Geriatric Update Dec 23, 2024

Obesity dipped slightly in U.S. adults from 46%to 45.6% in 2023– the first time in more than a decade that the US has seen a downward trend, likely due to GLP-1 meds. The largest drop occurred in Blacks, women and adults ages 66 to 75, while Asians saw an increase.

In a meta-analysis, brexpiprazole and risperidone have been shown to be effective in reducing agitation and/or aggression in patients with dementia. Of course, non-pharmacologic interventions should be first line.

Duloxetine capsules lot# 220218 were voluntarily recalled, and the U.S. Food and Drug Administration (FDA) assigned the recall as a class II risk. The risk level is the FDA’s second most severe level as it could cause ‘temporary or medically reversible adverse health consequences’. The contaminant is a nitrosamine, which can be carcinogenic, and is also found in foods such as processed meet (to keep it from turning brown) and vegetables.

The FDA adds Boxed Warning for increased risk of severe hypocalcemia in patients with advanced chronic kidney disease, taking osteoporosis medicine Prolia (denosumab).

The odds for depression decline as daily step levels rise, up to a level of about 10,000 steps per day. Compared with fewer than 5000 steps/d, achieving 5000 or more was associated with reduced depressive symptoms in cross-sectional studies, whereas a daily step count of 7000 or higher was associated with lower risk of depression in prospective studies, based on a systematic review and meta-analysis of 33 observational studies involving 96,173 adults.

Mindfulness meditation appeared to be similar to escitalopram (Lexapro) in reducing anxiety symptoms at 8 weeks based on several patient- and clinician-reported measures, based on a secondary analysis of a randomized clinical trial.

Treatment of subclinical hypothyroidism in older adults with TSH <10 can cause anxiety, osteoporosis, A-fib, dementia and much more.  The American Thyroid Association (ATA) recommended in 2014 to not treat asymptomatic patients if TSH s <10 and keep TSH between 4-6 in older symptomatic patients, requiring replacement.  At the 2024 ATA conference, the most significant study was thought to be about the  importance of age-based reference ranges at younger ages, for women >50 and men >60 and free T4 levels age >70.

Age-related macular degeneration (AMD) was greater in patients with obstructive sleep apnea (OSA) compared to the control cohort:

• nonexudative AMD (HR, 2.64, 95% CI, 2.37 – 2.96; P<.001) over 5 years,

• exudative AMD (HR, 2.48, 95% CI, 1.99 – 3.11; P=.002)

• requiring anti-VEGF therapy (HR, 2.85, 95% CI, 2.26 – 3.59; P<.001).

Individuals with non-advanced AMD with diagnosed OSA were associated with an elevated risk of:

• geographic atrophy (GA; HR, 7.00, 95% CI, 4.47 – 11.0; P=.03),

• exudative AMD (HR, 2.87, 95% CI, 2.37 – 3.48; P=.03),

• requiring anti-VEGF injections (HR, 4.72, 95% CI, 3.59 – 6.22; P=.02) compared to those with non-advanced AMD without diagnosed OSA.

The advisory committee to the Agriculture Department, suggest that the protein-packed legumes are the perfect substitute for red or processed meat. They came to that conclusion after analyzing scientific evidence on the topic. In addition to plant-based proteins they also recommend >50% of grains to be whole grains and encourage people to eat less salt, sugary drinks, and all processed foods.

Men who opt for watchful waiting instead of treatment for a low-risk prostate cancer might improve their odds if they take fish oil supplements, or change their diet. The Ki-67 index, a biomarker for prostate cancer progression, metastasis, and death, decreased in the diet or fish oil group by approximately 15% from baseline to 1 year (1.34% at baseline, 1.14% at 1 year) and increased in the control group by approximately 24% from baseline to 1 year (1.23% at baseline, 1.52% at 1 year). Longer studies with patient oriented outcomes are needed to confirm findings.

