Geriatric Update Nov 25, 2024
The 2024 Guideline for the Primary Prevention of Stroke have added sex-specific recommendations, new compared to 2014, in addition to the American Heart Association's Life's Essential 8 for optimizing cardiovascular and brain health:
Diet quality
Physical activity
Weight and obesity
Sleep
Blood sugar
Blood pressure
Lipids
Tobacco
Cardiovascular drugs reduce dementia risk. Particularly ≥ 5 years of antihypertensive use was most effective (odds ratio [OR] 0.75–0.91) and additional use of diuretics, lipid-lowering drugs (LLDs), and oral anticoagulants (OACs) added benefit, (OR 0.66–0.84) vs. non-users. Antiplatelets, such as aspirin, use was associated with more dementia diagnoses (OR 1.13–1.25).
People diagnosed with type 2 diabetes at a younger age appear to be at a higher risk for developing dementia than those diagnosed later in life. Compared to those diagnosed at 70 and older:
60–69 years HR 1.70 (95% CI, 1.03–2.80),
50–59 years 1.72 (95% CI, 1.06–2.79),
<50 years 1.90 (95% CI, 1.14–3.18)
Obese individuals diagnosed <50 years had the highest risk (HR 3.05; 95% CI 1.23–7.56) compared to non-obese individuals diagnosed at ≥50 years.
Replacing prandial insulin with once-weekly subcutaneous semaglutide in people with well controlled type 2 diabetes maintained and even improved HbA1c in 90% of patients, lowered body weight and lessened the burden of management.
Initiation vs no initiation of metformin resulted in 2.4 fewer cases of gout per 1000 person-years and a 32% reduced relative risk for incident gout (hazard ratio, 0.68; 95% CI, 0.48-0.96), regardless of age, sex, kidney function or diuretic use. Metformin was associated with a reduction in A1c levels and body mass index but not with significant changes in serum urate or C-reactive protein levels.
Audiology visits vs. health education showed no difference, 0.47 [95% CI, −0.41 to 1.35]) in health-related quality of life. The analysis was based on a randomized trial of 977 older adults, 78.6 years, over 3 years. Several parameters showed less decline in the hearing intervention group: social functioning, energy emotional well being, health-related quality of life, but did not reach statistical significance. I would like to see a longer study and larger number of participants to really determine efficacy: the SPRINT trial had 9361 and the zoledronic acid study had 7765 participants. Hearing aide adherence was not reported but is about 50% in the general population, and dementia may have contributed to 106 participants who did not have complete RAND-36 Health Surveys for quality of life.
At 10 years after the baseline audiogram, the numbers of additional cases of Parkinson’s were 6.1 (95% CI, 4.5-7.79, 15.8 (95% CI, 12.8-18.8), 16.2 (95% CI, 11.9-20.6), and 12.1 (95% CI, 4.5-19.6) among veterans with mild, moderate, moderate to severe, and severe to profound hearing loss, respectively, compared with those with normal hearing, among 3.5 million veterans mean age 67, who had an audiogram, 20% had normal hearing. Prompt hearing aid dispensation decreased incident cases of PD by 21.6 cases (95% CI, 19.5-23.6) at 10 years.
Central obesity (CO), characterized by excess fat around the abdomen, contributes to 21.7% of all pelvic organ prolapse (POP), particularly in those who are younger than 60 years, 2% were attributable to being overweight without CO. The risk for POP was 48% higher in individuals with CO regardless of BMI and 23% higher in those who had overweight without CO.
Frailty affects the risk, clinical presentation, and course of common age-related neurological disorders, including dementia, Parkinson's disease, stroke.
And another study showed that frailty is not merely a consequence of undetected dementia but contributes to its onset, (adjusted hazard ratios [aHRs] ranged from 1.18; 95% CI, 1.13-1.24 to 1.73; 95% CI, 1.57-1.92) in 4 prospective cohort studies, avg age 71.6 [7.7] years. Physical activity can prevent frailty.
Physical activity was consistently associated with a lower risk of mortality across all age groups, but risk reduction was greater as age increased, especially at high levels of PA, hazard ratio 0.78 (95% CI, 0.77-0.79). Activity also reduced modifiable health factors (HTN, DM, alcohol, smoking,…) leading to mortality, but the magnitude of associations was greater in younger vs older age groups.
Thank you, Joe for sending this: Athletes primarily engaged in basketball, football, and fencing, and other activities, compared to non-athletes, showed better working memory in a meta-analysis with low bias, of 21 studies involving 1455 participants. The difference was small but statistically significant (Hedges’ g = 0.30) and more pronounced when athletes were contrasted with a sedentary population (Hedges’ g = 0.63), but it may not be clinically significant. Many studies support exercise for memory, but we may not have to exercise at an athlete level.
