Geriatric Update July 8, 2024
Scientific advisers to the CDC reframed the respiratory syncytial virus (RSV) vaccine guideline. Based on recent safety and effectiveness data, they unanimously recommended that all Americans >75 years get the RSV vaccine, but offered a narrower recommendation for people 60 to 74 if they are at higher risk of disease: chronic heart disease, advanced-stage kidney disease, chronic lung illnesses, severe obesity, and nursing home patients, about 39% of people in that age group. The panel also declined to endorse giving the GSK vaccine to people in their 50s, even though the FDA this month licensed the company’s shot for that age group, and a newly approved RSV shot from Moderna will be subject to the same guidance. About 25% of older Americans have gotten an RSV shot.
A trial randomized 405 Chinese, age 45.5, to intermittent fasting (two nonconsecutive fasting days and five days of habitual intake per week with meal replacement diet (5:2 MR) over 16 weeks, compared with diabetes meds. Weight loss in the 5:2 MR group (least square mean (LSM), −9.7 kg [SE, 2.2 kg]) was greater than that in the metformin group (LSM, −5.5 kg [SE, 2.3 kg]) and empagliflozin group (LSM, −5.8 kg [SE, 2.3 kg]).
Thank You, Joe for this study Acetaminophen seems to lower risk taking threshold: students earned 5 cents for each pump of a ballon but lost it when it burst, at 128 pumps all ballons would have burst. Those on acetaminophen pumped it (M = 38.98, s.d. = 14.80) vs. placebo (M = 33.10, s.d. = 15.75) and burst balloons (M = 10.07, s.d. = 4.13) vs. (M = 8.58, s.d. = 4.64). This may have implications for anxiety management.
Thank you also for this study of 22,989 patients with type 2 diabetes from the UK Biobank, 2843 participants developed new-onset atrial fibrillation, over 12.3 years of follow-up, with 844 all-cause dementia, 342 Alzheimer's disease and 246 vascular dementia. Compared with participants without atrial fibrillation, those with atrial fibrillation had 3 fold higher risks of vascular dementia (HR 3.11, 95% CI 2.32-4.17), and higher risk of Alzheimer's disease (HR 1.44, 95% CI 1.06-1.96).
GLP-1 medications reduced obesity-related cancers. The risk was cut by more than half for gallbladder cancer, meningioma, pancreatic cancer and hepatocellular carcinoma:
gallbladder cancer (HR, 0.35; 95% CI, 0.15-0.83),
meningioma (HR, 0.37; 95% CI, 0.18-0.74),
pancreatic cancer (HR, 0.41; 95% CI, 0.33-0.50),
hepatocellular carcinoma (HR, 0.47; 95% CI, 0.36-0.61),
ovarian cancer (HR, 0.52; 95% CI, 0.03-0.74),
colorectal cancer (HR, 0.54; 95% CI, 0.46-0.64),
multiple myeloma (HR, 0.59; 95% CI, 0.44-0.77),
esophageal cancer (HR, 0.60; 95% CI, 0.42-0.86),
endometrial cancer (HR, 0.74; 95% CI, 0.60-0.91),
kidney cancer (HR, 0.76; 95% CI, 0.64-0.91).
Exponential increase in lifetime cumulative atherosclerosis risk, and the effect of lowering LDL cholesterol at various ages, on lifetime atherosclerotic cardiovascular disease events. In summary, the earlier after age 40 the better. Let me know if you want the article with impressive graphics.
Acupuncture improved degenerative lumbar spinal stenosis (DLSS) symptoms in 18 sessions of acupuncture by 43% vs. sham acupuncture (SA) over 6 weeks, with 24-week follow-up after treatment.
Acupuncture (RA) for 4 weeks had a statistically significant improvement in Parkinson Disease Sleep Scale (PDSS) scores compared with baseline RA group (29.65 [95% CI, 24.65-34.65]; P < .001) and the SA group (10.47 [95% CI, 5.35-15.60]; P < .001). Compared with the sham acupuncture (SA): group, the RA group had a significant increase in PDSS scores after 4 weeks of treatment (19.75 [95% CI, 11.02-28.49]; P < .001) and at 8 weeks of follow-up (20.24 [95% CI, 11.51-28.98]; P < .001).
In female current tobacco users, after full adjustment, heavy cannabis use was associated with all-cause mortality (HR, 2.25; 95% CI, 1.12-4.53), CVD mortality (HR, 2.56; 95% CI, 1.43-15.36), and cancer mortality (HR, 3.52; 95% CI, 1.50-8.33) and among never tobacco users was associated with CVD mortality (HR, 2.98; 95% CI, 1.67-6.61). In male current tobacco users, heavy cannabis use was associated with only cancer mortality (HR, 2.44; 95% CI, 1.14-5.23). Based on 121,895 UK Biobank participants (age of 55.15 years), over 11.80 years (IQR, 10.53-13.22 years) of follow-up, and 2375 total deaths.
Walking was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. 701 Australian adults age 54, 81% female, were randomly assigned (351 to the intervention group and 350 to the no treatment control group). The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28,000. Adverse events related to the lower extremities: 100 in the intervention group and 54 in the control group.
Fenofibrate reduced he progression of, or treatment for, diabetic retinopathy or maculopathy over 4 years. Progression occurred in 131 (22.7%) of 576 participants in the fenofibrate group and 168 (29.2%) of 575 in the placebo group (hazard ratio, 0.73; 95% confidence interval [CI], 0.58 to 0.91; P=0.006). There was no effect on visual function, quality of life, or visual acuity.
Plant-based meat alternatives, despite being ultra-processed, may be healthier for the heart than meat, in a systematic review showing that total cholesterol, LDL cholesterol and body weight, improved when various animal-based meats were replaced with a substitute made from plants.
A smaller amount of gut bacteria that produce riboflavin and biotin where associated with the development of Parkinson's disease (PD). These bacteria varied by country. The authors postulate that decreased short chain fatty acids and polyamines reduce the intestinal mucus layer, which subsequently facilitates the formation of abnormal α-synuclein fibrils in the intestinal neural plexus in PD, and also cause neuroinflammation in PD.
