Geriatrics

Protein plus vitamin D and multinutrient regimens improve sarcopenia outcomes

This network meta-analysis synthesized 59 RCTs including 5543 older adults with sarcopenia receiving nutritional or pharmacologic therapies. Multinutrition, protein alone, and protein plus vitamin D probably improve quality of life versus usual care with moderate-certainty evidence. Protein plus vitamin D probably improves handgrip strength by about 2 kg, and multinutrition may also increase strength, though with lower-certainty evidence. Drug interventions did not significantly improve handgrip or knee extension strength, or timed up and go, despite possible muscle mass gains. 1

Osteoporosis and fractures associated with higher dementia risk

This cohort of 176,150 Chinese adults ≥65 years without baseline cognitive impairment was followed for a median 2.2 years. Physician-diagnosed osteoporosis was associated with an 80% higher risk of all-cause dementia (HR 1.80, 95% CI 1.53-2.12). Dementia risk was higher in those with osteoporotic fractures (HR 2.43, 95% CI 1.83-3.23) than in osteoporotic patients without fractures (HR 1.63). Associations were similar for Alzheimer’s disease and vascular dementia, suggesting osteoporosis broadly signals increased dementia risk. 2

Sustained antihypertensive adherence lowers subsequent dementia risk

This longitudinal US cohort included 11,835 community-dwelling adults ≥50 years from the Health and Retirement Study. Hypertensive participants with persistent antihypertensive adherence over four years had a 27% lower dementia risk than low-adherence peers (HR 0.73, 95% CI 0.61-0.87). Dementia risk in the high-adherence group was similar to normotensive participants (HR 1.03, 95% CI 0.88-1.21). Results were consistent in APOE ε4 carriers and noncarriers, with no evidence of interaction. 3

High post-ED mortality in dementia; admin-only models predict poorly

This retrospective cohort studied 250,343 Traditional Medicare beneficiaries ≥66 years with dementia and an index ED visit in 2018. Most lived in the community pre-ED (83.9%), and 34.4% were hospitalized after the encounter. One-year mortality ranged from 18.4% in community dwellers not hospitalized to 47% in nursing home residents admitted and returned to nursing homes. Recent hospitalization predicted higher mortality, reaching 40.3% when hospitalized within the prior month. Administrative-data models had at best moderate discrimination for mortality and high costs, with most C-statistics ≤0.72. 4