Version August 2025
The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
GENERAL GERIATRICS
Diet and healthy aging (April 2025)
Healthy eating is associated with numerous benefits, including reduced mortality and improved quality of life. In a new observational study following over 100,000 patients for up to 30 years, higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy were associated with an increased likelihood of healthy aging (defined as surviving to the age of 70 years without major chronic diseases or impairments in cognitive, physical, or mental health), whereas higher intakes of trans fats, sodium, sugary beverages, and red or processed meats were associated with a decreased likelihood of healthy aging [1]. These results are consistent with prior observational studies linking these specific dietary components to health benefits and harms. We continue to promote a healthy diet for all patients, emphasizing the components associated with health benefits and limiting or avoiding those associated with harms. (See "Healthy diet in adults", section on 'Dietary guidelines: Recommended dietary patterns'.)
GERIATRIC CARDIOVASCULAR MEDICINE
Home-based cardiac rehabilitation for older patients (February 2025)
Home-based cardiac rehabilitation (CR) using portable electronic devices is an attractive alternative to traditional CR; however, its benefits in older adults are unclear. In a study of 400 patients (median age 71 years, range 65 to 91 years), those who were randomly assigned to home-based CR did not experience clinically meaningful improvements in six-minute walk duration (6MWD) or the ability to perform activities of daily living (ADL) compared with those undergoing usual care [2]. Subgroup analysis showed improved 6MWD in female patients and patients who had undergone coronary artery bypass grafting (CABG). These findings suggest that home-based CR may not be effective for most older adults but may benefit certain subgroups; further studies are needed to confirm these results. (See "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary artery disease", section on 'Home-based and hybrid cardiac rehabilitation'.)
GERIATRIC ENDOCRINOLOGY AND DIABETES
Accelerated bone loss in older men with type 2 diabetes (February 2025)
In people with type 2 diabetes, fracture risk is elevated despite normal or increased bone mineral density (BMD). In an analysis of 4095 older men (mean age approximately 73 years) in whom BMD at the total hip was measured at baseline and after a mean of 4.6 years, those with type 2 diabetes (n = 578) exhibited a greater decline in BMD than those with normoglycemia (n = 1993; mean decrease -2.23 versus -1.57 percent, respectively) [3]. Accelerated bone loss was evident despite higher mean baseline BMD at the hip among men with diabetes. These findings suggest that accelerated bone loss may contribute to fracture risk in people with type 2 diabetes. (See "Bone disease in diabetes mellitus", section on 'Bone quantity and quality'.)
Age-related increase in upper reference limit for TSH (January 2025)
Although a growing number of studies have reported an age-related increase in the upper reference limit for thyroid stimulating hormone (TSH), few laboratories provide age-specific reference ranges for adults. In a recent multicenter, retrospective study (7.6 million TSH samples), the upper reference limit for TSH increased starting at age 50 years in females and 60 years in males [4]. The upper reference limit for an individual 70 to 80 years old ranged from 5.0 to 6.2 mU/L, depending on assay, with the reported upper limit ranging from 4.1 to 4.8 mU/L. If age-adjusted normal ranges for TSH were employed, there would be a decrease in the diagnosis of subclinical hypothyroidism in adults >50 to 60 years of age; we favor using age-based normal ranges for TSH. (See "Laboratory assessment of thyroid function", section on 'Serum TSH'.)
GERIATRIC HEMATOLOGY
Associations of preoperative anemia with frailty, cognitive dysfunction, and postoperative mortality (January 2025)
Anemia is common in older adults. In a retrospective study of more than 8500 patients older than 65 years who had elective surgery, preoperative mild anemia (hemoglobin 11 to 12 g/dL), moderate anemia (hemoglobin 8 to 11 g/dL), and severe anemia (hemoglobin <8 g/dL) were diagnosed in 17 percent, 10 percent, and 0.4 percent, respectively [5]. Lower preoperative hemoglobin values were associated with preoperative cognitive dysfunction and frailty and an increased risk of death within one year of surgery, compared with those who were not anemic. Since even mild anemia may have important perioperative ramifications, timely management of preoperative anemia is necessary. (See "Anesthesia for the older adult", section on 'Assessment for anemia'.)
GERIATRIC INFECTIOUS DISEASES
Nursing homes as sources of spread of multidrug-resistant microorganisms (April 2025)
Nursing homes are thought to be a major reservoir of multidrug-resistant microorganisms. In a nursing home in Chicago, shot-gun metagenomic sequencing of skin swabs from 42 residents revealed widespread sharing of specific strains of Candida auris and multidrug-resistant bacteria among residents [6]. Comparing the strains to publicly available databases of genomic sequences from other locations revealed geographic spread throughout metropolitan Chicago and to patients and healthcare facilities in other states as far away as New Hampshire and Massachusetts. These findings highlight the efficiency of nursing homes as sources of spread across broad geographic regions and the importance of infection prevention measures to minimize person-to-person spread and skin colonization. (See "Outbreaks in long-term care facilities: Detection and management", section on 'Candida auris'.)
