Geriatric Update Jan 8, 2024
All vaccine uptake in the US is alarmingly low, this has led to measles outbreaks with hospitalization of 42% of infected children! For the updated COVID-19 vaccine (XBB.1.5 monovalent) uptake is only about 35% in >65 year olds, which is about half the rate of this age group in the UK. The authors suggest to counter the current large volume of vaccine misinformation by diluting it with large amounts of truthful, accessible scientific evidence.
Compared with untreated persons (n = 55), those taking Paxlovid (n = 72) were older, received more COVID-19 vaccinations, and more commonly had immunosuppression. Fifteen participants (20.8%) taking Paxlovid had viral rebound (VR) vs 1 (1.8%) who was untreated (absolute difference, 19.0 percentage points [95% CI, 9.0 to 29.0 percentage points]; P = 0.001). All persons with VR had a positive viral culture result after a prior negative result. In multivariable models, only Paxlovid use was associated with VR (adjusted odds ratio, 10.02 [CI, 1.13 to 88.74]; P = 0.038). I would be interested in seeing if tapering the course by increasingly raising the interval of Paxlovid during the course could reduce VR.
This NY Times article describes the damage COVID does to lungs and shows it in impressive 3-D videos.
In Geriatric and Other News,
The high dose, quadrivalent recombinant influenza vaccines contain three times the amount of hemagglutinin protein as standard-dose egg-based vaccines, and the recombinant formulation is not susceptible to antigenic drift during manufacturing. We have been using it with success in patients >65 for several years. In 50-64 yo the recombinant-vaccine group had 2 cases per 1000 vs. 2.34 cases per 1000 in the standard-dose group. Though statistically significant, the difference is not as great as in the older adult population, and in the younger group there was no difference in hospitalizations.
Of 9885 participants, mean age of 48.6 years (SD 18.1) at baseline, the prevalence of audiometry-measured hearing loss was 14.7% and the all-cause mortality rate was 13.2% at 10·4 years of follow-up. Hearing loss was an independent risk factor associated with higher mortality (adjusted hazard ratio [HR] 1.40 [95% CI 1·21–1·62]). Regular hearing aid use was only 12.7%, but in them, compared with never users, mortality was an impressive 24% lower (adjusted HR 0·76 [0·60–0·95])! There was no difference in adjusted mortality between non-regular hearing aid users and never users (adjusted HR 0·93 [0·70–1·24]).
This article describes the health benefits of “dry January” or avoiding alcohol during the 1st moth of the year, along with approaches how to accomplish it.
The app Health & Her reduced menopausal symptoms by half in this UK study.
A systematic review and meta-analysis of 11 RCT showed that 30-60 min aerobic exercise 3-5 times a week improved erectile function scores by 2.8 points on a 30 point scale over controls, with the greatest benefit, 4.9 points, for those with severe erectile dysfunction.
Patients started on oral anticoagulants, also started on proton pump inhibitors (PPIs) had a 20% lower risk of upper gastrointestinal bleed. Make sure to also start vitamin B-12 as PPIs decrease B-12 absorption, leading to deficiency over about 9 months, and B-12 deficiency is a common cause of neuropathy.
Of 68,263 teens, 2.5 % had cannabis use disorder and 10.2% had occasional use. Occasional users had 2 to 4 times greater odds of all adverse psychosocial events examined:
major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08)
suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29)
slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96)
difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00)
truancy (aOR, 1.90; 95% CI, 1.67-2.16)
low grade point average (aOR, 1.80; 95% CI, 1.62-2.00)
arrest (aOR, 4.15; 95% CI, 3.17-5.43)
fighting (aOR, 2.04; 95% CI, 1.80-2.31)
aggression (aOR, 2.16; 95% CI, 1.79-2.62)
“Love, like strength and courage, is a strange thing; the more we give the more we find we have to give.”
Olga Jacoby
