Internal Medicine

Potentially inappropriate CNS-active prescribing is common in older adults, including those with cognitive impairment

This cohort study evaluated prescribing patterns of potentially inappropriate CNS-active medications in older adults with and without cognitive impairment. Findings indicate that cognitively impaired patients frequently receive CNS-active drugs despite vulnerability to delirium, falls, and cognitive decline. Clinicians should systematically review and deprescribe CNS-active agents during medication reconciliation, especially in patients with suspected or established cognitive impairment. Results support embedding structured CNS-medication review into routine geriatric and general internal medicine workflows. 1

MOUD receipt after opioid overdose among Medicaid enrollees is low and strongly tied to prior treatment

In 318,536 Medicaid overdose events, only 26.0% had any MOUD within 6 months postdischarge, versus 22.8% in the prior 6 months. Baseline MOUD exposure strongly predicted follow-up MOUD, with a steep gradient in receipt across increasing proportion-of-days-covered categories. Timely 30-day follow-up MOUD was 76.0% among those with prior MOUD, compared with 32.4% among MOUD-naive patients. These data show major missed opportunities for initiating MOUD at overdose-related encounters, particularly for those not already in treatment. 2

Medical debt is associated with higher next-year housing instability in a national U.S. cohort

In a nationally representative cohort of 1515 adults, 16.4% reported medical debt in 2024. Unadjusted housing instability in 2025 was substantially higher with medical debt than without (23.5% vs 5.8%). After propensity weighting and doubly robust adjustment, medical debt remained associated with a 7.0–percentage-point higher probability of next-year housing instability. Clinicians should screen for medical debt, document it as a social risk, and connect affected patients to financial counseling or community resources. 3

Prediabetes plus elevated hs-troponin or NT-proBNP substantially increases heart failure risk in hypertension

This SPRINT post hoc analysis included 8234 adults with hypertension without diabetes or prior heart failure. At baseline, prediabetes, subclinical myocardial injury, and subclinical myocardial stress were each common in this population. Compared with normoglycemia and normal biomarkers, prediabetes plus myocardial injury conferred markedly higher HF risk (HR 4.20; 95% CI 2.31–7.63). Prediabetes with myocardial stress similarly yielded substantially increased HF risk (HR 5.20; 95% CI 2.52–10.70). 4