Geriatric Update Sep 9, 2024

Patients, age >45, BMI >27,  treated with semaglutide 2.4 mg had lower rates of all-cause death (HR: 0.81; 95% CI: 0.71-0.93), cardiovascular (CV) death (HR: 0.85; 95% CI: 0.71-1.01) and particularly reduced death of COVID-19 (HR: 0.66; 95% CI: 0.44-0.96).

Respiratory syncytial virus (RSV) associated hospitalization are 3-9 times higher for adults ≥65 years living in assisted living and 3-4 times higher for those living in SNF compared to community-dwelling adults ≥ 65 years, and 2-5 times and 2-3 times higher, respectively, for adults ≥85 years compared to the community dwelling age group.

Vaccine efficacy against RSV-associated hospitalization was 75% (95% CI, 50%-87%) in US Adults >60 years old. The recommendation is to immunize all older adults >75 and high risk persons >60.

In 128 patients with acute coronary syndrome, i.e. decreased blood flow in coronary arteries, colchicine increased plaque stability as measured by optical coherence tomography, compared to those randomized to placebo. Patient outcomes such as heart attack was not measured. 

This issue of the Caring for the Ages has one article on 8 models that help people age in place and another on cohousing.

Home and community based services

house sharing models

universal design principles

senior housing cooperatives

program of all inclusive care for the elderly (PACE)

the village model

guiding and improved dementia experience (GUIDE)

smart homes

Patients with depression, age 45 (18-74 years), on maximally tolerated dose of a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor were randomized to add-on therapy with esketamine nasal spray or extended-release quetiapine. Over 32 weeks remission occurred earlier and more often in the esketamine group (49.1% vs. 32.9%; NNT = 7). Adverse events occurred in 5% to 6% of patients in each group, but discontinuation was more common with quetiapine (11.0% vs. 4.2%).

After 20-year follow-up, in post-menopausal women, estrogen-alone, vs. placebo, significantly increased ovarian cancer incidence (hazard ratio [HR], 2.04 [95% CI, 1.14 to 3.65]) but estrogen plus progesterone did not (HR, 1.14 [95% CI, 0.82 to 1.59]; P = .44), and the combination significantly lowered endometrial cancer incidence (HR, 0.72 [95% CI, 0.56 to 0.92]).

A review of 18 randomized control trials showed that a comprehensive geriatric assessment during hospitalization lowered risk of having decreased activities of daily living vs. the control group (RR = 0.55, 95% CI: 0.33 to 0.92, P = 0.021, low certainty evidence), and reduced mortality risk (RR = 0.85, 95% CI: 0.73 to 0.99, P = 0.038, high certainty evidence).

Cincinnati again ranks in the top 10 most desirable cities to retire based on 45 metrics across four dimensions: affordability, activities, quality of life and healthcare.

Outdoor nighttime light exposure (light pollution) is associated with Alzheimer’s disease. The mechanism of action is thought to be through sleep disruption that can activate microglia and astrocytes, promote inflammation, negatively alter the clearance of amyloid beta (potentially via the glymphatic system), is associated with loss of neurons in the cortex, hippocampus, and locus coeruleus, and hippocampal atrophy.  I wonder how much this is confounded by air pollution as usually light and air pollution occur together in densely populated areas.  The study also could not account for black-out shades in sleeping areas or eye masks, and of course, the biggest disruptor of sleep is untreated sleep apnea.

12 things to control for a healthy brain, including dementia, depression and stroke:  

Decrease

Blood pressure 

Alcohol 

Processed food 

Blood sugar 

Smoking 

Waist hip ratio 

Blood cholesterol 

Stress

Sleep apnea

Increase

Purpose 

 Exercise 

Connections 

Only half as many respondents, 28%, spontaneously mentioned diet when asked what steps women can take to lower their chances of breast cancer, than  to screening methods, 56%.

Stopping anticoagulation for transcatheter aortic valve replacement (TAVR) was slightly better than continuing anticoagulation, in a randomized trial of 858 patients. Thromboembolic events occurred in 38 patients (8.8%) in the continuation group and in 35 (8.2%) in the interruption group (risk difference, 0.6 percentage points; 95% CI, -3.1 to 4.4). Bleeding occurred in 134 patients (31.1%) in the continuation group and in 91 (21.3%) in the interruption group (risk difference, 9.8 percentage points; 95% CI, 3.9 to 15.6).

Most older adults take prescription medicine, 86.9% among folks aged 65-74 to > 91% among those aged >75 and older. But 3.6% did not get needed prescription medication due to cost, and 3.4% did not take medication as prescribed due to cost.

More time spent on the cellphone was associated with higher risk of incident cardiovascular disease (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.02-1.06) in 444,027 UK Biobank participants. I don't think this result is valid because of the small effect, 4% in such a large observational study. And, the World Health Organization has commissioned a study that showed no link between cellphone use and health outcomes.