The aging of the U.S. population continued to put intense stress on the healthcare system. Lee A. Lindquist, MD, MPH, MBA, Chief of Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, talked about recent updates in Geriatric Medicine Pri-Med East, 2022, held in Boston. The session’s objectives were to review the most recent updates and research findings in Geriatric Medicine; to discuss updated recommendations in geriatrics about medication use, preventing Alzheimer’s disease, and gun safety among older adults; to identify cutting-edge geriatrics research to the real-life clinical care of older adults.
What can I recommend to prevent memory loss or Alzheimer’s disease?
The Mini-cog test and the Montreal Cognitive Assessment (MOCA) are cognitive screening tests designed to assist health professionals in detecting cognitive impairment and Alzheimer’s disease. Mild memory loss can be of two types:
- Mild Cognitive Impairment (MOCA score < 26): It is characterized by a deficit in memory in at least one domain but no impairment in activities of daily living. There is no functional impairment. Mild construction, language, or executive dysfunction occurs. Individuals are more aware of memory loss and have insight into the loss.
- Early Alzheimer’s Disease (MOCA score 21 – 25): It is characterized by naming difficulties, recent recall problems, decreased insight, irritability, and mood changes.
Alzheimer’s and the Diet
Researchers found that eating a Mediterranean diet slows some changes in the brain, which may indicate early A.D.s. The results suggest that lifestyle change could help reduce the risk of age-related dementia. A study presented at Alzheimer’s Association International Conference 2022 reported that people who consume more than 20% of their diet from ultra-processed food showed a 28% faster decline in global cognitive scores, including memory, verbal fluency, and executive function.
Role of exercise in MCI
Physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants, the EXERT Study (presented in Alzheimer’s Association International Conference 2022) reported. Regular physical activity, even modest or low exertion, such as stretching, may protect brain cells against damage. Other researchers from the University of Miami also demonstrated that two months of exercise was sufficient to improve cognitive performance and fitness, and there was an association between the two.
What can I do to prevent delirium?
To prevent delirium, clinicians should not prescribe gabapentin. Gabapentin increases delirium & antipsychotic use when used in peri-operative phases and has a high risk for side effects. Instead, clinicians should do frequent reorientations, limit vitals at night and ambulate as soon as possible.
Should I be worried about Gun Violence with my older adult patients? …with dementia
Clinicians should be aware of the consequences of gun violence on their patients who have dementia. Almost 4 in 10 U.S. households have guns, and many adults live in those households. Clinicians should openly talk with their patients regarding gun ownership, emphasizing safety culture and responsibility.
What drugs should I deprescribe for older adults in 2022?
Clinicians should stop prescribing docusate (Colace, Dulcolax) for constipation in older adults. Docusate, when compared with placebo, psyllium, or sennosides in trials, did not show any benefits for constipation. Instead, psyllium and sennosides showed to be more effective compared with docusate.
Upcoming Changes to the BEERs list for inappropriate prescribing among older adults
Aspirin: Clinicians should avoid initiating aspirin for primary prevention of cardiovascular disease and deprescribe it in older adults already taking it for primary prevention. The risk of significant bleeding from aspirin increases markedly in older age. Studies suggest a lack of net benefit, instead a potential for net harm when initiated for primary prevention in older adults.
Warfarin: Clinicians should avoid warfarin as initial therapy for treating venous thromboembolism (VTE) and non-valvular atrial fibrillation (NVAF) unless alternative options are contraindicated or substantial barriers to their use. Compared to direct oral anticoagulants, warfarin has a higher risk of bleeding and similar or lower effectiveness for treating VTE and NVAF.
What should I be doing for older adults who become disabled without hospitalization?
Older adults with a community-onset disability were more likely to have dementia. They are more likely to enroll in Medicaid and Hispanic/Latinx. These patients are significantly less likely to receive physical therapy. Clinicians should focus on connecting these patients to community resources and prescribe rehabilitation services, including physical therapy.