Catheter ablation of atrial fibrillation compared with conventional medical therapies was associated with reduced risk of heart failure events in patients with reduced ejection fraction, while no benefit was observed in patients with preserved ejection fraction, based on a systematic review and meta-analysis of 12 randomized clinical trials including 2465 participants.

Hospices have been acquired by private equity firms (PEFs) and publicly traded companies (PTCs). Across all Consumer Assessment of Healthcare Providers and Systems (CAHPS) data measures, PEF/PTC-owned hospices demonstrated the lowest performance 79.8 (5.2) points and not-for-profit hospices the highest performance 83.1 (4.3) points.

Beer and cider, more than red wine and other types of alcohol elevated the risk for gout among men more than women, age 56 (men: HR, 2.05 [95% CI, 1.84-2.30]; women: HR, 1.34 [95% CI, 1.12-1.61]) over 2 years. 

Diets higher in inflammatory foods were tied to an increased incidence of dementia in older adults, avg age 69, over 13 years of follow-up, from the Framingham Heart Study. Higher Dietary Inflammatory Index (DII) scores averaged across three time points were linearly associated with an increased incidence of all-cause dementia and Alzheimer’s disease.

Individuals who developed an acute kidney injury (AKI) by  clinical diagnoses and transient creatinine elevations according to Kidney Disease Improving Global Outcomes criteria, were at a significantly greater risk of a subsequent dementia diagnosis was 2-fold higher after an AKI episode (36.99 per 1,000 person-years, 95% CI 36.23–37.75) compared with before (17.34 per 1,000 person-years, 95% CI 17.17–17.52). After adjustment for age and other cofounders (HR, 1.49, 95% CI 1.45–1.53). Dementia was established by the presence of 2 issued dementia diagnoses in outpatient care, or initiation of specific antidementia medications, with the association consistent across all dementia types in 305,122 individuals with a median age of 75 years, over 12.3 years follow up. Possible mechanisms are increased vascular permeability, disruption of the blood-brain barrier, peripheral inflammation leading to brain inflammation, hippocampal inflammatory response, retention of neuronal toxins, hypoperfusion and reduced central dopamine turnover, resulting in cognitive impairment, anxiety, depression, and subsequent dementia. More info in “crosstalk between the nervous system and the kidney.”

In participants with obesity, control of each of 6 modifiable risk factors: Blood pressure, A1c levels, LDL-C cholesterol, albuminuria, smoking, and physical activity, contributes to an 11% reduction of chronic kidney disease (hazard ratio: 0.89; 95% confidence interval: 0.86–0.91). If all 6 are controlled, the risk is reduced to half (49%).

From 1990 to 2021, age-standardized disability-adjusted life years (DALY) and deaths attributable to BM >25 kg/m2 increased by 24.9%, whereas the age-standardized death rates increased by 5.2%. Age disparities showed DALYs peaking at 60-64 years for males and 65-69 years for females.

Diagnosis of type 2 diabetes 1 month after a COVID diagnosis among adolescents 10 to 19 years old had a 55% higher risk for a new compared with peers diagnosed with a non-COVID respiratory infection.

Women with endometriosis do not have a higher risk for COVID-19 infection  (RR = 1.42; 95% CI, 0.88-2.27), nor worsened symptoms of menstrual flow, intermenstrual bleeding and pelvic pain  with mRNA vaccinations, but may experience temporary increases in dysmenorrhea.

Cannabinoid-based medicines are widely used in older people but adverse effects are not widely known. This review of 58 RCTs (37 moderate-high quality studies) showed that tetrahydrocannabinol (THC) dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.

Cryoneurolysis is a freezing procedure to treat rib fracture pain for several weeks. A 3.5 in probe causes a small lesion, about 16 mm x 8 mm, which is enough to engulf the nerve and pretty much stun it. It causes axonotmesis, and only destroys the myelin sheath and the axon but the epineurium, the endoneurium, and the perineurium — the inner workings of the nerve — stay intact, allowing it to regrow.