute SARS-CoV-2 infection reduced lung inflammation and tissue fibrosis in mice.

The adjusted relative incidence of acute myocardial infarction during 1 year after influenza infection compared with 1 year before was 6.16 (95% confidence interval [CI], 4.11 to 9.24). The relative incidence of acute myocardial infarction in individuals without prior hospitalization for coronary artery disease was 16.60 (95% CI, 10.45 to 26.37) compared with 1.43 (95% CI, 0.53 to 3.84) for those with prior admission for coronary artery disease. While I would have liked to have seen if flu vaccine was protective, this information was not obtainable in the Dutch database that was analyzed.

This study showed that higher major bleeding (hazard ratio [HR], 1.57; 95% CI, 1.04-2.38; P = .03) and higher gastrointestinal bleeding (HR, 2.24; 95% CI, 1.29-3.90; P = .004) with edoxaban, 60 mg vs. 30 mg in 2966 patients >80 years with atrial fibrillation, without an offsetting increase in ischemic events.

Average annual exposure to these air pollutants – particulate matter <2.5 μm and <10 μm, nitrogen dioxide, and any nitrogen oxide species, was associated with increases of 19% - 47% in risk for incident psoriasis for each step up in quartiles of exposure.

Although I learned in medical school that statins were hepatotoxic, and tested liver functions in patients before starting statins, this study using real-world data did not show that. However, they found 17 other medications: >10 hepatotoxic events per 10,000 person years:, stavudine, erlotinib, lenalidomide or thalidomide, chlorpromazine, metronidazole, prochlorperazine, and isoniazid. 5-9.9 events per 10,000 person years for: moxifloxacin, azathioprine, levofloxacin, clarithromycin, ketoconazole, fluconazole, captopril, amoxicillin-clavulanate, sulfamethoxazole-trimethoprim, and ciprofloxacin.

Medication use for alcohol use disorder (oral naltrexone, acamprosate, or disulfiram) after hospitalization, led to 51% reduction of alcohol related rehospitalization in 6794 individuals representing 9834 alcohol-related hospitalizations, median age, 54.

At week 8, more of the 60 patients randomized to acupuncture reduced their methadone dose 20% or more than the 58 with sham acupuncture (37 [62%] vs. 16 [29%]; risk difference, 32% [97.5% CI, 13% to 52%]; P < 0.001). In addition, acupuncture was more effective in decreasing opioid craving than sham acupuncture with a mean difference of −11.7 mm VAS (CI, −18.7 to −4.8 mm; P < 0.001).

A high-fiber diet (46.3-47.9 grams daily) affects small intestine metabolism, spurring release of the appetite-suppressing gut hormone peptide tyrosine tyrosine (PYY) more than a low-fiber diet (12.6 grams daily), and it does so regardless of the food's structure. The mechanism is through the slower release of metabolites in the gut that stimulate PYY, prolonging its appetite suppression. 

A meta-analysis of 7 of 2160 studies with a total of 25,916 (78.2%) participants showed no benefit of vitamin D for fracture prevention. While the average daily dose equivalent of vitamin D was >1500 IU 6 of the 7 trials used monthly or annual doses of vitamin D. Prior studies showed no benefit from vitamin D <800 IU and increased risk with monthly and yearly intermittent dosing.  I am not surprised at the findings and don’t find it valid, given the small number of trials selected.  I still recommend my patients >50 years old take a multivitamin for seniors daily to prevent vitamins D and B-12 from drifting down over time as absorption and conversion by sunlight decreases as we age..

Daily antioxidant vitamins and minerals slowed the progression of late-stage dry age-related macular degeneration in participants with “geographic atrophy“ far from the fovea, by slowing the expansion rate toward the central foveal region by about 55% over 3 years.

Reaching age 65 and qualifying in Medicare was associated with an increase of $23.04 in mean quarterly out-of-pocket costs for T2D drugs, including an increase of $56.36 at the 95th percentile of spending, after utilization adjustment. At that age, utilization decreased by 5.3 percent (3.40 claims per quarter to 3.22 claims per quarter). A shift in utilization composition showed increased insulin use, which was associated with additional increases in patient costs. I would be interested in seeing how the trend was compared to before the availability of insurance through the Affordable Care Act, and before Medicare Part D implementation, and ultimately how this affects cardiovascular outcomes.

The Kaiser Family Foundation analyzed daily payroll-based journal data (PBJ) from nursing homes, covering the final three months of 2023 and totaling 1.3 million records and found no improvement in quality of care with increased staffing, based on states with stringent nursing home staffing requirements: California, Florida, Massachusetts, New York, and Rhode Island. The biggest problem is staff turnover and open positions. 

This is an excellent TedTalk on artificial intelligence (AI) regulation.