Geriatric Update Mar 3, 2025

IV thrombolysis for ischemic stroke beyond 4.5 hours, increased excellent (OR 1.43, 95% CI, 1.17-1.75) and good functional outcomes (OR, 1.36, 95% CI, 1.12-1.66) compared with standard medical care, but increased symptomatic intracerebral hemorrhage (OR, 4.25, 95% CI, 1.67-10.84), and difference in mortality.

Among 20,167 British patients (median age 81 years), non-exposure to anticoagulation was associated with higher risks of stroke (HR 3.07, 95% CI 2.39 to 3.93), myocardial infarction (HR 1.85, 95% CI 1.34 to 2.56) and death (HR 2.87, 95% CI 2.63 to 3.12) compared with exposure. Compared with warfarin, apixaban was associated with lower risks of non-major bleeding (HR 0.73, 95% CI 0.64 to 0.85), whereas rivaroxaban was associated with higher risks of major (HR 1.33, 95% CI 1.15 to 1.55) and non-major (HR 1.29, 95% CI 1.16 to 1.44) bleeding. This confirms the Beers Criteria recommendation of apixaban over warfarin and to avoid rivaroxaban. 

Participants with high adherence to the Mediterranean Diet (7-9 points) had a lower risk of obesity related cancers compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). The mechanism is thought to be due to the high fiber, antioxidants and phytochemicals because participants had no weight loss. 

In grocery stores, 71% of products were classified as ultra-processed. 

Microplastic altered the response of airway epithelial cells in obstructive lung diseases and asthma differently than in controls. In lung disease tissue, microplastics stimulate inflammation via Type 2 helper T (Th2) cells, a subset of CD4+ T cells, and 8 different inflammatory cytokines, leading to stress response modulation, and carcinogenesis, compared to only IL-8 in healthy controls.

Compared with non-use, the greater the dose of antidepressants, the greater cognitive decline and higher risks of dementia, all-cause mortality, and fracture were observed. Mirtazapine had the greatest correlation.

Antidepressants at clinically relevant concentrations induce resistance to multiple antibiotics, even following short periods of exposure. The mechanism may be through enhanced production of reactive oxygen species following exposure to antidepressants that was directly associated with increased resistance. Another reason to exercise for depression and deprescribe when antidepressants are not effective.

Changing dual antiplatelet therapy (DAPT) to ticagrelor monotherapy after 3 months showed no difference vs. DAPT in ischemic outcomes (1.7% vs. 2.1%; hazard ratio [HR], 0.85 [95% CI, 0.63 to 1.16]), with lower bleeding rates (0.8% vs. 2.5%; HR, 0.30 [CI, 0.21 to 0.45]), in patients with STEMI, NSTEMI, and unstable angina from 3 randomized controlled trials.

The brain endothelial glycocalyx was found to be highly dysregulated during ageing and neurodegenerative disease, especially the O-glycosylated proteins known as mucin-domain glycoproteins, leading to dysregulated blood brain barrier (BBB) function and, in severe cases, brain hemorrhaging. The researchers improved BBB function and reduced neuroinflammation and cognitive deficits in aged mice by restoring core 1 mucin-type O-glycans to the brain endothelium using adeno-associated viruses.