Geriatric Update Feb 12, 2024

In Geriatric and other news:

Use of gabapentinoids was significantly associated with an overall increased risk for severe chronic obstructive pulmonary disease (COPD) exacerbation (hazard ratio, 1.49) compared with nonuse.

I have been writing about the benefits of exercise a lot because there are so many recent studies supporting it. And for benefits on brain health, this TED Talk: Brain changing benefits of exercise is quite informative. However, this umbrella review of randomized controlled trials showed little benefit of exercise on cognition in healthy persons, when controlling for selective inclusion of studies, publication bias and large variation in combinations of pre-processing and analytic decisions.

A systematic review of 63 studies with >15 million subjects, found that reducing or giving up alcohol reduced people's risk for hospitalization, injuries, death, and improved people's physical and mental health and their quality of life. However, cutting back on alcohol did not have the same robust evidence to clearly reduce cancer risk according to the International Agency for Research on Cancer of the World Health Organization (WHO).

The available data support a favorable efficacy versus safety balance for gut-hormone hormone receptor analogues (GLP-1 inhibitors) in the treatment of obesity, however, longer-term data are needed.  The article has a nice figure of side-effects by organ.

In older and frail adults >65,  SGLT2 inhibitors were associated with a significant reduction in the risk of all-cause mortality (risk ratio (RR) 0.81, 95%CI: -0.69 to 0.95), cardiac death (RR 0.80, 95%CI: -0.94 to 0.69) and hospitalization for heart failure (HHF) (RR 0.69, 95%CI: 0.59-0.81). However, SGLT2s did not demonstrate significant effect in reducing HbA1c level, the risk of macrovascular events (acute coronary syndrome or cerebral vascular occlusion), renal progression/composite renal endpoint, acute kidney injury, worsening HF, atrial fibrillation or diabetic ketoacidosis.

The double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL), which was designed primarily to study the effects of vitamin D and Omega 3 supplementation on incident cancer and cardiovascular disease, also showed that 5.3 years of vitamin D supplementation was associated with a 22% lower autoimmune disease incidence (hazard ratio [HR] 0.78, 95% confidence interval 0.61-0.99). Omega-3(n-3) fatty acid supplementation showed a statistically non-significant reduction (HR 0.85, 0.67-1.08). This study evaluated additional 2 years after discontinuation of meds. The protection against autoimmune diseases from daily vitamin D (cholecalciferol; 2000 IU/d) was no longer statistically significant, but the benefits of Omega 3 were: HR 0.98 (0.83-1.17) at 7 years. AD was confirmed in 234 participants initially randomized to Omega 3 fatty acids vs. 280 randomized to its placebo: HR 0.83 (0.70-0.99) at 7 years. What I take away from this study is that vitamin D needs to be continued to get benefit, not sure if Omega 3 is effective. 

In 3015 US Black adults, both individual and cumulative gun violence events was associated with more than double the lifetime suicidal ideation, suicide attempt preparation, and attempting suicide. Being shot was associated with reporting ever planning a suicide (OR, 3.73; 95% CI, 1.10-12.64). Being threatened (OR, 2.41; 95% CI, 2.41-5.09) or knowing someone who has been shot (OR, 2.86; 95% CI, 1.42-5.74) was associated with reporting lifetime suicide attempts.

This is a TED Health talk on population aging.

Short update because I have been sick but am on the mend.