Geriatric Update Mar 24, 2025
Ohio has its first case of measles, an unvaccinated adult who had contact with an infected traveler. Nationally the cases are up to 378 confirmed cases in 18 states.
Measles virus (MV) causes immune amnesia. It actually replaces the old memory cells of its host with new, MV-specific lymphocytes. As a result, the patient emerges with both a strong MV-specific immunity and an increased vulnerability to all other pathogens. This lasts on average 27 months, up to 5 years. Studies before and after the launch of measles vaccine showed a dramatic drop in childhood deaths from other illnesses because children were not susceptible to other diseases they had already had.
A website filled with false and misleading vaccine claims was created at realcdc[.]org by an NGO led by the current HHS Secretary until December 2024, to look like the CDC website. To prevent from adding clicks to the imposter, I have hyperlinked this article comparing the two sites with screenshots. This raises serious health concerns for the public and legal concerns under federal impersonation statutes. We will see if the HHS Secretary will address this in the next few days.
Use of donepezil (Aricept), an acetylcholinesterase inhibitor, for 3 weeks failed to demonstrate efficacy in treating fatigue and psychological symptoms of long COVID in a Japanese randomized trial. Secondary outcomes including depression, anxiety, and quality of life scores at 3 and 8 weeks were also not different.
PET scans have shown high glucose uptake in the rectal region, similar to the brain. To see if defecation improves brain function, they had 13 elite tri-athletes complete the Stroop test an executive function test of identifying the color of the text, even though it may read a different color. Participants completed the Stroop test more quickly after defecating compared to when they had not, 27.1 seconds vs. 24.4 seconds after voluntary defecation, and 23.4 seconds after magnesium-induced defecation. (Prevagen's active ingredient is magnesium).
Non-steroidal anti-inflammatory drug (NSAID) use was associated with 12% lower dementia risk for long-term (>24 months) users (hazard ratio [HR] = 0.88; 95% confidence interval [CI], 0.84-0.91), and an increased risk with <24 months use (HR = 1.04; 95% CI, 1.02-1.06). The authors do not recommend of long-term treatment with NSAIDs for the prevention of dementia, given its potential adverse effects. I agree, given the small and inconsistent observational result, and NSAIDs are on the Beers list because of renal-, heart failure and stroke risk due to blocking vasodilatory effects of prostaglandins.
The amyloid cascade hypothesis is among the most well-supported in neurology research. Amyloid facilitates phosphorylation of tau leading to neurofibrillary tangles and the associated characteristic MRI findings and physical symptoms of Alzheimer's disease. The newer anti-amyloid meds donanemab and lecanemab have been shown to slow the decline of cognitive testing and function. While statistically significant, which led to FDA approval, they may not be clinically significant, which requires a 10% difference in tests. E.g. The Clinical Dementia Rating - Sum of Boxes is an 18 point test and would require a 1.8 point difference to be clinically significant, yet in the study only had a 0.05 point difference from the placebo group over 18 months.
Long-term removal of amyloid beta with gantenerumab in people genetically destined to develop Alzheimer’s disease did not reach statistical significance in clinical dementia findings, but may provide a hint that early treatment and amyloid plaque removal in asymptomatic Alzheimer’s disease might delay symptoms and reduce the risk of progression.
Dementia caregiving education and integrating 4 of 5 tested psychosocial components: self-care skills, behavioral problem management, mindfulness-based intervention, and support group but not behavioral activation was an effective multicomponent approach to support caregivers with depression and caregiving burden, although ongoing support was needed to mitigate potential short-term risks.
In patients with peripheral artery disease, high intensity exercise increased the 6-minute walk test compared to control (+44.8 meters (95% CI:21.7,68.0) and compared to low-intensity exercise (+37.6 meters [95%CI:18.6,56.5]), low intensity exercise had no significant benefit vs. control (+7.3 meters [95% CI:-16.3,30.9]). But for subjective patient-oriented outcome measures no difference was seen of high vs. low intensity exercise.
The Glucagon-like peptide 1 receptor agonist (GLP-1) Tirzepatide produced a comprehensive improvement in heart failure across multiple complementary domains; enhanced health status, quality of life, functional capacity, exercise tolerance, and well-being; and reduced symptoms and medication burden in patients with heart failure with preserved ejection fraction and obesity vs. placebo over 12 months in patients avg 62 years old, and BMI 38.
GLP-1 receptor agonists were significantly associated with a reduced risk of all kidney outcomes (OR, 0.85 [95% CI, 0.77-0.94] in a meta-analysis of RCTs with 17,996 participants of baseline eGFR<60mL/min/1.73m2. CV outcomes were also lower (OR, 0.86 [95% CI, 0.74-0.99], P=0.03; I2=40.3%), as was all-cause mortality (OR, 0.77 [95% CI, 0.60-0.98], P=0.03).
