Geriatric Update Sep 2, 2024

The antiviral influenza medications: zanamivir, oseltamivir, laninamivir, and baloxavir prevented symptomatic influenza in individuals at high risk of severe disease by 57-65% when given prophylactically within 48 h after exposure to seasonal influenza.

Of 4,635 young French adults, 75% men, hospitalized with myocarditis, those from COVID vaccine had about half the hospital readmission for myopericarditis, other cardiovascular events, all-cause death, and a composite outcome of these events over the 18 months than those with conventional myocarditis (weighted hazard ratio, 0.55; 95 percent confidence interval, 0.36 to 0.86), or individuals with post-COVID-19 infection myocarditis, who had similar outcomes to conventional myocarditis (weighted hazard ratio, 1.04; 9% CI, 0.70 to 1.52).

Direct oral anticoagulants (DOACs), are apixaban, rivaroxaban, edoxaban, and dabigatran, with apixaban being the preferred choice for older adults. Perioperatively, DOACs should be stopped 2 days prior to high bleeding risk surgery, such as spinal, bladder, orthopedic, chest and abdominal surgery, and restarted 2 days after. For medium risk, laparoscopic cholecystectomy, hernia repair, hysterectomy, angiography using femoral artery access, colon- or endoscopy, 1 day pause before and after is enough. For low risk, cataract surgery, dental extractions, skin biopsies, radial access angiography, or pacemaker insertion, there is no need to stop the DOAC, but moving the dose to evening before or skipping the morning dose of twice daily DOACs is recommended. 

How to Eat for a Long and Healthy Life was in today’s NY Times that addressed: Plant-based sources like legumes, nuts and whole grains seem to be especially beneficial, whereas protein from red and processed meat has been linked with shorter lives. In addition to protein, be sure to get enough calcium and vitamin D to support your bone health as you age, polyphenol-rich foods like berries, dark leafy green vegetables, avocados, coffee, green tea and extra virgin olive oil to health benefits, and fatty fish like salmon, tuna, anchovies and sardines are rich in omega-3 fatty acids. Beyond food, exercise, quality sleep and a healthy weight are key, as are the things to avoid: In one study published in 2023, researchers found that processed meats and sugar-sweetened beverages like soda, often high in sodium. 

This 5 min video summarizes the study I mentioned Aug 12 that showed that 14 lifestyle changes can reduce dementia by almost 50%.

Individuals who engaged in some form of exercise or physical activity on a regular or semi-regular basis demonstrated better brain health compared with inactive individuals, even weekend warrior (≥150 min week−1 with ≥50% of total moderate-to-vigorous physical activity (MVPA) occurring within 1–2 days) is associated with similarly lower risks of dementia, stroke, Parkinson’s disease, depressive disorders and anxiety compared to regularly active (≥150 min per week but not meeting weekend warrior criteria) and better than inactive (<150 min per week of MVPA).

Of 1213 Swedish patients with Alzheimer’s dementia (AD) based on abnormal cerebrospinal fluid Aβ42:Aβ40 ratio and p-tau217 or clinical AD,  primary care doctors, identified 61%, dementia specialist identified 73%, and the blood tests identified 91% of patients with disease. The blood test consisted of a ratio of plasma phosphorylated tau 217 (p-tau217) to non–p-tau217 (expressed as percentage of p-tau217) alone and was combined with the amyloid-β 42 and amyloid-β 40 (Aβ42:Aβ40) plasma ratio, as the amyloid probability score 2 [APS2]). Diagnostic accuracy using the APS2 was not different from the diagnostic accuracy using the percentage of p-tau217 alone (90%). 

Prior studies have shown increased risk of falls and related injuries (FRI) with antidepressants, but this may have been confounded by indication or immortal time bias, and depression also increases falls. Psychotherapy use was not associated with FRI (aHR, 0.94 [95% CI, 0.82-1.17]), while other first-line antidepressants were associated with a decreased FRI risk (aHR ranged from 0.74 [95% CI, 0.59-0.89] for bupropion to 0.83 [95% CI, 0.67-0.98] for escitalopram). The survival time ranged from 349 (95% CI, 346-350) days for those who were untreated to 353 (95% CI, 350-356) days for those treated with bupropion.

Dual sensory impairment (DSI) of hearing and vision loss showed higher risk of falls (odds ratio 3.432, P = .006) than in those with vision or hearing impairment alone. When adjusted for physical function, cognitive function, depression, and discharge location, DSI was significantly associated with an increased risk of falls after hospital discharge (odds ratio 3.107, P = .021).

Similarly, the combination of hearing loss and peripheral neuropathy (PN) Increase the risk of impaired balance, falls, and premature mortality. Of 793 community living older adults, age >64 years, 83% had some level of hearing loss, was associated with significant physical functioning deficit, impaired balance, increased gait time, and 36% increased mortality, and this was associated with age and peripheral neuropathy (PN). The combination with PN reduced survival by 51%. In addition to lifestyle, ear plugs in loud nose, or noise cancelling headphones can protect hearing, and vitamin B-12 supplementation can prevent neuropathy, especially when patients take proton pump inhibitors,  metformin or other meds that block absorption of B-12. For more information, read my commentary.

This Radiolab podcast explains sleep very well.

This BBC News episode is a nice brief summary of the GLP-1 meds start at 6:20 min - 10:25 min. 

This is a BBC special that puts processed food into perspective.