As little as 10% weight loss can reverse metabolic dysfunction–associated steatotic liver disease (MASLD). Of 16,058 veterans, age 60, started on a GLP-1 RA or a DPP-4i, the GLP-1 RA group had a 30% lower risk of developing cirrhosis-related complications and a 11% lower risk of all-cause mortality, over 18 months. GLP-1 RA use, compared with DPP-4i use, was associated with a lower risk of cirrhosis (9.98 vs 11.10 events per 1000 person-years; hazard ratio [HR], 0.86; 95% CI, 0.75-0.98). If GLP-1 RAs were started after cirrhosis developed, it did not lower rates of progression to hepatic decompensation or hepatocellular cancer.
New UTI guidelines recommend shorter treatment durations including 5 days for nitrofurantoin, 3 days for TMP/SMX and fluoroquinolones, and a single dose for fosfomycin in acute cystitis cases. For acute pyelonephritis, fluoroquinolones are advised for 5-7 days, with dose-optimized beta-lactams for 7 days. Gram-negative bacteremia from urinary sources warrants a 7-day course.
These 8 Factors increase the risk of severe flu: very young or old age, lung disease such as asthma, pregnancy suppresses the immune response, obesity and diabetes because high blood sugars impair immune cell activity. Neurological disorders may cause difficulty with coughing or clearing fluids, and flu virus may cause heart attacks in those with heart disease.
More intensive systolic blood pressure target, median <118 mmHg vs. 132 mm Hg, in people with type 2 diabetes over 4.2 years, improved the prevention of major cardiovascular events (1.65 events per 100 person-years) in the intensive-treatment group and 492 patients (2.09 events per 100 person-years) in the standard-treatment group (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90).
In patients with acute brain injury, liberal blood transfusion at hemoglobin <9 did better than <7. At 180 days after randomization, 246 patients (62.6%) in the liberal strategy group had an unfavorable neurological outcome compared with 300 patients (72.6%) in the restrictive strategy group (absolute difference, −10.0% [95% CI, −16.5% to −3.6%]; adjusted relative risk, 0.86 [95% CI, 0.79-0.94).
Intravenous thrombolysis with alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg) were equally effective within 4.5 hours after stroke with equal risks and side effects, such as bleeding.
Anticoagulation within 4 days after ischemic stroke with AF was noninferior to 7-14 days for: hemorrhage, unclassifiable stroke, or systemic embolism in RCT of 3648 patients at 90 days.
Vaginal estrogen use with a history of breast cancer was not associated with an increased risk of breast cancer recurrence, breast cancer-specific mortality, or overall mortality, in a meta-analysis of 6 studies including 24,060 patients.
Those who ate ≥45% daily calories after 5 pm, had a poorer tolerance of glucose, regardless of their weight or the composition of their diet. It also found that they tended to eat larger amounts of carbohydrates and fats during the evening. The body's ability to metabolize glucose is limited at night, because of reduced insulin secretion, and our cells' sensitivity to this hormone declines due to the circadian rhythm, which is determined by a central clock in our brain that is coordinated with the hours of daylight and night.
Shortened sleep duration (60% of habitual sleep) while eating a eucaloric diet, led to lower glycerol and non-esterified fatty acid secretion, and increased oxidative phosphorylation and adipogenesis, which contribute to abdominal fat deposits. The study involved 9 healthy postmenopausal women (mean [SD], age: 59 [4] years; BMI: 28.0 [2.6] kg/m2) who were randomized and compared to their usual sleep in a crossover design.
Denosumab is effective for osteoporosis but after stopping it, can cause rapid bone loss. In this randomized clinical trial of 101 participants who received denosumab for 2 or more years, sequential therapy with zoledronate did not prevent loss of bone mineral density in the lumbar spine (LS-BMD) in the first year, however, BMD in the femoral neck and total hip was preserved after sequential therapy.
Combining transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) was associated with a greater reduction in symptoms of major depressive disorder (MDD) than either treatment alone, reduction in mean scores on the 24-item Hamilton Depression Rating Scale (HDRS-24; score range: 0-52 with higher scores more severe disease, in In 240 Chinese patients avg. age 32.5 years:
active tDCS + active rTMS: 18.33
sham tDCS + active rTMS: 14.86
active tDCS + sham rTMS: 9.21
sham tDCS + sham rTMS: 10.77
