Geriatric Update March 11, 2024
Sorry for the late sending. I was at the AMDA meeting, which was renamed to PALTC a few years ago, and this year got a new name: Post-acute and Long-term Care Medical Association (PALTMed), much easier to pronounce.
Paxlovid is underused, especially by nursing home patients, only 1 in 6 get it. Part of it may be hospice status, another is family declines use as we have to get permission, and for community living patients a reason may be the cost of >$1400. The Pfizer Paxlovid website has options to help with cost.
The new hip osteoarthritis guidelines are out. Here I summarized those that are actionable for geriatricians and primary care:
For patients with mild-to-moderate symptomatic osteoarthritis of the hip, PT may be considered as a treatment measure to improve function and reduce pain.
For patients with symptomatic osteoarthritis of the hip, intra-articular corticosteroids (not hyaluronic acid) may be considered as a means of achieving short-term improvement of function and reduction of pain.
In older adults who are undergoing THA for symptomatic osteoarthritis of the hip, cemented femoral stems may be considered, being associated with a lower risk of periprosthetic fracture.
Norovirus is highly infectious and as few as 10 particles can cause the symptoms. A mutation in a gene called FUT2, in 20% of European descendants, prevents infection to the 29 most common norovirus strains. People with the mutation lack an enzyme necessary for the production of an oligosaccharide (H1-antigen) in the mucosa that the virus needs to infect the person.
Microplastics and nanoplastics (MNP) such as polyethylene and polyvinyl chloride were detected in carotid artery plaque of 150 of 304 patients (58.4%). Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris.
Patients in whom MNPs were detected within the atheroma were at >4 times higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001).
We may want to take the veggies out of the plastic bag before microwaving them, or better yet, get them through a community shares agriculture (CSA) box.
The FDA approved the GLP-1 agonist semaglutide (Wegovy) to reduce risk of serious heart problems specifically in adults with obesity or overweight.
A nested case-control study of Alzheimer's disease biomarkers in cognitively normal Chinese participants who were followed for 20 years, showed early divergence of cerebrospinal fluid (CSF) amyloid decline at 20 years before diagnosis, and CSF p-tau and t-tau rise around 18 years before. Hippocampal volume loss occurred about 10 years and cognitive testing scores (CDR-SB) declined about 8 years before diagnosis.
However, amyloid does not predict cognitive decline, and removing amyloid has not shown to preserve cognition. Eric Widera, the host of GeriPal podcast wrote a commentary in the Journal of the American Geriatrics Society about the recent decision to revise the Alzheimer’s Association decision to base the diagnosis on abnormal accumulation of amyloid, regardless of current or future cognitive function. He points out potential conflict of interest, and shows in a graph that the board that made the decision, consists of 31% industry employees, 32% had significant conflict of interest and 27% did not disclose their conflict. The remaining 9% were Alzheimer’s Association employees and NIA advisors in equal number.
Of 272 French patients ≥65 years consecutively hospitalized, 78 with vitamin D deficiency (≤25 nmol/L = 10 ng/ ml) had worse scores on agitation, disinhibition and aggressiveness (p = 0.02) than those without vitamin D deficiency (n = 194). Remember to avoid intermittent high dose vitamin D as monthly and yearly supplementation have increased fractures and falls, but daily administration reduced them.
Over long-term (>20 years), a randomized study of Vitamin D and calcium supplementation vs placebo, increased cardiovascular (CVD) by 6% and decreased cancer mortality by 7% in >36,000 postmenopausal women.
Becker’s Hospital Review listed 13 healthcare takeaways in Biden's State of the Union address, and 16 healthcare takeaways from the budget.
In 54 veterans, age 45.7 years, with PTSD, transcranial direct current stimulation (tDCS) compared to sham, led to a large reduction in self-reported PTSD symptom severity at 1 month (t = −2.27, P = .02; Cohen d = −0.82) and objective reductions in pathological arousal. Both groups improved without difference between groups in depression, quality of life and function.
A diet high in solid fats, refined grains, and cheese showed 4 times the risk of pre-eclampsia over a diet high in fruits, vegetables and oils (OR, 4.10 [95% CI, 1.25–13.5]). This was more pronounced in pre-pregnancy overweight women.
Nirsevimab, a long-acting monoclonal antibody against RSV, for infants aged <8 months showed 90% efficacy in preventing hospitalization, the most common reason for hospitalization in this age group.
