Geriatric Update Feb 5, 2024

The latest versions of COVID-19 vaccines were 54% effective at preventing symptomatic infection in adults, according to the CDC that looked at 9,000 people who got tested for COVID-19 at CVS and Walgreens pharmacies, checking who tested positive and whether they had gotten a new shot or not. The 54% figure “is similar to what’s been reported in other countries, and it’s also about what was reported for an earlier vaccine version. Vaccine manufacturers updated their formulations to target the Omicron variant XBB.1.5, which was predominant much of 2023. The latest vaccines are similarly effective against JN.1, which has been causing most Covid-19 infections in the United States since late December. The vaccines are highly effective a preventing severe disease, hospitalization and death.

This paper evaluated 702 Brazilians with a nutritional questionnaire and followed the incidence of COVID-19 among them. The authors controlled for the healthier lifestyle choices that is generally associated with vegetarians, including educational status, history of chronic disease, smoking, BMI, physical activity, and the number of personal contacts. The findings were most significant when they combined the data into two main groups — omnivores and vegetarians. The vegetarian group had the lowest incidence of COVID-19 with an odds ratio of 0.61, or a 39% lower incidence of COVID-19. There was no difference in the duration or severity of COVID-19 between the omnivores and the vegetarians. Eating less meat and dairy while eating more vegetables, legumes, and nuts was associated with the lowest incidence of COVID-19.

Moderate-to-severe cognitive slowing was evident among 270 long COVID (PCC) patients from UK and Germany compared with age-matched healthy individuals who had previous symptomatic SARS-CoV-2 infection and recovered. On the 30 second repetitive reaction time test, patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. On the Number Vigilance Test, 53.5% of patients with PCC's response speed was >2 standard deviations slower from the control mean.

Another German study of 3038 patients with long COVID (PCC), at baseline, median 9 months after infection, 21% had fatigue and 23% had cognitive deficits according to cutoff scores on the FACIT-Fatigue or MoCA. On follow-up, median 26 months after infection, 46% had recovered from fatigue and 57% had recovered from cognitive deficits.

From the CDC webinar on COVID and influenza:

• The Liverpool website allows interaction check with Paxlovid

• Molnupiravir does not reduce hospitalization and has efficacy of only 30% compared to 88% with Paxlovid and 87% with remdesivir. (15 min)

• Website to get free Paxlovid, depending on insurance coverage.

• Best prevention for long covid is COVID vaccination.

• Baloxavir is slightly better at reducing duration of symptoms by 1 day and viral spread compared to oseltamivir. The cost is $166 vs. $26 for an adult course. (slide 52)

Merck, the manufacturer of molnupiravir reported that, it is safe to be put into soft foods such as apple sauce and pudding providing it is approximately 200 calories or less. I don’t understand the reason for the calorie limit….

In geriatric and other news:

In patients with heart failure with preserved ejection fraction (HFpEF) and obesity, semaglutide produced large improvements in heart failure related symptoms, physical limitations, exercise function, inflammation, body weight, and N-terminal pro-brain natriuretic peptide, regardless of baseline health status.

Patients (avg age 61) on sodium-glucose cotransporter 2 inhibitors (SGLT-2) had lower risk of kidney stones than patients on GLP-1 or DPP-4 meds.   This makes sense as it increases flow through the kidney. I am concerned with our older patients who often don’t drink enough fluids, of getting dehydrated on this medication. An easier way to prevent kidney stones is to encourage more fluid intake.

Participants with sleep apnea were significantly more likely to feel sleepy while driving, use at least one coping strategy "frequently" vs control participants (43.7% vs 10.5%; P ≤ .0001) rolling down the window, drinking tea or coffee, or listening to music at a high volume, or have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).

Patients hospitalized with ischemic stroke and cardiac intervention were much less likely to receive endovascular thrombectomy (EVT) than those without cardiac intervention (adjusted odds ratio [aOR], 0.27; 95% CI, 0.23-0.31). Yet those receiving EVT had a 2-fold higher chance of discharge home (aOR, 2.21; 95% CI, 1.14-4.29).

Aerobic exercise, as measured in cardiorespiratory fitness (CRF) in 57,652 men over 6.7 years, reduced prostate cancer. In those with increased fitness, the risk of prostate cancer incidence decreased by 35% compared with those with decreased fitness (HR 0.65, 95% CI 0.49 to 0.86).

In Chinese patients >60 years old, the prevalence of mobility impairment was 30.4% (95% CI = 28.8-32.1 %). The average age was 67 but those with mobility impairment were on average 4 years older. The standardized incidence (new onset) of mobility limitation in 2 years was 18.1% (95% CI = 15.8-20.4 %). A total of 189 patients died during the follow-up period. After adjusting for sociodemographic factors and chronic diseases, mobility limitation was associated with an almost double risk of death (odds ratio = 1.84, 95% CI = 1.33-2.55, P < .001).

7139 women (age 67.7) participated in leisure-time physical activity at or above the level recommended by the World Health Organization (150 to <300 min/wk) was associated with 25% reduced odds of noninjurious falls, those with ≥300 min/wk: with 35% reduction.  For injurious falls 150 to <300 min/wk: 30% and ≥300 min/wk: 23%, regardless of the type of activity.

Complementary health approaches for pain mgmt. have increased from 42% to 49% over the last 20 years. The biggest increase was in the use of yoga for pain from 11% in 2002 to 23% in 2012 and 29% in 2022.

The CDC encourages physicians to test for PFAS, forever chemicals that have been associated with increase in cholesterol levels, decrease in birth weight, lower antibody response to vaccines, kidney and testicular cancer, pregnancy-induced hypertension, preeclampsia, and changes in liver enzymes. PFAS are in packaging, another reason to avoid ultraprocessed food, in clothes that repel water and dirt, in furniture and carpet, and about 20% from water supply. The Cincinnati water supply is actively filtering out PFAS in treated water.

This Ted Talk is a brief summary of the Turn-Away Study on effects of abortion.

The VA’s federal Ending Veteran Homelessness initiative decreased veteran homelessness 55.3% compared with 8.6% for the general population. The Housing First program included housing vouchers, grants to community partner agencies, and growth in VA clinical and social programming to provide homeless-tailored wrap-around services and support once participants were housed.

After World War I, in 1928, 60 Nations signed a pact, initiated by U.S. Secretary of State Frank B. Kellogg and French Minister of Foreign Affairs Aristide Briand, deterring future conflict. Only 3 years later, in 1931, the Japanese invasion of Manchuria, China, began the cascade that led to WW II. The Kellogg-Briand Pact failed possibly because it allowed for self defense of nations, and there weren’t any real legal consequences for violations. Today it may be different with the international criminal court.