Geriatric Update Sep 23, 2024

Respiratory syncytial virus (RSV) starts about a month before influenza season starts, so mid October. RSV is more likely to be transmitted by contact than flu or covid, so frequent hand washing and not touching mucosa is important. RSV presents more like a cold and with wheezing than the other viruses.

Among patients with severe hypoxemia, long-term oxygen therapy used for 24 hours per day did not result in a lower risk of hospitalization or death within 1 year than therapy for 15 hours per day, (mean rate, 124.7 and 124.5 events per 100 person-years, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.72 to 1.36). Being able to go a few hours without oxygen would make life much easier for our patients requiring oxygen therapy.

In a vaccinated population, people treated with molnupiravir (the alternative to Paxlovid) for acute COVID-19, felt better, experienced fewer and less severe COVID-19 associated symptoms, accessed health care less often, and took less time off work at 6 months. However, the absolute differences in this open-label design are small with high numbers needed to treat: 100 for time off from work and 200 for healthcare use, and no differences in hospitalizations at long-term follow-up.

Type 2 diabetes of >10 years was associated with an increased risk of any fracture. Also, very tight control with HbA1c level <6% vs. 6% to <7% and presence of one or two microvascular complications showed higher fracture risk in a database review of patients > age 30.

SGLT2 use was associated with a reduced risk for Alzheimer disease (adjusted hazard ratios [aHR] 0.81), vascular dementia (aHR 0.69), and Parkinson’s Dementia (aHR 0.80), among 6,837 incident dementia or Parkinson’s Dementia events.

Two recent meta-analyses suggest that use of benzodiazepines is associated with higher dementia risk. A new Dutch study showed no increased risk of dementia with low, but an association with dementia with high cumulative dose of anxiolytics (HR [95% CI] 1.33 [1.04–1.71]), and on imaging, with lower brain volumes of the hippocampus, amygdala, and thalamus. Of concern is the high use: of all 5443 participants, 2697 (49.5%) had used benzodiazepines at any time in the preceding 15 years, and the young age, 54 at onset and 70 at analysis. The argument is that reverse causality could contribute. I recently reported on a study that showed that anxiety itself also increased risk of dementia.

Muscle relaxants, baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine, and tizanidine, may improve painful spasms or cramps and neck pain, but they do not appear to be beneficial for low back pain, fibromyalgia, or headaches and can have adverse effects such as sedation and dry mouth, according to a systematic review of 30 randomized clinical trials with 1314 participants and 14 cohort studies with 1168 participants. Age of participants was not listed, but all these meds are on the Beers list and should not be used in older adults. I have seen gait imbalance, falls, delirium and confusion with these meds and have tapered them off in my patients using calcium twice a day and magnesium at bedtime, both work well for muscle cramps.

These 3 antidepressants and 1 therapy showed benefit on cognition: Sertraline and vortioxetine had positive effects on processing speed and memory. Duloxetine had positive effects on memory. Citalopram and escitalopram, likely the most used, had no effect. Problem Solving Therapy had modest effects on processing speed but no effect on memory. This needs to be confirmed or replicated.

The U.S. ranks as the worst performer among 10 developed nations in critical areas of health care, including preventing deaths, access (mainly because of high cost) and guaranteeing quality treatment for everyone. Measured were: access to care, care process, administrative efficiency, equity, and health outcomes. People in the U.S. die the youngest and experience the most avoidable deaths, even though the country spends nearly twice as much – about 18% of gross domestic product – on health care than any other nation ranked. The three top-performing countries in the report were Australia, the Netherlands and the United Kingdom.

Alcohol use may be one factor driving a trend of higher rates of breast cancer and colorectal cancer among adults under age 50.

Overdose deaths have fallen sharply over the last year, driven mostly by decrease in fentanyl deaths by 10-15%.