Geriatrics

CGM shows high burden of unrecognized hypoglycemia in very old adults with type 2 diabetes on high‑risk regimens

In 315 adults with type 2 diabetes (mean age 83), 32% were using insulin or sulfonylureas. Among high-risk medication users, median time <70 mg/dL was 3.4%, and about two-thirds exceeded guideline targets (>1% time hypoglycemic). Hypoglycemia was predominantly nocturnal, with median episode duration around 1.5 hours on insulin or sulfonylureas. Those not on high-risk drugs had much lower hypoglycemia burden (median 0.7% time <70 mg/dL). Cardiovascular disease, cognitive impairment, poor physical function, and CKD were linked to more hypoglycemia regardless of regimen, highlighting patients needing deintensification and closer monitoring. 1

Mortality risk differs across second‑generation antipsychotics in Alzheimer’s disease

This cohort of 17,004 patients with incident Alzheimer’s disease compared aripiprazole, quetiapine, risperidone, and olanzapine using a new-user design. Aripiprazole was associated with lower all-cause mortality than olanzapine and quetiapine after adjustment (AHRs about 0.67). Quetiapine showed lower mortality than olanzapine and risperidone (AHRs about 0.83). Treatment effect heterogeneity emerged, with aripiprazole particularly protective among patients using type 2 diabetes medications. Findings support preferring aripiprazole or quetiapine over olanzapine or risperidone when antipsychotics are unavoidable in Alzheimer-related behaviors. 2

Component analysis clarifies which fall‑prevention elements help or harm

This systematic review and component network meta-analysis synthesized 69 randomized trials of multifactorial and exercise fall-prevention programs. Traditional health education in multifactorial programs increased overall and recurrent fall risk, while medication management increased recurrent falls and fractures. Exercise components overall increased fracture risk, but environmental modification substantially reduced fracture risk (iRR 0.56). Combining risk assessment and advice, exercise, and environmental modification reduced overall fall risk. Within exercise-only programs, gait and balance training, especially combined with strength and resistance, reduced recurrent falls and injuries, guiding program design. 3

Hospital-wide dementia screening is feasible and identifies substantial unrecognized cognitive impairment

A hospital-wide program screened 11,180 medical and surgical hospitalizations for dementia and cognitive impairment using an EHR algorithm plus 4AT and AD8. Screening completion was high at 83.3%, demonstrating feasibility of systematic inpatient cognitive assessment. Among screened patients, 18% had known dementia, 4.3% screened positive for potential new dementia, and 9% for cognitive impairment. Older adults (≥85) and Black patients were more likely to screen positive for potential dementia than younger or White patients. Screening rates were similar across demographic groups, suggesting the program improved detection without introducing new disparities. 4