Geriatric Update May 13, 2024

Metformin has been shown to decrease COVID infections with significantly lower mean viral loads at days 5 and 10 and less detectable viral load at both time points. The mechanism appears to be suppression of protein translation via the rapamycin pathway.

There was a 50% reduction in heart attacks in the US between 2004 and 2020 but disparities persist with women, Black, and Hispanic patients, who are up to 25% less likely to receive potential life-saving procedures after a heart attack.

Among patients (avg age 62) undergoing hip or knee surgery, with at least 1 Revised Cardiac Risk Index condition, no difference was observed in cardiovascular outcomes between patients who did and did not undergo preoperative stress testing.

From my attendance of the AGS conference Thu thru this weekend:

Perioperative gabapentin use was associated with increased risk of delirium 3.4% vs. 2.6%; RR, 1.28 (1.23-1.34), new antipsychotic use 0.8% vs. 0.7%; RR, 1.17 (1.07-1.29), and pneumonia (1.3% vs. 1.2%; RR, 1.11 (1.03-1.20) after major surgery among  237,872 propensity score matched older patients (age 74). The risk was higher in those with more co-morbidities.

In patients, age 70, undergoing hip or knee replacement surgery, perioperative screening colonoscopy was not associated with periprosthetic joint infection and should not be delayed for periprocedural risk.

Egg consumption did not increase risk of CV death over 48 years. (Need AGS conference registration to view this presentation)

We reduced  dehydration in our nursing home from 75% to 36% and presented our research at the AGS conference last week.

Thank you, Dr. Gebhardt for asking about type 3 diabetes.  This article goes into detail that Alzheimer’s disease represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with diabetes mellitus, such as: brain insulin resistance and experimental treatment of brain diabetes with insulin sensitizer agents. That would explain why patients with diabetes have a higher risk of dementia and that diet, exercise and weight control through life prevents both.

A meta-analysis of 2142 participants from 27 randomized controlled trials showed that exercise modalities such as Pilates, yoga, and traditional Chinese exercises, significantly improve sleep quality when compared to a no-exercise control group, with Pilates exhibiting the most potent effect at a 95.3% improvement level. The authors also state to adapt exercise to individual preferences and needs.  I would add that any exercise the patient will do will help with sleep.

A systematic review and meta-analysis showed higher levels of physical activity are associated with a decreased risk of developing inflammatory bowel disease, particularly Crohn's disease.

Thank you, Dr. Grade for pointing out that Beethoven’s 9th not the 5th symphony is Ode to Joy and celebrated its 200th anniversary.