The edition · Geriatrics
Hearing loss and multimorbidity together, not either alone
In 874 US adults over 70 followed for a median 9.3 years, hearing loss alone carried a 1.4-fold mortality risk and three or more conditions 1.7-fold - neither interval excluding 1. The two together carried 2.3-fold, and the interaction was significant. Plus what education does for everyday function, when disability actually begins before death, statins and frailty in HIV, and the vaccine almost nobody gives on admission.
The edition in brief
Today's geriatrics desk opens with hearing. In 874 US adults aged 70 or over with audiometry, linked to death records through 2020, 46% died over a median 9.3 years. Hearing loss carried an adjusted hazard ratio of 1.4 (95% CI 1.0-2.0) and three or more comorbidities 1.7 (0.9-3.1) - but the combination carried 2.3 (1.7-3.2), with a significant interaction at P = 0.03. Sixty-five per cent had hearing loss and only 27% of those used a hearing aid. In 1,571 cognitively unimpaired older adults, higher cognitive reserve was associated with less impairment in everyday activities (count ratio 0.58, 95% CI 0.36-0.94), driven by a 49% reduction in applied cognitive tasks, with education the most consistent component. Harmonised data from six Swedish cohorts covering 2,294 people who died aged 70 or over identified three disability trajectories: constantly low in 53%, low then sharply increasing in 36%, and high-increasing in 11% - meaning for most people activities of daily living stay intact until roughly the last two years. Among 3,444 people with HIV, statin initiation was associated with a falling frailty index over time, though walking speed, physical performance battery and grip strength showed no difference. The edition closes on 16,799 veterans newly admitted to long-term care: cumulative herpes zoster incidence was 2.1% over two years, highest at 4.1% in those with prior zoster, and only 2.9% received any zoster vaccine dose in the 90 days after admission.
The mortality risk sits in the combination, not in either exposure
In an older patient with several conditions, treat hearing as part of the chronic disease management, not a separate sensory complaint.
Cognitive reserve showed up in everyday tasks before any cognitive impairment did
Take a functional complaint seriously in a cognitively unimpaired older patient, particularly one with less educational reserve behind them.
For half of people, function holds until the last two years
Expect function to hold until roughly the last two years for most people, and treat a sharp decline as a short window to organise care rather than the start of a long slope.
Statins and a falling frailty index, with nothing to show for it on the walking test
Keep prescribing statins in HIV for cardiovascular reasons; the frailty index improvement was not matched by any change in measured physical function.
Before you write 'confused', check the batteries
Check the hearing aid and the room before you record that a patient is confused or non-adherent.
Almost nobody gets a zoster vaccine on admission to long-term care
Put zoster vaccination status on the long-term care admission checklist - fewer than 3% of residents received a dose in the first 90 days.
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