Geriatric Update Sep 16, 2024

Positive airway pressure (PAP) use for sleep apnea was associated with lower all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and major adverse cardiovascular events (MACE) incidence risk (HR, 0.90; 95% CI, 0.89-0.91).  Higher compliance was associated with better outcomes among the 888,835 older adults, age 73, in the central US.

Adding a cognitive task of naming animals while measuring gait speed in a test was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%).

This editorial summarizes the evidence on chelation therapy well, and found no benefit in patient outcomes in reducing cardiovascular events with the lowering of blood levels of cadmium and lead after myocardial infarction.

Aspirin has been shown to lower risk of colon cancer. This study showed that the effect is much greater in those with poor lifestyle habits. Aspirin in 2 or more standard tablets (325 mg) per week lowered the 10-year incidence of colon cancer for lifestyle scores 0 to 1 (unhealthiest: body mass index, alcohol intake, physical activity, diet, and smoking) by 1.28%. In contrast, the 10-year incidence for lifestyle scores 4 to 5 (healthiest) was 0.11%. The 10-year number needed to treat with aspirin was 78 for participants with lifestyle scores 0 to 1, 164 for score 2, 154 for score 3, and 909 for scores 4 to 5.

Metformin is specifically associated with an increase in the abundance of several bacteria linked to positive metabolic effects, such as mucin-degrading A. muciniphila, and bacteria producing short-chain fatty acids. Of the 33 individuals without bacteria harboring antibiotic resistance gene (ARG), 30% had ARG after 4 months. Conversely, of 5 patients with multi-drug resistant (MDR) ARG, 3 lost their antibiotic resistance over that time. Of dozens of bacteria, E. coli had the highest correlation with the MDR-ARGs. This does not change my approach in the use of metformin, which guidelines place first line in treatment of diabetes, but warrants monitoring.

Defibrillation pads placed anterior-posterior for patients presenting with shockable out-of-hospital cardiac arrest had 2.64-fold (95% CI, 1.50-4.65) greater odds of return of spontaneous circulation compared with pads placed anterior-lateral after adjustment for known confounders, in 255 patients, age, 66 [55-74]. However, there was no significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission or discharge or functional survival at hospital discharge.

Thrombo-embolic events in patient with atrial fibrillation/flutter (AF/AFL), after COVID-19 vaccine were not different from before the vaccine. However, patients without anticoagulant therapy had an incidence rate ratio (IRR) of blood clots 1.88 (95% CI 1.39-2.54) following vaccination. The analysis included 124,127 individuals with AF/AFL, based on the National Health Insurance Service in South Korea.

Proton pump inhibitor (PPI), such as omeprazole, use >1 yr was significantly associated with lower trabecular bone scores TBS (-0.039, 95%CI:[-0.058, -0.020], p<0.001) and bone mineral density femoral neck T-score (-0.21, 95%CI:[-0.42, -0.01], p=0.045) at all sites in males, but not in females.

Erectile dysfunction (ED) and lower urinary tract symptoms, such as nocturia, are the canary in the coal mine, and sentinel indicators of chronic diseases or their risk factors in men.  The small blood vessels supplying the area are especially susceptible to damage that can later lead to stroke and heart attack. We should ask about it to start the conversation of preventing it.

Eprognosis includes calculators for palliative and hospice care and have been validated in 4479 patients. The need for nursing home level of care has been validated in community-dwelling older adults with probable dementia. And this article on surgery describes the need to have all members of the team on the same page before discussing prognosis. All of this is discussed in this GeriPal podcast.

Apple’s AirPods Pro 2 can now be used as hearing aids, after the FDA on Thursday approved the first over-the-counter hearing aid software that is intended to be used with compatible versions of the AirPods Pro headphones.