Geriatric Update March 25, 2024

The online supervised group physical and mental health rehabilitation program for British adults with post-covid-19 condition (REGAIN RCT), improved depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P<0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02).

Healthcare claims data compared 77,272 patients who were hospitalized with COVID-19 to the same number hospitalized with influenza, and surprisingly, found higher rates in influenza patients for any of the 6 most common neurologic disorders: migraine, epilepsy, stroke, neuropathy, movement disorders, and dementia. New neurologic diagnoses were observed in 2.79% of the COVID-19 cohort vs 4.91% of the influenza cohort (HR 0.618, 95% CI 0.582–0.657).

Statin drugs were associated with 40% improved mortality over 4 years in 282,693 older German nursing home residents, and 20% in those with dementia.

Concomitant use of SSRIs and oral anticoagulants (OACs) was associated with an increased risk of major bleeding compared with OACs alone (IRR, 1.33; 95% CI, 1.24-1.42), regardless of demographics and OAC or Warfarin. The risk peaked during the initial month of use: IRR, 1.74; 95% CI, 1.37-2.22 and persisted for up to 6 months. 

Exercising for upwards of 30 minutes most days may help relieve pain in >60,000 patients, including 10,000 with cancer.  Participants who surpassed 150 minutes of moderate activity a week were 16% less likely to report pain than those who did not exercise or who exercised less. Exercise was particularly helpful for those with moderate to severe pain, and the more people exercised, the less pain they felt — with and without a history of cancer.

Increased protein intake >22% of caloric intake increased cardiovascular risk in a mouse study, via a leucine-mediated effect governing macrophage mTOR signaling. I heard a presentation of a mouse study years ago that showed increased inflammation with more than 8% protein. Interestingly, breast milk contains 8% protein and supports a very rapidly growing body.

Time restricted eating (TRE) in 20,078 National Health and Nutrition Examination Surveys (NHANES) participants based on dietary survey, showed higher risk of cardiovascular mortality (Abstract P192). Compared with an eating duration of 12-16 hours:

• 8-hour TRE increased risk for CV mortality (hazard ratio [HR], 1.91; 95% CI, 1.20-3.03).

• in adults with CVD (HR, 2.07; 95% CI, 1.14-3.78)

• adults with cancer (HR, 3.04; 95% CI, 1.44-6.41)

• eating duration of 8 - 10 hours in people with CVD (HR, 1.66; 95% CI, 1.03-2.67)

• >16 hours was associated with a lower risk for cancer mortality in people with cancer (HR, 0.47; 95% CI, 0.23-0.95).

For some of my patients TRE really works to control blood sugars, if it works for you, take this observational study in context.

Serum levels of the terminal metabolites of excess niacin, N1-methyl-2-pyridone-5-carboxamide (2PY) and N1-methyl-4-pyridone-3-carboxamide (4PY), were associated with double the 3-year major adverse cardiovascular events (MACE) in two validation cohorts (US n = 2,331; European n = 832); (adjusted hazard ratio (HR) for 2PY: 1.64 (1.10–2.42) and 2.02 (1.29–3.18), respectively; for 4PY: 1.89 (1.26–2.84) and 1.99 (1.26–3.14), respectively). The mechanism is through a genetic variant of a vascular adhesion molecule, and through inflammation. Like with thiamine, we need not too little but also not too much.

Improvements of type 2 diabetes measures were observed with five spices: black cumin, ginger, cinnamon, turmeric, and saffron.

Only 1/3 of patients with diabetes are aware of diabetes being the major risk factor for cardiovascular disease. 

EHR-based Elders Risk Assessment (ERA) score, based on age, marital status, number of hospital inpatient days in the previous 2 years, diabetes, heart disease, stroke, chronic obstructive pulmonary disease, cancer, and dementia was used in primary care clinic to identify older patients at high risk of future critical illness. A score of ≥9 of 34 was identified as optimal for predicting the increased rate of annual ICU admission.

In 142,141 patients starting antiarrhythmic drugs (AAD) was associated with 2- fold increased risk of syncope and 5- fold risk of pacemaker implantation compared to non-users. Negative dromotropic effects of AADs, which is conduction speed (in fact the magnitude of delay) in the AV node, via ion channel blocking may cause bradyarrhythmia.  Additionally, normal aging changes with atrophy of the SA node further contributes to bradycardia.

Thank you, Dr. Mueller for sending this interesting analysis of retirement age.  For men working in physically demanding jobs, and minority groups, who have more comorbidities, an earlier retirement age is beneficial. 

Congratulations, Drs. Pickle and Stryker, and UC medical student Ishita Dubey, on your publication of: “Insurance Coverage for Gender-Affirming Voice and Communication Services.”

“Hope lies in dreams, in imagination, and in the courage of those who dare to make dreams into reality.” – Jonas Salk