GLP-1 meds also reduced long-term risk of major adverse liver-related outcomes by a fourth, better than other diabetes meds, in a meta-analysis of observational studies.
GLP-1 meds were linked to a 54% lower risk for developing hematologic cancers than insulin in patients with type 2 diabetes (T2D). The greatest reduction was for myelodysplastic syndromes of GLP-1 compared with insulin therapy (HR, 0.19; 95% CI, 0.11-0.35; P < .001) and for myeloproliferative neoplasms (HR, 0.50; 95% CI, 0.41-0.61; P < .001) and lower risk than metformin for myelodysplastic syndromes (HR, 0.61; 95% CI, 0.42-0.89; P = .01) and myeloproliferative neoplasms (HR, 0.67; 95% CI, 0.52-0.87; P = .002). Metformin alone has been reported to reduce the risk of cancer by up to 23% worldwide, a video in the article explains the mechanism.
Older adults are at higher risk of heat stroke due to dehydration and fewer, less efficient sweat glands in the skin. Active cooling measures are recommended over passive cooling methods, with cold- or ice-water immersion achieving the fastest cooling rate. Here are the guidelines’ good practice statements. Clinicians should:
Prioritize cooling methods that achieve the most rapid rate of cooling, which is ice-water immersion (1–5°C) or cold-water immersion (9–12°C).
Use similar cooling strategies for either classic or exertional heat stroke.
Choose cooling methods that reach the target temperature within 30 minutes from recognition of heat stroke symptoms.
Prioritize cooling modalities that achieve a cooling rate greater than or equal to 0.155°C/min.
Not use dantrolene in patients with heat stroke (strong recommendation, very low certainty of evidence).
Avoid the routine use of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), and salicylates for temperature reduction.
Use prophylactic antibiotics or prophylactic antiseizure medications only in the context of research.
Oral cholecalciferol 100,000 IU every 2 weeks for 24 months in early (<90 days) relapsing-remitting multiple sclerosis improved disease activity in 94 French patients (60.3%) in the vitamin D group and 109 patients (74.1%) in the placebo group (hazard ratio [HR], 0.66 [95% CI, 0.50-0.87]; P = .004), and median time to disease activity was longer in the vitamin D group (432 vs 224 days; log-rank P = .003). New and/or contrast-enhancing lesions on MRI showed significant differences favoring the vitamin D group vs the placebo group.
Clinician educational intervention studies showed a 19% reduction in potentially inappropriate medication (PIM) prescribing (OR, 0.81 [95% CI, 0.68-0.96]; P = .02) in a systematic review and meta-analysis of 25 eligible studies with 44,640 participants. Two computerized CDSS studies showed a 40% reduction in PIM ordering (OR, 0.60 [95% CI, 0.48-0.74]; P < .001). However, targeting fall risk–increasing drugs were not associated with reduced falls in older adults.
A 2024 US study of >430,000 respondents found that 4% of respondents with daily cannabis use had a 49% increased risk for myocardial infarction and a twofold increased risk for stroke.
Microplastics are all over the planet. They have made their way up food chains, accumulated in oceans, clustered in clouds and on mountains, and been found inside our bodies at alarming rates. Bacteria, E. coli, exposed to microplastics became resistant to multiple types of antibiotics commonly used to treat infections. The mechanism is through biofilms on microplastics, compared to other surfaces like glass, are much stronger and thicker, causing a hugely higher rate of antibiotic resistance on the microplastic compared to other materials. The researcher performed the experiments multiple times, testing different combinations of antibiotics and types of plastic material, each time, the results remained consistent.
Dengue fever cases increased among U.S. travelers by 84%, a total of 3,484, compared to the year before. It is transmitted by mosquitoes, mainly in tropical and subtropical areas of the world, including Mexico, the Caribbean and South America, in addition to Southeast Asia.
Immigrants comprise a large segment of health care employment. According to labor market data, roughly one-quarter of practicing physicians are non–US born, as are 16% of registered nurses. Immigrants account for an even larger share of employment among low-wage health care workers, including 40% of home health aides, 28% of personal care aides, and 21% of nursing assistants. The immigrant share of these occupations has been increasing over time because US-born individuals are less likely to do these jobs at the current rates of pay.
This Thursday 8 am OMDA presentation is: “Oral Health of Individuals in Hospice Care” by Leonard Brennan, DMD
Thank you, Dr. Mitro for the opportunity to give a lunch presentation on Thursday on “Normal Aging Changes” to the UC Alumni Association. Meeting ID: 878 1074 3995 Passcode: 957593
