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Medscape
21-05-2025
- Health
- Medscape
Mobility Over Metrics: A New Take on Senior Obesity
For older adults living with obesity, the goal of treatment should not just be shedding pounds — it should be improving physical function, preserving independence, and enhancing quality of life. That was the central message from a group of experts who presented on patient-centered approaches to obesity care at the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting in Chicago. Rather than defaulting to weight loss as the primary measure of success, clinicians should focus on what matters most to each patient, said Julianna Marwell, MD, geriatrician and assistant professor of medicine at the Duke University School of Medicine in Durham, North Carolina. 'We can't afford to be weight-centric,' she said. Marwell framed obesity management using the 5Ms of geriatrics, which include mind, mobility, medication, multicomplexity, and what matters most. Through the case of a 73-year-old woman with a body mass index of 38 who had multiple chronic conditions, Marwell explained how functional goals like fall prevention, sleep improvement, and managing depression should drive treatment decisions. Research shows intentional weight loss in older adults can lead to better mobility, reduced medical complications, and improved quality of life. Marwell said clinicians have to integrate nutrition, physical activity, behavioral support, and medication review to achieve these benefits. Many medications commonly prescribed to older adults like antidepressants and pain medications can contribute to weight gain or hinder weight loss efforts, underscoring the need for routine medication reassessment, she said. Structural inequities such as not having access to healthy food options, limited access to exercise spaces, and lack of transportation can make weight loss guidance unrealistic for many patients without broader systems-level support, said Anna Pendrey, MD, primary care physician at Indiana University Health in Indianapolis. 'We can't recommend diet and exercise without acknowledging the social and economic realities our patients face,' Pendrey said. Pendrey and her colleagues at the Indiana University Student Outreach Clinic are addressing these barriers through community partnerships, free clinic services, transportation support, and embedding pharmacists, dieticians and physical therapists to support underserved older adults. Pendrey said obesity treatment requires 'tackling structural obstacles to care, not individual willpower.' That same level of intentionality is important when considering newer pharmacologic treatments, she added. While incretin mimetics drugs, including glucagon-like peptide 1 receptor agonists like semaglutide, offer promising results for both obesity and diabetes management, they must be used cautiously in older adults, given side effects, high costs, and limited long-term data in this age group, panelists said. The expert panel members did not report any relevant disclosures.
Medscape
20-05-2025
- Health
- Medscape
Malnutrition Often Missed in Geriatric Care
Primary care clinicians are not screening older adults for malnutrition, largely due to an overreliance on outdated diagnostic measures like body mass index (BMI), according to a new study presented at the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting in Chicago. Researchers at Stanford Health in San Jose, California , analyzed the medical records from 159 visits at a geriatric clinic over a 6-month period and found that not a single patient was screened for malnutrition. Only 4% of patients had a BMI < 18.5, the conventional threshold for flagging possible malnutrition. But 15.4% of patients (n = 23) met thresholds for further investigation after researchers used a framework for malnutrition identification that combines physical symptoms and underlying health conditions, the Global Leadership Initiative on Malnutrition criteria. 'This research highlights a critical gap in our approach to care of older adults,' said Richard Stefanacci, DO, geriatrician at Thomas Jefferson University in Philadelphia, who was not involved in the study. Just one patient was referred to a dietitian. Inaccurate diagnostic coding further masked the extent of the problem, according to the researchers. Clinicians used vague or inaccurate diagnostic codes, such as 'abnormal weight loss' or 'poor appetite,' without meeting full malnutrition criteria or failing to code malnutrition when criteria were met. Malnutrition-related codes like frailty or poor appetite appeared in about one quarter of patient records but correctly identified patients who met the diagnostic criteria for malnutrition in 17% of cases. 'Malnutrition isn't just about being underweight — it's a complex syndrome that affects multiple health outcomes including mobility, cognitive function, and resilience to illness,' Stefanacci said. Stefanacci called the underutilization of dietitian referrals 'particularly concerning.' 'One of the key takeaways here is that care of older adults is best delivered as a team effort. Involving dietitians more consistently in care isn't optional — it's essential,' he said. The researchers wrote their findings will inform a future quality improvement to increase the use of screening tools and standardizing diagnostic practices for malnutrition in geriatric settings. Stefanacci said that the findings are a call to action. 'By implementing standardized screening protocols and fostering stronger collaboration with nutrition professionals, we have an opportunity to significantly improve quality of life and health outcomes for our older adults,' he said. The study authors and Stefanacci reported having no relevant disclosures.
