Conference Offers Look at Latest Developments in Geriatric Care
| The University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging recently hosted its annual Geriatrics Updates conference, convening health professionals and community members who wanted to learn about the latest developments in geriatric care.
The three-day conference covered a variety of topics that affect the lives of older adults, including cancer, cardiopulmonary and renal diseases, diabetes management, gastrointestinal diseases, medication development, neurocognitive disorders, prescription opioids and nonpharmacological aspects of healing. The final day focused on resources for the caregivers of those with cognitive impairment and memory disorders.
Many of the segments offered practical advice in addition to medical expertise. This included a forum on weight loss drugs that featured panelists Donald Bodenner, M.D., Ph.D., director of the UAMS Thyroid Cancer Clinic and chief of endocrine oncology; Christopher Johnson, Pharm.D., M.Ed., assistant professor in the Department of Pharmacy Practice; and Jeanne Wei, M.D., Ph.D., executive director of the Institute on Aging and chair of the Department of Geriatrics.
Faculty members gather for a photo during the Geriatrics Updates conference at the UAMS Donald W. Reynolds Institute on Aging.
Wei noted that the latest generation of prescription weight loss drugs has become a popular topic of discussion among health professionals and patients. She said these drugs, known as glucagon-like peptide-1 (GLP-1) receptor agonists, offer another option for people who are struggling with diabetes and/or obesity.
“I think it’s not a bad idea to consider,” she said. “So far, the results of studies that have used these GLP-1 drugs have been pretty positive.”
Bodenner talked about a 2023 segment on the news program “60 Minutes” that reframed the issue of obesity, describing it as an illness rather than a problem of willpower.
“The biggest point is that we shouldn’t view this as a failure on the part of our patients,” he said.
The panelists agreed that while these drugs represent a new paradigm in the fight against obesity, the central elements of a healthy lifestyle haven’t changed.
“We don’t at all want to minimize the importance of diet and exercise,” Bodenner said.
In another session, Elizabeth Eoff-McDaniel, M.D., assistant professor in the Department of Geriatrics and a geriatrician in the Institute on Aging’s Thomas and Lyon Longevity Clinic, provided an update on the newest medications being used to slow the progression of Alzheimer’s disease.
UAMS has begun treating patients with lecanemab, a monoclonal antibody that targets amyloid plaques in the brain. Patients receive the drug via infusion under the observation and care of a health professional, she said.
UAMS has proceeded with caution in its use of the drug, Eoff-McDaniel said, noting the potential for serious side effects in some patients. A team of health professionals must confirm that a candidate is in the early stages of cognitive impairment and has biomarkers that point to Alzheimer’s disease. The patient also must be screened for exclusion criteria such as substance abuse disorders, bleeding disorders that aren’t under adequate control, and a history of strokes or seizures.
Eoff-McDaniel said that while the new drug can’t reverse the effects of Alzheimer’s, it nonetheless represents a significant breakthrough in treatment.
“To our patients and their families, this means a little more time,” she said. “That’s something we’ve never before been able to offer.”
Conference attendees also heard from a pair of guest speakers who presented their research on neurocognitive disorders.
James Galvin, M.D., MPH, professor of neurology and psychiatry at the University of Miami’s Miller School of Medicine, spoke about Lewy body dementia, a progressive disease that causes a decline in cognitive function and motor skills. Galvin described it as “the most common disease that no one has heard of,” affecting about 1.4 million Americans.
Galvin described the biomarkers of Lewy body dementia, showing how the disease progresses and how to diagnose it. Experts have also developed questionnaires that serve as diagnostic aids for health professionals.
Despite these tools, the disease is often difficult to diagnose, Galvin said. He cited a survey from the Lewy Body Dementia Association, a Georgia-based nonprofit, that showed that a majority of patients were initially diagnosed with conditions such as Alzheimer’s, Parkinson’s disease or schizophrenia.
“This can be a real burden for patients and family members, not knowing what’s really going on,” he said.
Finding the right treatment also presents a challenge. Galvin said the United States has no medications specifically approved for Lewy body dementia, so clinicians repurpose drugs used to treat other conditions. Alzheimer’s medications can help with a patient’s cognitive symptoms, and Parkinson’s treatments can be used to address motor symptoms.
“We tend to borrow medicines from other fields, but there’s still a large unmet need for our patients,” he said.
Ann Kolanowski, Ph.D., RN, professor emerita at the University of Pennsylvania, followed Galvin’s speech with a presentation about a condition known as delirium superimposed on dementia (DSD).
Delirium and dementia both cause cognitive changes, Kolanowski said. Delirium is marked by a sudden, fluctuating decline in cognitive function that can be resolved through medical interventions, while dementia develops slowly and usually can’t be reversed.
Kolanowski played a series of videos that showed how difficult it is to determine whether those two conditions are manifesting concurrently in a patient.
“There’s great interest in measuring DSD and differentiating it from dementia,” she said.
Researchers have developed questionnaires that serve as a screening tool for DSD, Kolanowski said. For those who are in the later stages of dementia and aren’t verbally communicative, clinicians diagnose DSD based on deviations from the patients’ baseline function.
“This is where family members and knowledgeable care providers are extremely important,” she said.
For patients who have dementia but not delirium, Kolanowski suggested several preventive measures to lower their risk of DSD. Clinicians should regularly reorient their patients and be careful with medications, avoiding those that can interfere with cognition. It’s also important to keep them as physically and mentally active as possible, she said.
“These nonpharmacological interventions can modify risk factors and maintain our patients’ resilience,” she said.