2 Minute Medicine ® - Geriatrics

1. Elderly participants who consumed cannabis 30 minutes before driving in a simulator were found to have increased standard deviation in their lateral position (SDLP), which was used as a measure to determine the amount of swerving a driver experienced.  2.  Blood tetrahydrocannabinol (THC) levels were not significantly correlated with SDLP, though the study was limited by its smaller sample size.  Evidence Rating Level: 2 (good) Study Rundown:   Although prior literature suggests that cannabis consumption increases risks of motor vehicle collisions while under the influence, specifics surrounding the role of tetrahydrocannabinol (THC) levels remains unclear...

1. This prospective study found that low eosinophil counts (< .01 g/L) were significantly associated with acute bacterial infection in older adults, and was more sensitive than a CIBLE score of > 87, but less specific.  Evidence Rating Level: 2 (Good) Sepsis is significantly associated with increased age, as is the incidence of bacterial infection. Oftentimes, older patients present atypically, typical inflammatory markers are not as reliable in this population, and they can be afflicted by distinct pathogens compared to their younger counterparts...

1. In this randomized controlled trial, universal decolonization with topical antiseptics significantly reduced the risks of hospitalization due to infection among nursing home residents as compared to routine care.  2. The number needed to treat (NNT) was 9.7 to prevent one hospitalization due to infection in the nursing home setting. Evidence Rating Level: 2 (Good) Study Rundown: Healthcare-associated infections are a major cause of death among nursing home residents, arising from many sources and affecting a particularly medically vulnerable population...

1. In this randomized controlled trial, complete revascularization reduced the risk of myocardial infarction, stroke, or ischemia-driven revascularization at one year in patients with myocardial infarction compared to culprit lesion revascularization.  2. There was no difference in safety outcomes, including acute kidney injury, stroke, or bleeding, between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: The decision process surrounding the management of myocardial infarction in older adults is challenging...

1. In this randomized controlled trial, there were no significant differences in the Montreal Cognitive Assessment (MoCA) scores of older adults on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) versus a control caloric restriction diet at three-year follow-up.  2. There were also no significant differences in brain magnetic resonance imaging (MRI) findings between the two groups at the end of three years. Evidence Rating Level: 1 (Excellent) Study Rundown: There has been growing interest in identifying strategies possibly beneficial towards the prevention of dementia...

1. In this single-centre prospective cohort study, development of a Swedish Palliative Care Guide to improve integrated geriatric and palliative care medicine was found to significantly improve patient satisfaction with care although no differences were found in other outcomes such as health-related quality or symptom burden.  Evidence Rating: 1 (Excellent)  The overall proportion of older adults in the world population continues to increase, and with this comes more individuals affected by multimorbidity, cognitive decline, and frailty...

1. In this randomized controlled trial, dexamethasone treatment was not noninferior to burr-hole drainage regarding functional outcomes in patients with chronic subdural hematoma. 2. Dexamethasone treatment led to more complications and a greater likelihood of surgery as compared to burr-hole drainage for patients with chronic subdural hematoma. Evidence Rating Level: 1 (Excellent) Study Rundown: Chronic subdural hematoma is a condition that has a relatively high prevalence in the geriatric population. Burr-hole craniostomy is often the mainstay of treatment in symptomatic patients, which is a form of surgical evacuation of the hematoma...

1. A first episode of stroke was found to precipitate an acute decline in cognitive function for adults in China.  Evidence Rating Level: 2 (Good) Strokes are a known risk factor for the development of cognitive decline and dementia. Previous research has not addressed whether a degree of cognitive decline may exist prior to stroke or the timeline of decline following stroke. Researchers collected data on 13,311 adults over the age of 45 in China. At baseline, participants had no known stroke history. Their cognition was assessed initially between June 2011 and March 2012, with a subsequent 7-year follow-up period...

1. In this cohort study, individuals with Type 1 diabetes (T1D) had consistently higher brain age values than their non-diabetic counterparts, averaging to approximately 6 years older, and were additionally observed to score lower on measures of cognitive performance for psychomotor and mental efficiency.  2. Alzheimer’s Disease (AD) related atrophy and neurodegeneration were comparable between the two groups when measured by magnetic resonance imaging (MRI).  Evidence Rating Level: 2 (Good) The literature has established some modest structural and functional changes that occur in the brains of those with T1D, including declines in memory performance, mental efficiency tests, and smaller gray matter volumes...

1. In this cross-sectional, longitudinal study, power and speed scores measured during the sit-to-stand motion were predictive of frailty in older adults with cardiometabolic disease.  Evidence Rating Level: 2 (Good) Frailty, characterized by decreased physiologic reserve, increased vulnerability to stressors, and a high risk for adverse health outcomes, is an important concept linked to life expectancy and well-being in older adults. With the largest proportion of the population entering older adulthood in the coming years (≥ 65), it is crucial that we focus on the prevention and early detection of frailty...

