Geriatric Update Jan 13, 2024
In patients after traumatic brain injury, donepezil was associated with significantly greater improvements in verbal learning in both modified intent-to-treat and per-protocol analyses (P = .034 and .036, respectively) than placebo.
Treatment-responder rates were significantly higher in the donepezil group than in the placebo group (42% vs 18%; P = .03), with improvements in delayed recall and processing speed. Diarrhea and nausea, led to the number needed to harm of 6.25 and a likelihood to be helped ratio of 1.79. There was no mention of bradycardia, which likely would have not been an issue in the 37 year old study population.
Nighttime and weighted 24-hour day-evening-night aircraft noise levels, provided by the UK Civil Aviation Authority for 2011, were associated with cardiovascular magnetic resonance (CMR) imaging abnormalities and were connected with a 4 times higher risk of major adverse cardiac events (MACE) , based on health data from UK Biobank participants living near 4 UK major airports (London Heathrow, London Gatwick, Manchester, and Birmingham).
Body weight, waist circumference, and body fat measures decreased linearly in association with increasing duration of aerobic exercise to 300 minutes per week. While 30 minutes of aerobic exercise per week was associated with modest reductions in body weight, waist circumference, and body fat measures in this meta-analysis of 116 randomized clinical trials involving 6880 adults with overweight or obesity, aerobic training exceeding 150 minutes per week at moderate intensity or greater may be needed to achieve clinically important reductions.
Adopting a combination of healthy lifestyle behaviors – high dietary quality, active physical activity, optimal sleep, never smoking, moderate or less drinking and maintaining a healthy weight – was associated with lower odd[s] of obstructive sleep apnea.
The older someone gets, the more genetics seem to matter. Overall, scientists think that how long we live is about 25 percent attributable to our genes, and 75 percent attributable to our environment and lifestyle. But as people near 100 and beyond, those percentages start to flip.
Adopting 8 healthy behaviors could add up to 24 years to people’s lives, found the VA’s Million Veteran Program (2011–2019. They included eating a healthy diet, getting regular physical activity, sleeping well, managing stress, having strong relationships, and not smoking, abusing opioids or drinking to excess.
A higher plant-to-animal protein ratio was associated with lower risks for CVD [HR: 0.81; 95% confidence interval (CI): 0.76, 0.87; P trend < 0.001], CAD (HR: 0.73; 95% CI: 0.67, 0.79; P trend < 0.001), but not stroke (HR: 0.98; 95% CI: 0.88, 1.09; P trend = 0.71), when comparing highest to lowest deciles, among adults in three ongoing U.S. prospective cohort studies: 70,918 women in the Nurses’ Health Study, 89,205 women in the Nurses’ Health Study II and 42,740 men in the Health Professionals follow-up study. Replacing red and processed meat with several plant protein sources showed the greatest cardiovascular benefit. When switching to plant protein, make sure to include legumes at least every 24 hours to complement grains.
The NY Times published this article on 10 ways to eat healthier:
Eat more legumes
Scale back on sweet drinks
Put vegetables in everything
Eat fewer ultraprocessed foods
Take a walk after meals
Try eating three square meals per day
Make big batches of food when you can
Use convenience foods to build healthy meals
Go easy on alcohol
If your relationship with food has suffered, work on improving it
Among almost 100 dietary factors analyzed, calcium had the greatest association. For every 300 mg of daily calcium intake, the risk of CRC decreased by 17%.
People who primarily drink coffee in the morning may have a lower risk of dying prematurely: all-cause (hazard ratio: .84; 95% confidential interval: .74–.95) and cardiovascular disease-specific (hazard ratio: .69; 95% confidential interval: .55–.87) mortality than people who sip coffee throughout the day or skip it altogether.
Although gut microbiome and dysbiosis are connected to brain health, among initially healthy older adults, any or repeated antibiotic use was not associated with incident dementia, incident cognitive impairment, no dementia (CIND), or accelerated cognitive decline.
Use of any anticholinergic drug increased the risk for dementia (adjusted odds ratio, 1.18). Men had a greater elevation of risk than women (adjusted odds ratio, 1.22 vs 1.16). Lower and higher total standardized daily doses (366-1095 and >1095) vs none, the risk for dementia was for: oxybutynin hydrochloride (adjusted odds ratios, 1.31, and 1.28), solifenacin succinate (1.18, and 1.29), and tolterodine tartrate (1.27 and 1.25). The risk for dementia was elevated by the use of mirabegron at total standardized daily doses of 91-365 and 366-1095 (adjusted odds ratios, 1.27 and 1.62), Five other anticholinergics (darifenacin, fesoterodine fumarate, flavoxate hydrochloride, propiverine hydrochloride, and trospium chloride) were not significantly associated with elevated risk. The association is weak as the odds ratio is <2, and some meds may not have reached significance because of small prescribing numbers. I have not found worsening when I discontinued my patients’ bladder meds, so I think there is a strong placebo effect. I recommend weight loss to reduce intraabdominal pressure and prescribe Kegel exercises >48 times daily with good effect. (Most providers don’t recommend enough or patients don’t do that many.)
This Top Story of 2024 titled: How We Apply Science and Evidence to Major Federal Policy, addresses good policy is good preventive care, and that research and science can best inform policy.
