The edition · Geriatrics
After a heart attack, easing off the stronger antiplatelet cut events and bleeding in under-75s
Plus which multimorbidity clusters flag a higher risk of death, the rising dementia burden across South and Southeast Asia, and why the time of day you train does not matter.
The edition in brief
Today's geriatrics edition closes on antiplatelet de-escalation after myocardial infarction. In a secondary analysis of the TALOS-AMI trial, switching from ticagrelor to clopidogrel one month after PCI reduced both net adverse events and bleeding in patients under 75, with point estimates pointing the same way in those 75 and over but too few events to be sure. A latent-class analysis of 16,095 community-dwelling adults over 70 identified multimorbidity clusters, with a frailty, depression and osteoporosis cluster carrying higher mortality in both sexes — a possible way to flag risk. A meta-analysis found dementia prevalence across South and Southeast Asia rising sharply, with literacy, sleep, periodontal care and cognitive stimulation as protective factors, underscoring early screening in these settings. A randomised trial showed that aligning resistance training to a person's peak time of day gave no advantage over any other time. A pearl reinforces structured deprescribing at every review. The practice-changer: de-escalation clearly benefits under-75s after MI and is reasonable to consider, though unproven, in older patients.
A frailty, depression and osteoporosis cluster marked higher mortality in older adults
Treat the older adult whose conditions cluster around frailty, depression and osteoporosis as high-risk, and manage them proactively and holistically rather than disease by disease.
Dementia burden is climbing across South and Southeast Asia
Expect a rising dementia burden in South and Southeast Asia and build early screening and modifiable protective factors — sleep, cognitive engagement, oral health — into routine care.
The time of day you do resistance training does not change the result
Do not prescribe a specific time of day for resistance training in older adults — consistency matters, timing does not.
Make deprescribing a step at every older-adult review
Make structured deprescribing, using an explicit tool, a routine step at every older-adult review rather than an afterthought.
After MI, de-escalating ticagrelor to clopidogrel benefits under-75s; older adults less certain
In stabilised patients under 75 after MI, de-escalate ticagrelor to clopidogrel at about a month to cut bleeding without losing protection; consider but do not assume the same benefit in the over-75s.
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