Geriatric Update Dec 16, 2024

Respiratory syncytial virus (RSV) vaccine was 75% effective in preventing hospitalization in patients 60 years and older. Individuals who tested positive for RSV (case patients) were compared with controls who tested negative for RSV, flu, and COVID-19. 

For chronic constipation treatment, abdominal massage increased weekly stool frequency (MD = 1.59; 95 % CI 1.06, 2.11), decreased gut transit time (MD = -21.53 h; 95 % CI -35.94, -7.12) and decreased constipation symptoms (SMD = -1.06; 95 % CI -1.33, -0.80; df = 18; I2 = 79 %) as compared to the control group; however, it did not reduce laxative use.

After age 85, compared with white adults, significantly more non-Hispanic Black, Hispanic, and Asian adults reached centenarian status, age of 100 years, with Asians having the greatest longevity. The authors think that healthier diet lower tobacco use and lower average body mass index contribute.  My theory for the Hispanic paradox is the higher intake of legumes that provide lysine, lacking in grains, which are prevalent in the western diet. 

Higher urinary levels of the elements: arsenic, cadmium, cobalt, copper, tungsten, uranium, and zinc were individually associated with dementia over 20 years, with hazard ratios per IQR of metal ranging from 1.15 (95% CI, 1.03-1.29) for tungsten to 1.46 (95% CI, 1.06-2.02) for uranium. The joint hazard ratio of dementia comparing percentiles 95th with the 25th of the 9-metal mixture (lead and manganese in addition to the 7 above) was 1.71 (95% CI, 1.24-3.89), with no significant difference by APOE4 status. An increase in the 9-metal mixture from the 25th to the 95th percentiles, was comparable with the association of a 6-year increase in age with the outcome. Another argument for a clean environment.

FINGER is a Finnish multidomain intervention study of patients 60-77 years old, at risk of developing dementia. Participants in the intervention group had lower use of hospital inpatient care (RR 0.73, 95% CI 0.54-1.00) and emergency services (RR 0.83, 95% CI 0.70-0.97) than those in the control group. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68-0.99).

This study measured longer term effects of moderate to vigorous physical activity started at age 45 in 1505 participants, age 57.6 years at start, on three main outcomes: cognitive status, conversion to cognitive impairment and dementia, and mortality over 12 years.

Telephone calls by laypersons decreased HgA1c from 10.1% (1.9%) at baseline to 8.9% (1.8%) at 6 months. Layperson callers had a Bachelor education but no health care background and received 8 hours of training in empathetic interviewing. The 260 participants with diabetes, who were called, were 49 years old and 75% had high school or less education.

Metformin, 1700 mg daily with or without mediterranean diet prevented age-related morbid events in people with metabolic syndrome. Over 3 years

Healthcare workers' perception and experience in communicating with people over 50 about vaccines was evaluated in a Cochrane review. Some healthcare workers thought it was important to provide information but emphasized the right and responsibility of older adults to decide for themselves. Others used information to persuade and convince older adults to vaccinate in order to increase 'compliance' (the extent to which a person correctly follows health advice) and 'improve' vaccination rates, and in some cases to gain financial benefits. Other healthcare workers tailored their approach to what they believed the older adult needed or wanted (moderate confidence).

Active monitoring for low-risk ductal carcinoma in situ (DCIS) of the breast was noninferior to guideline-concordant care (surgery with or without radiation therapy). Over 2 years, ipsilateral invasive cancer was 5.9% in the guideline-concordant care group vs 4.2% in the active monitoring group of avg 63 year old women. 

Clozapine is effective in treatment-resistant schizophrenia but prescribed to only 148,000 of the estimated 1 million people with treatment-resistant cases in the United States because of barriers and red tape.

A Food and Drug Administration (FDA) panel voted 14-1 against the Clozapine Risk Evaluation and Mitigation Strategy (REMS), designed to monitor for the relatively rare side effect of neutropenia, most likely to occur in the first 18 months of clozapine treatment. The dissenting voter wanted to keep some warning during early treatment

In 133,760 hospitalized veterans  from 2015-2020, as-needed blood pressure medication use was associated with a greater risk of acute kidney injury RR 1.23; 95% CI, 1.18-1.29), rapid drop in blood pressure 1.5-fold greater risk of rapid BP reduction (RR 1.5; 95% CI, 1.39-1.62), myocardial infarction (RR, 2.92; 95% CI, 2.09-4.07), stroke (RR, 1.99; 95% CI, 1.30-3.03), and death (RR, 1.52; 95% CI, 1.32-1.75). My theory is that dehydration is the underlying mechanism, and I have observed BP spikes with dehydration that went away with hydration.

In a cohort study assessing 66,387 data points from 16,236 unique veterans, a 1% increase in the percentage of virtual mental health visits relative to the total visits was associated with a statistically significant 2.5% decrease in suicide-related events. 

English youths, who persisted smoking tobacco from childhood, showed significant cardiac damage by age 24 years and potentially irreversible cardiac injury.

Glyphosate use in the United States (US) has increased each year since the introduction of glyphosate-tolerant crops in 1996. This study exposed mice to glyphosate daily for 13 weeks followed by a 6-month recovery period and showed reduced survival, increased disorientation, significant increases in the beta secretase enzyme (BACE-1) of amyloidogenic processing, amyloid-β (Aβ) 42 insoluble fractions, Aβ 42 plaque load and plaque size, phosphorylated tau (pTau) and increased pro- and anti-inflammatory cytokines and chemokines.