1. In this randomized controlled trial, respiratory syncytial virus prefusion F protein-based vaccine (RSVpreF) prevented RSV-associated lower respiratory tract illness in adults 60+ years of age . 2. The RSVpreF vaccine also was associated with significantly decreased rates of acute respiratory illness in adults aged 60+. Evidence Rating Level: 1 (Excellent) Study Rundown: RSV is a common cause of lower respiratory tract illness worldwide, with severe illness being most prevalent in young children and older adults...

Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801581 1. In patients with newly initiated antipsychotic medications following infection-related hospitalization, discontinuation rates were lower among atypical antipsychotic users compared to haloperidol users. Evidence Rating Level: 2 (Good) Delirium, characterized by an acute change in mental status and cognition, presents a significant health care burden...

1. The integration of pharmacist independent prescribers in long-term care homes can improve drug burden among admitted residents. 2. Long term care homes using pharmacist independent prescribers did not change fall risk compared to general practice. Evidence Rating Level: 1 (Excellent) There is an ongoing need to improve prescribing processes in long-term care facilities internationally. As many drug errors continue to occur in care homes, studies have demonstrated that it may be beneficial for an individual to assume central responsibility for medication management...

1. The omicron BA.1-adapted BNT162b2 vaccine candidates elicited significant neutralizing antibodies against the omicron strains as well as the ancestral strains while maintaining similar safety to the original vaccine.  2. The BA.1-adapted vaccine also induced neutralizing responses against the novel BA.4, BA.5, and BA.2.75 strains. Evidence Rating Level: 1 (Excellent) Study Rundown: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health issue. The BNT162b2 vaccine from Pfizer-BioNTech previously demonstrated effectiveness against previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and proved to be invaluable in the global strategy for combating COVID-19...

1. For healthy elderly patients randomized to take low-dose aspirin for 4 weeks, there was no difference in occurrence of fractures, but a higher occurrence of serious falls prompting hospitalization, compared to patients taking placebo. Evidence Rating Level: 1 (Excellent) For elderly patients, falls and fractures are a major contributor to morbidity and mortality with 700,000 deaths associated with falls globally each year. Falls can be attributed to both environmental and physiologic factors, such as bone strength...

1. Among older adults with atrial fibrillation with no cognitive compromise at baseline, there was no statistical difference between warfarin or dabigatran groups in cognitive outcomes. Evidence Rating Level: 1 (Excellent) Atrial fibrillation has been shown to be associated with an increased risk of cognitive decline and dementia, which is concerning given its higher prevalence and incidence among older adults. Certain theories surrounding this presentation may be related to silent brain infarctions, cerebral microbleeds, and hypoperfusion...

Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults : https://jamanetwork.com/journals/jamasurgery/article-abstract/2797666#:~:text=Question%20What%20are%20the%20population,%2Dyear%20mortality%20was%2013.4%25. 1. In this prospective cohort study, the mortality rate in community-living older persons in the United States following major surgery within one year was 13.4%. 2. Age 90 or above, frailty, and probable dementia were associated with significantly increased one-year mortality rates in community-living older adults following major surgery...

1. The decision to discontinue anticoagulation in palliative care patients was not strongly associated with patient factors and comorbidities, except recent knee or hip arthroplasty. 2. Discontinuation was associated with lower rates of bleeding, similar rates of thrombosis, and increased rates of mortality. Evidence Rating Level: 2 (Good) Patients in palliative care are often on anticoagulation medication due to a medical history that increases the risk of stroke and venous thromboembolism. However, it is a goal in palliative care to minimize medication burden, only taking those that are compatible with patient goals...

1. The incidence of multimorbidity increased with age amongst the Korean geriatric population. 2. The strongest predictors of multimorbidity in the Korean population included alcohol consumption, social interaction and support, obesity, and smoking. Evidence Rating Level: 2 (Good) With the rapid growth of the aging population, multimorbidity has become a significant global concern and presents substantial burdens on the healthcare system. Several studies have focused on identifying key determinants and at-risk populations for multimorbidity; however, longitudinal studies remain quite scarce, to date...

1. Older adults treated with nirmatrelvir were significantly less likely to be hospitalized for coronavirus disease 2019 (COVID-19) than those not taking nirmatrelvir.  2. Those in the nirmatrelvir group were also significantly less likely to die from COVID-19 infection. Evidence Rating Level: 1 (Excellent) Study Rundown: The omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide resurgence of COVID-19. Nirmatrelvir was approved by the Food and Drug Administration (FDA) for the treatment of patients with mild-to-moderate COVID-19 when the delta variant was the predominant strain...