Geriatric Update July 29, 2024

Blood pressure management in the hospital should occur, unless the patient is frail, end of life, has baseline good control at home, or hospital associated functional or cognitive impairment.

Frailty based on the electronic frailty index (36 items) predicted mortality over 12 months: 13% of those who were fit and 48% who were classified as severely frail died, avg age was 77 years.

Those who had a COVID-19 infection had a roughly 50% reduced risk of developing symptomatic illness from endemic coronaviruses that cause the common cold. COVID-19 vaccination alone didn't because CD8 killer T cells target 2 nonstructural proteins of the virus genome that’s not present in the COVID-19 vaccines.

If all states had imposed Covid-19 restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period.

studies have challenged that alcohol consumed at low levels can protect against serious diseases, such as heart disease, stroke and type 2 diabetes. Although many observational studies suggest that people drinking at “moderate” (i.e., low-volume) levels live longer and have fewer illnesses than “abstainers,” the usual reference group of abstainers fills up among older cohorts with people who have stopped or cut down on their drinking for health reasons. The appearance of protection against all-cause mortality for low-volume drinkers vanished when a measure of lifetime rather than recent drinking was incorporated.

Greater nurse practitioner involvement at end of life showed fewer hospitalizations and higher hospice use among 334,618 US nursing home residents with dementia. The adjusted differences were larger with extensive vs minimal NP care in states with full scope of practice regulations than in states with restrictive regulations.

D-dimer testing for acute aortic syndromes (life-threatening aortic dissection, intramural thrombus, or penetrating aortic ulcer) found a sensitivity of 96.5% and a specificity of 56.2% in patients suspected of having acute aortic syndromes. This is similar to the sensitivity and specificity of D-dimer testing for pulmonary embolus.

Another article supporting apixaban, this time in patients with atrial fibrillation and cirrhosis. Rivaroxaban had significantly higher rates of major hemorrhagic events (HR, 1.47 [CI, 1.11 to 1.94]), and warfarin (HR, 1.38 [CI, 1.03 to 1.84]), particularly hemorrhagic stroke (HR, 2.85 [CI, 1.24 to 6.59]), with similar rates of ischemic events or death.

In healthy older adults, avg age 73 yo, low-dose aspirin does not affect the progression of age-related hearing loss.

Each additional 2 hours of TV watching per day associated with a 12% reduction in likelihood of healthy aging. Light physical activity was associated with a significant increase in healthy aging, with a 6% increase in the likelihood of healthy aging for each additional 2 hours of light activity. Each additional 1 hour of moderate to vigorous activity was associated with a 14% increase in the likelihood of healthy aging.

Tirzepatide resolved Metabolic dysfunction–associated steatohepatitis (MASH) without worsening fibrosis: 10% in the placebo group, 44% in the 5-mg tirzepatide group, 56% in the 10-mg, and 62% in the 15-mg tirzepatide group. improvement of at least one fibrosis stage without worsening of MASH was 30% in the placebo group and about 50% across the tirzepatide dosages.

Empagliflozin may be slightly better than dapagliflozin in the combination of all-cause mortality or hospitalization 32.2% vs. 34.8 and less hospitalization. However, all-cause mortality, mean hemoglobin A1c, or adverse events did not differ between groups in this NIH supported study.

Men at higher genetic risk accounted for 88% (94 of 107) of early prostate cancer deaths. Men at higher genetic risk had more than a threefold higher rate of early (HR, 3.26) and more than a twofold increased rate of late prostate cancer death (HR, 2.26) than those with lower genetic risk. A healthy lifestyle, diet, exercise, and particularly BMI <30 and not smoking may prevent 22%-36% of early prostate cancer deaths among men at higher genetic risk.

People with central obesity were 13% more likely to develop neurodegenerative diseases than people with low levels of central obesity. Those with high levels of arm fat were 18% more likely, while people with high muscle strength were 26% less likely to develop neurodegenerative diseases than those with low levels of strength. This was partly explained by the occurrence of cardiovascular diseases after the start of the study.

This blood test has made the headlines of all news channels: the combination of plasma p-tau217 and Aβ42/40 showed better performance, area under the curve (AUC) = 0.949; 95% CI, 0.929-0.970; P <.02, than individual biomarkers. While an AUC (sensitivity over specificity) of 0.95 is excellent, the study is based on a convenience sample of 983 cognitively unimpaired individuals avg age 65.7 comparing the blood test with positron emission tomography (Aβ-PET) or cerebrospinal fluid (CSF) Aβ42/40, not patient oriented outcomes such as: cognitive testing, functional status or progression of cognitive decline. And what can we do with the results, current treatments are no panacea.

Among women with breast cancer, who had a lumpectomy or a mastectomy and kept their other breast did just as well as women who had a double mastectomy. There is no survival advantage to having the other breast removed and most women did very well – the chance of cancer in the other breast was about 7% over 20 years. Deaths from breast cancer were 8.54% in the lumpectomy group, 9.07% in the unilateral mastectomy group, and 8.50% in the bilateral mastectomy group.

The Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. In a validation study, a point total ≥25 showed a CT scan is indicated, had a sensitivity of 100.0% (95% CI: 96.0-100) and specificity of 12.3% (95% CI: 10.9-13.8), for significant intracranial injury and need for neurosurgical Intervention:

• Arrival via Emergency Medical Services (+30 points)

• Glasgow Coma Scale (GCS) <15 (+20 points)

• GCS <14 (+50 points)

• antiplatelet medications (+17 points)

• loss of consciousness (+16 points)

• signs of basilar skull fracture (+50 points)

• headache (+20 points)

Medicare drug price negotiations are approaching their final stage, with agreed prices for 10 key medications,

4 diabetes meds and 2 direct oral anticoagulants will affect older adults most.

With summer heat, this BBC Inside Science podcast, explaining our comfortable temperature, starts at 25 min.