Medscape
19-05-2025
- Health
- Medscape
Digital Tool Improves Early Dementia Detection
CHICAGO — Combining machine learning and patient-reported tools significantly improved early detection of dementia in primary care, according to new research presented at the annual meeting of the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting. Researchers from Indiana University Indianapolis found that using a machine learning algorithm and a patient-reported screening tool — together known as the Digital Detection of Dementia (D3) approach — led to a 44% higher likelihood of a clinician diagnosing a patient with dementia over a 1-year period compared with usual care. The researchers tested the D3 model in a randomized trial across nine federally qualified health centers (FQHCs) in Indianapolis. Of the more than 5300 patients aged 65 years or older who enrolled, 62% were women, and more than half were Black or Hispanic. The clinics were assigned to provide three types of care, the first being usual care. Patients in the second group were evaluated for dementia using the passive digital marker, an artificial intelligence (AI) algorithm that analyzed existing electronic health record data to flag potential cases. Clinicians at the third clinic evaluated patients by analyzing results from the Quick Dementia Rating System, a 10-item questionnaire that takes patients 2-3 minutes to complete, and viewed flagged cases produced by the algorithm. Providers at the third clinic diagnosed significantly more patients with dementia than those at clinics using usual care, even after accounting for age, sex, race, and ethnicity (odds ratio, 1.44; 95% CI, 1.19-1.75). In contrast, clinics using only the AI tool showed no statistically significant increase in diagnoses. Researchers hypothesized that even partial use of the questionnaire — completed by just 21% of eligible patients — may have improved clinicians' trust in AI alerts, nudging them toward making a diagnosis. 'Providers…are very busy and are bombarded with computerized decision support,' said lead study researcher Malaz Boustani, MD, a geriatrician and professor of aging research at Indiana University. But 'with the right messenger and time,' trust in digital tools can grow and lead to behavior change. According to previous research, 62% of older adults seen in FQHCs have mild cognitive impairment, and 12% have dementia. Yet most go undiagnosed. Black patients were more than twice as likely as White patients to have unrecognized cognitive decline. The tools were embedded directly into the clinics' electronic health record system, triggering alerts in the chart view. Patients were offered the questionnaire during electronic check-in. A clinical decision support system then guided clinicians with next steps. 'This hybrid model lets clinicians do the right thing without adding to their workload,' Boustani said. The D3 model is now being evaluated for broader implementation, Boustani said. He and his colleagues are also exploring ways to increase patient completion of the questionnaire and refine clinician prompts. 'We're waiting on the result of an ongoing trial that is trying to replicate our study using interruptive alerts instead of non-interruptive alerts,' Boustani said. 'If that trial shows similar or better results, we will work with existing consulting companies to distribute the digital tools across the country.' Boustani serves as a chief scientific officer and co-founder of two private companies and has various financial relationships involving equity with other companies. He also serves on various advisory boards for pharmaceutical companies.
Medscape
15-05-2025
- Health
- Medscape
The New Playbook for Ditching Dangerous Senior Meds
A new tool presented at the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting may give clinicians practical and safer alternatives to risky medications for patients. Developed as a companion to the widely cited AGS Beers Criteria, the new Alternatives List was unveiled by a panel of clinicians and researchers who spent months identifying and reviewing safer options for high-risk medications. The list has pharmacologic and nonpharmacologic approaches and is tailored to the realities of treating geriatric patients. Originally updated in 2023, the AGS Beers Criteria outlines medications that may be inappropriate for use in older adults who are not receiving end-of-life care. 'The real goal is to help older adults feel better and function better while reducing the risk of medication harms,' said Michael Steinman, MD, geriatrician and professor of medicine at the University of California San Francisco, who led the development of the list. Eight workgroups covered 21 conditions commonly linked to potentially inappropriate medications, such as insomnia, anxiety, and allergic rhinitis. Clinicians from a range of disciplines — pharmacy, nursing, psychology, physical therapy, and medicine — collaborated to ensure the recommendations were practical, evidence-informed, and clinically relevant. Yet even assembling the list came with challenges. 'Treatments for common conditions are often not well-studied in older adults, and practice guidelines often give little information on how approaches to treating these conditions should be modified to meet the unique needs of older adults,' Steinman told Medscape Medical News . Each entry on the list includes commonly used medications flagged in the Beers Criteria, safer nonpharmacologic and pharmacologic alternatives, and resources for clinicians and patients. 'We focused on what clinicians actually see and treat every day,' Steinman said. 'If someone's taking diphenhydramine for sleep or allergies, what should we be recommending instead? That's what this tool answers.' During the panel, members of the AGS-convened work group shared insights from the development process. Judith Beizer, PharmD , clinical professor of pharmacology at St. John's University College of Pharmacy and Health Sciences in New York City, highlighted treatment considerations for gastroesophageal reflux disease, a condition often treated with medications deemed high-risk for older adults. 