Geriatric Update Nov 11, 2024

Respiratory syncytial virus (RSV) vaccines proved highly effective at preventing hospitalization in older adults, >60 years without immunocompromising conditions, 80% (95% CI 71–85), against emergency room visits was 77% (70–83) and critical illness (ICU admission or death, or both) 81% (52–92). Among 8435 adults with immunocompromising conditions, vaccine effectiveness against hospitalization was 73% (48–85). Vaccine effectiveness estimates were similar by age group and product type.

Irregular sleep increases the risk of diabetes by 1/3. Compared with regular sleepers, irregular (hazard ratio [HR] 1.38; 95% CI 1.20–1.59) and moderately irregular sleepers (HR 1.35; 95% CI 1.19–1.53) were at higher risk of T2D incidence, even when sleep duration was met.

Obstructive sleep apnea (OSA) was associated with higher cumulative incidence of dementia across ages 60 to 84 years. Of 18,815 older adults, 9% of women and 8% of men (weighted proportions) met criteria for incident dementia. Known/suspected OSA was more prevalent in men than in women (68% vs 31%).  By age 80, relative to adults without known/suspected OSA, the cumulative incidence of dementia over 10 years was 4.7% higher for women with known/suspected OSA, and 2.5% for men with known/suspected OSA.

Lifestyle improves outcomes of brain health, independent of genetic risk, a 5-point increase in the 21-point Brain Care Score corresponded to lowered hazards of stroke (hazard ratio [HR] 0.70, 95% CI 0.68–0.73), late life depression (HR 0.65, 95% CI 0.63–0.67), and dementia (HR 0.82, 95% CI 0.78–0.85) among 368,340 UKB participants, median age 58 years.

Over 14-year follow-up, the incidence rates (events per 1000 person-years) of all-cause dementia were 6.1 for nonusers, 6.2 for those with cumulative tramadol use of 1–14 days, 7.7 for those with 15–90 days of use, and 8.0 for those with > 90 days of use. Longer cumulative duration of tramadol use was associated with an increased risk of all-cause dementia compared with nonuse (1 to 14 days: adjusted hazard ratio (aHR) 1.06, 95% CI 0.96–1.17; 15 to 90 days: aHR 1.14, 95% CI 1.10–1.35; and more than 90 days: aHR 1.18, 95% CI 1.00–1.39; test for trend: P < 0.001). Although the HRs are not large, this adds to other risks of tramadol: hypoglycemia, even in non-diabetics, hip fractures, falls and death, which led to its listing on the Beers Criteria.

Cytotoxic effects of microplastics and nanoplastics (MNPs), and their ability to induce inflammation, reduce cell viability, and disrupt signaling pathways, raise significant public health concerns related to bladder cancer, chronic kidney disease, chronic urinary infections, and incontinence. 18 articles suggest MNPs have a cytotoxic effect, increase inflammation, decrease cell viability and alter mitogen-activated protein kinases (MAPK) signaling pathways. And I learned from my grandchildren this weekend that the US buys 50 billion plastic water bottles a year, and less than 20% are recycled.

Of 295 pesticides, 22 showed consistent, direct association with prostate cancer incidence, and 4 of these were also associated with prostate cancer mortality. The incidence increase of 1 standard deviation (kg per county) per 100,000 individuals was: trifluralin 6.56 (5.04-8.07), cloransulam-methyl 6.18 (4.06-8.31), diflufenzopyr 3.20 (1.09-5.31) and thiamethoxam 2.82 (1.14-4.50).  

Exercise interventions reduced daily alcohol dependence and significantly improved physical and mental health, like heart rate and anxiety, among patients with alcohol use disorder, according to a systematic review and meta-analysis.

Adding five minutes of exercise to daily routine lowers blood pressure, cuts odds for heart disease, and includes all exercise-like activities, from climbing the stairs to a short cycling errand, many of which can be integrated into daily routines. Just 5 minutes lowered systolic blood pressure –0.68 mm Hg (95% CI, –0.15, –1.21) and diastolic by –0.54 mm Hg (95% CI, –0.19, 0.89). Clinically meaningful improvements in SBP and DBP were estimated after 20 to 27 minutes. Even small amounts of exercise are beneficial, but the more the better. 

With temperatures dropping this fall we don’t think of heat related health problems, but this new study showed, in the absence of air conditioning, simple measures proved effective at lowering heat-induced cardiac strain in older people:  electric fans and skin wetting both worked better than no cooling in a hot and humid environment – and in people with or without coronary artery disease – to reduce the mean change from baseline to hour 3 in rate-pressure product (heart rate multiplied by systolic blood pressure).

Vitamin K2 reduced the frequency, intensity and duration of nocturnal leg cramps in a randomized study of 199 participants, age 72.3 years, with markedly fewer episodes of nocturnal leg cramps to an average of 1 per week in the vitamin K group and increased to 3.6 per week in the placebo group with no reported adverse events. In a commentary Dr. Rakel explained: Vitamin K1 is obtained mainly through eating plants (dark greens), and vitamin K2 is obtained through eating animal products, fermented foods, and is produced with the help of gut bacteria. Vitamin K2 may be more effective in vegetarians or individuals without an adequate microbiome to produce vitamin K2. Warfarin works by blocking the clotting action of vitamin K, and if using the vitamin, the warfarin dose needs to be adjusted upward, and can help regulate fluctuating INR levels.  For muscle cramps I use Calcium twice a day and magnesium at bedtime, and chewable as needed, vitamin K is another option.

Adding 2000 IU vitamin D daily in individuals with low levels results in improved glucose control, with greatest effect in individuals with diabetes and obesity who had vitamin D deficiency and an HbA1c measurement of 8% or greater. Fasting blood glucose weighted mean difference (WMD; −0.49 [95% confidence interval {CI}: −0.69 to −0.28] mmol/L), HbA1c (WMD −0.30% [95% CI: −0.43 to −0.18]), Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) (WMD −0.39 [95% CI −0.64 to −0.14]) and insulin (WMD −1.31 [95% CI: −2.06 to −0.56] μIU/mL).

Unexplained chorea, especially among women, though rare, may be associated with antiphospholipid syndrome and should prompt testing for antibodies. Combination therapies of neuroleptics, anticoagulants, antiplatelets, steroids and immunosuppressants led to complete or partial improvement in 95.5% of patients.

Majority of patients with liver cirrhosis with hepatic encephalopathy (HE) had zinc deficiency. There was a statistically highly significant (P < .00001) association between low serum zinc levels and grades of HE. The serum zinc levels in different classes of cirrhosis showed highly significant differences (P < .00001). The mean serum zinc level was significantly low in patients who died (35.56 ± 11.65 vs 48.36 ± 10.91, P < .0001). The study revealed a strong positive correlation (r = .88, P = .048) between serum zinc and serum albumin levels. It would be interesting to see if supplementing zinc would help encephalopathy, cirrhosis, albumin levels and ultimately mortality.