2025 immunization schedules for adults in the United States (February 2025)
The United States Centers for Disease Control and Prevention (CDC) has published the 2025 immunization schedule for adults (figure 1 and figure 2) [7]. Persons 65 years of age or older are now recommended to receive two or more doses of a 2024-2025 COVID-19 vaccine. Pneumococcal vaccine is now recommended for all adults 50 years or older, and the newest conjugate vaccine (PCV21) is now included in the recommendations. Respiratory syncytial virus (RSV) vaccine has a stronger recommendation for persons 75 years or older. Our approach to immunization is largely consistent with these recommendations. (See "Standard immunizations for nonpregnant adults", section on 'Immunization schedule for nonpregnant adults'.)
RSV vaccination and Guillain-Barré syndrome (January 2025)
In January of 2025, the US Food and Drug Administration issued a warning about Guillain-Barré syndrome (GBS) in persons receiving either of the glycoprotein subunit RSV vaccines [8]. In analyses of observational data from persons ≥65 years, there were an estimated seven excess cases of GBS per million doses of the adjuvanted vaccine (Arexvy) and nine excess cases of GBS per million doses of the bivalent vaccine (Abrysvo). By contrast, RSV disease in adults ≥65 years causes 60,000 to 160,000 hospitalizations and 6000 to 10,000 deaths annually. This information is important for patients considering RSV vaccination, with decisions tailored to individualized risk assessment for severe RSV disease (table 1). (See "Respiratory syncytial virus infection in adults", section on 'Risk of Guillain Barré'.)
RSV vaccine effective in mild to moderately immunocompromised individuals (October 2024)
The respiratory syncytial virus (RSV) vaccine is recommended for immunocompromised individuals aged 60 and above, although the data on the efficacy of the RSV vaccine in this population is limited. In an electronic health records-based observational study that included over 10,000 predominantly mild to moderately immunocompromised individuals ≥60 years old (46 percent of whom had a malignancy), the adjusted RSV vaccine effectiveness against respiratory virus-associated hospitalizations in the first year of follow-up was 73 percent [9]. This study provides preliminary evidence of vaccine efficacy in this patient population and supports vaccination against RSV in immunocompromised individuals aged 60 and above. (See "Immunizations in adults with cancer", section on 'Respiratory syncytial virus (RSV)'.)
GERIATRIC NEUROLOGY
Geriatric care management in community-dwelling patients with dementia (March 2025)
Geriatric care management can assist patients with dementia and their caregivers in accessing support services and provide guidance in patient care. In one trial of 201 patients with moderate to severe dementia and their caregivers, an intervention consisting of monthly calls from a trained nurse or social worker resulted in fewer combined emergency department and hospitalization events over 24 months (1.1 versus 2.4 mean events/patient in the intervention versus usual care group), but did not improve patient neuropsychiatric symptom severity or caregiver distress [10]. While care management has the potential to improve patient outcomes, the best model for such care is not clear. (See "Management of the patient with dementia", section on 'Care management'.)
GERIATRIC RHEUMATOLOGY
Giant cell arteritis in patients initially diagnosed with polymyalgia rheumatica (April 2025)
Polymyalgia rheumatica (PMR) may be an isolated diagnosis or a feature of giant cell arteritis (GCA); however, the frequency with which patients with isolated PMR are eventually diagnosed as having GCA has been unclear. In a prospective cohort study of 62 patients with PMR, 3 percent of patients had radiologic evidence of subclinical GCA and another 3 percent developed late-onset GCA during the following year [11]. Although the risk is relatively low, GCA should be considered in all patients presenting with PMR. At presentation and at each follow-up visit, we assess for symptoms or physical findings referable to GCA (eg, new-onset headache, visual impairment, jaw pain with mastication) and pursue large-vessel imaging as indicated by symptoms. (See "Clinical manifestations and diagnosis of polymyalgia rheumatica", section on 'Association with GCA'.)
OTHER GERIATRICS
Exercise to prevent sarcopenia in older adults (May 2025)
Strength training has been studied as a method for preventing sarcopenia in older adults. In the randomized multicenter European DO-HEALTH trial, 1495 community-dwelling adults over 70 were assigned to an exercise intervention that consisted of five simple exercises using only bodyweight or light resistance with no planned increases in load or normal activities three times weekly [12,13]. This intervention had no impact on sarcopenia over three years. These data confirm prior studies that document the ineffectiveness of strength programs that do not emphasize robust exercises with progressive increases in load. (See "Practical guidelines for implementing a strength training program for adults", section on 'General principles'.)
Risk of delayed bleeding in older adults following head trauma (January 2025)
Older adults, particularly those taking anticoagulant medication, are at high risk for intracranial hemorrhage (ICH) following blunt head trauma. However, the risk of delayed ICH is less well studied. In a prospective observational study of 3425 older adult patients with acute head injury (median age 82, 33 percent of whom were prescribed anticoagulants), acute ICH was identified in 6.7 percent of patients but only 0.4 percent had delayed ICH [14]. The rates of delayed bleeding were similar for patients prescribed anticoagulants versus those who were not. All delayed bleeding occurred between several hours and five days following injury. These findings are consistent with prior studies and support the safety of discharge in older adults with isolated closed head injury who have a normal initial neurologic examination, no bleeding on CT scan (if obtained), and remain stable with no change in neurologic status after 12 hours of observation. (See "Geriatric trauma: Initial evaluation and management", section on 'Risk of bleeding'.)