'We know that proton pump inhibitors (PPI) are often continued far longer than necessary,' Beizer said. Beizer presented a range of safer alternatives for long-term PPI use to treat gastroesophageal reflux disease, emphasizing first-line nonpharmacologic strategies such as avoiding trigger foods, elevating the head of the bed, and modifying meal timing. When pharmacologic intervention is necessary, Beizer recommended transitioning to H2 blockers like famotidine or using antacids with alginic acid while tapering patients off PPIs. 'It's not just about stopping the medication,' she said. 'It's about doing so thoughtfully and supporting the patient through the transition.' The panel also addressed nocturia, another condition in older adults that is often treated with desmopressin, a drug the Beers Criteria advises avoiding due to the risk for hyponatremia. Instead of using this drug, clinicians should conduct a comprehensive review of underlying causes of nocturia using the SCREeN approach, which examines sleep disorders, cardiovascular health, renal function, endocrine issues, neurologic conditions, and medication side effects, Beizer said. 'Nocturia is a symptom, not a diagnosis,' she said. 'We have to explore the root cause before prescribing.' Alternative approaches to treating nocturia include bladder retraining, fluid management, and, in certain cases, pharmacologic agents such as beta-3 agonists or, for men with benign prostatic hyperplasia, alpha blockers and 5-alpha reductase inhibitors. For women, Beizer noted that vaginal estrogen could be beneficial. Steinman said that the tool is not just about safer prescribing but about creating a more individualized approach to care. 'Deprescribing is not just about stopping a medication — it's about communication and trust,' he said. 'Sometimes a potentially inappropriate medication is still the right choice, but that decision should come after weighing risks, exploring safer alternatives, and engaging in shared decision-making.' But implementing alternatives — especially nondrug strategies — can be difficult in time-constrained primary care settings. Steinman acknowledged this reality but offered solutions. 'The list is designed to be easy to use in busy practice settings,' he said. In some cases, nonpharmacologic strategies can take longer to explain than simply writing a prescription, he said. But clinicians can hand patients off to nurses or other staff to offer more detailed explanations. 'Building buy-in takes time, but that time can be shared across multiple visits and supported by handouts or other team members,' he said. Clinicians will soon be able to access the Alternatives List in an upcoming issue of the Journal of the American Geriatrics Society , and The AGS Beers Criteria Alternatives List is still evolving, with plans to be updated as evidence grows, panelists said. Steinman reported no relevant disclosures. Beizer reported serving as an editor for Wolters Kluwer.
Yahoo
11-03-2025
- Health
- Yahoo
One Senior Place: Being a good mom, and a good daughter, can be exhausting
Women in the "sandwich generation," those caring for both aging parents and minor children, face significant mental health challenges. Trying to meet the demands of being both a "good" daughter and mother, combined with work and personal obligations, can lead to anxiety, depression, burnout, and some major guilt. According to the American Geriatrics Society, 2.5 million women in the U.S. are sandwich generation caregivers. Most women in the sandwich generation are in their 40s and 50s, the typical age for perimenopause and menopause. The decline in estrogen levels during this time can cause mood swings, irritability, anxiety, and heightened emotional sensitivity, making it even harder to manage stress. The result? Well-being may be significantly affected by the physical, emotional, and psychological stressors from both caregiving and menopausal symptoms. Sleep disruptions: Hot flashes, night sweats, and insomnia can lead to chronic sleep deprivation, further impairing cognitive function. Memory and concentration issues: Many experience brain fog, forgetfulness, and difficulty focusing, making it harder to juggle caregiving and work. Increased anxiety and depression: Some women experience panic attacks, intrusive thoughts, or overwhelming worry. Physical fatigue and discomfort: Joint pain, headaches, and low energy make the physical demands of caregiving more difficult. Marital/partner relations: Couples may experience intimacy issues with menopause, adding to emotional stressors. Therapy can provide professional coping strategies. But don't underestimate the power of connecting with other sandwich moms who are sharing your journey. Support groups and online forums can offer practical advice and validation, and even a cup of coffee with an understanding friend can provide a needed release. Regular exercise, a balanced diet, quality sleep and relaxation techniques like yoga and meditation can help manage stress. Sandwich Generation Survival Guide suggests, "Schedule your self-care like you would any other important appointment. Put it in your calendar and treat it as non-negotiable. Even 15 minutes a day can make a difference." Additionally, increase calcium and vitamin D to support bone health, and reduce caffeine and alcohol to manage hot flashes and mood swings. Talk candidly to your doctor about your situation. Don't be afraid to tap family members for help. Acknowledging that you are not Wonder Woman will ease stress and help free you from demands of perfection. Responsibilities can weigh heavily on women sandwiched between two needy generations. Enjoy a Friday break during Women's Day in two Central Florida locations, beginning with Altamonte Springs on April 11 and Viera on April 25. RSVP for the fun planned at Brenda Lyle is a Certified Care Manager and Certified Dementia Practitioner with One Senior Place, Greater Orlando. One Senior Place is a marketplace for resources and provider of information, advice, care and on-site services for seniors and their families. Submit your questions toAskOSP@ For immediate help, call 321-751-6771 or visit One Senior Place, The Experts in Aging. Support local journalism by subscribing at Special Offers - USAToday Network. This article originally appeared on Florida Today: One Senior Place: Being a good mom, and a good daughter, can be exhausting
