Geriatric Update Oct 7, 2024

Endovascular thrombectomy of basilar artery occlusion within 12 hours of stroke, was associated with excellent outcome (modified Rankin Scale score 0-1) at 1 year compared with 90 days function increased in the thrombectomy group (62 of 222 [27.9%] vs 45 of 226 [19.9%]) but not in the control group (9 of 108 [8.3%] vs 9 of 114 [7.9%]) resulting in a magnified treatment benefit. 

57% of U.S. adults have a pro-inflammatory diet, and that number was higher for Black Americans, men, younger adults and people with lower education and income, based on the National Health and Nutrition Examination Survey (NHANES) 20 year data. Inflammation was based on the dietary inflammatory index that correlated 45 food patterns to the effect on six inflammatory biomarkers: IL-1β, IL-4, IL-6, IL-10, TNF-α and C-reactive protein.

Life's Essential 8 (LE8) were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001). LE8 include: health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure).

Nurse-supported self-directed cognitive behavioral therapy intervention was more effective than health education control for reducing insomnia severity and improving sleep outcomes. At 8 weeks, Insomnia Severity Index (ISI) scores decreased by 5.7 points in the intervention group and 2.0 points in the control group, (95% CI, -5.0 to -2.4; P < .001), on the ISI (score range, 0-28; remission <8; differential improvement of 3 points targeted) . Although less effective than therapist-delivered CBTI, in a randomized trial of 176 veterans. 

Adults who ate more flavonoid-rich foods, had a significantly lower risk for dementia, and individuals with depressive symptoms or hypertension, benefited even more from higher adherence to a flavonoid-rich diet in the 121,986 UK Biobank participants (adjusted hazard ratio [AHR], 0.72; 95% CI, 0.57-0.89). after multivariable adjustment, those at high genetic risk (AHR, 0.57; 95% CI, 0.42-0.78), and those with depressive symptoms (AHR, 0.52; 95% CI, 0.33-0.81) had the most benefit. Flavonoid-rich foods include: Berries, leafy green vegetables, dark chocolate, tea, onions, red vegetables.

A 16-week, 24-session nurse-led art-based cognitive intervention program showed greater improvement than the control group in general cognitive functions (MoCA, between-group mean difference, 1.4 [95 % CIs, 0.4 to 2.5], p = 0.009), including language, memory, quality of life, sleep quality and physical activity level after the intervention. Statistically significant group differences remained in sleep quality (PSQI, between-group mean difference, -1.3 [95 % CIs, -2.5 to -0.1], p = 0.035) at the 6-month follow-up in this randomized, wait listed trial of 144 participants with Alzheimer’s, aged 71.6.

Osteoarthritis knee pain decreased from 6.4 at baseline to 5.1 at 6 months in the methotrexate group and from 6.8 to 6.2 in the placebo group. There were also improved stiffness and function at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) (max 8 points) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008) (max 68 points). Four unrelated serious adverse effects were reported (methotrexate: 2, placebo: 2).

This study describes a direct to patient intervention for deprescribing sedative meds. Most of the 565 participants, age of 72.1 years, used benzodiazepines for insomnia (87.1%) but there were 12% that said they were using them for chronic anxiety, with a mean benzodiazepine use duration of 11.4 years. The direct to patient intervention consisted of Sleepwell: a cover letter and 2 booklets (“How to Stop Sleeping Pills” and “How to Get Your Sleep Back”), had the highest rate of sedative discontinuation and dose reduction, as well as improvements in sleep outcomes compared with, updated versions of informational booklets from the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study, and treatment as usual. The number needed to mail to have 1 person discontinue long-term sedative use was 5.3 with Sleepwell and 7.8 with EMPOWER.

Older adults (n=668) age 76.8, diagnosed with a blood cancer exhibited similar rates of cognitive decline as propensity matched cancer-free controls.

Thank you, Joe: After adjusting for factors like age, gender, and medical history, regular laxative users had higher risk of developing dementia, but only for people who used osmotic laxatives: all-cause dementia (HR 1.64; 95% CI 1.20–2.24) and vascular dementia (HR 1.97; 95% CI 1.04–3.75) and not for Alzheimer’s dementia. Over 9.8 years, 1.3% of those who regularly used laxatives were diagnosed with dementia vs. 0.4% who did not regularly use them. It may correlate with diet, as higher vegetable and fiber intake has shown to reduce dementia, and exercise, which all help prevent constipation.

Vitamin D improved diabetes labs: Fasting blood glucose, weighted mean difference (WMD; -0.49 [95% confidence interval {CI}: -0.69 to -0.28] mmol/L), HbA1c (WMD -0.30% [95% CI: -0.43 to -0.18]), insulin resistance (WMD -0.39 [95% CI -0.64 to -0.14]) and insulin (WMD -1.31 [95% CI: -2.06 to -0.56] μIU/mL).

In the new constipation guidelines, the American Society of Colon and Rectal Surgeons recommend: Dietary Fiber and increases water intake, followed by Polyethylene glycol (PEG) and magnesium salt.

Rates of breast cancer cases have increased since 2012 by 2.5% a year among older women, but breast cancer deaths continuously declined during 1989–2022 by 44% overall.

Suicide care in primary care led to an increase in the rates of safety planning and a reduction in suicide attempts, compared to usual care (4.5 vs. 6.0 per 10 000 patients; rate difference, −1.5 [CI, −2.6 to −0.4]). The Kaiser Permanente Health System used depression screening, suicide risk assessment, and safety planning, supported by practice facilitators, electronic medical record clinical decision support, and performance monitoring in 953,402 primary care visits.

Florida Health Department and State Surgeon General Joseph Ladapo still question the safety and effectiveness of the mRNA Covid vaccines from Pfizer and Moderna, including for older adults and people with underlying health problems. All the concerns they claim are disproven, e.g.: Studies have shown that the risk of myocarditis is 7 times higher in the Covid infection group than vaccination group (RR: 15 (95% CI: 11.09–19.81, infection group) and RR: 2 (95% CI: 1.44–2.65), vaccine group) and is more severe than the vaccine-associated condition. And people diagnosed with Covid are 5 times more likely to develop POTS after infection post-infection, odds of new POTS-associated diagnoses (n = 1,004, odds = 1.52 (1.33–1.72) than after Covid vaccination 1.10 (1.03–1.17).

This COVID-19 Prognostic Tool estimate mortality rates in patients with COVID-19. Adapted from CDC materials and Chinese data.

Of the 3 COVID treatments, nirmatrelvir/ritonavir (Paxlovid), remdesivir, and molnupiravir, Paxlovid is most effective, reducing hospitalizations by 89% and death by 87% among high-risk, unvaccinated outpatients with mild to moderate COVID-19 illness. Yet, of adults at high risk of severe disease only 16.5% had ever received COVID-19 treatment. Possibly because clinicians fear the drug interactions with Paxlovid. But of 425 medications, only 12 have absolute contraindications for Paxlovid treatment (great table in the article).

Influenza vaccines during the 2024 Southern Hemisphere Influenza season were 35% effective in preventing hospitalizations.