Medical Bulletin 20/August/2025 - Video
Overview
Here are the top medical news for the day:
Updated Guidelines for Safer Medication Use in Older Adults: American Geriatrics Society
The American Geriatrics Society (AGS) has released a significant update to its widely used AGS Beers Criteria, providing comprehensive alternatives to potentially harmful medications commonly prescribed to older adults. Published in the Journal of the American Geriatrics Society, the update includes both safer pharmacologic substitutes and effective non-pharmacologic treatments, marking a major step toward improving medication safety in geriatric care.
The AGS Beers Criteria® identifies medications that are considered potentially inappropriate for older adults due to risks such as sedation, falls, delirium, and adverse drug interactions. The updated resource expands on this by offering actionable alternatives, structured in user-friendly tables organized by symptom or diagnosis. The effort was led by a 19-member multidisciplinary panel from 14 states, including physicians, pharmacists, nurses, psychologists, and physical therapists. Among them, Dr. Noll Campbell from the Regenstrief Institute was the sole expert representing Indiana.
Panelists were assigned to eight topic-specific workgroups covering insomnia and anxiety; allergy and pruritus (itchy skin); cardiovascular and anticoagulation therapies; pain; delirium and dementia; diabetes; gastrointestinal syndromes; and genitourinary syndromes. These were distilled into a detailed table of safer options for 21 common geriatric conditions. The recommendations include behavioral and lifestyle changes such as cognitive behavioral therapy for insomnia, exercise for Parkinson’s disease, and dietary modifications for constipation or heartburn.
Importantly, the update introduces patient-friendly materials like decision aids and deprescribing handouts, reinforcing a modern, team-based and patient-centered approach to care.
"We recognize that simply removing a medication may not be enough, especially if symptoms return or worsen,” said Dr. Campbell. "Our intent is to provide practical, prioritized alternatives that can be started or considered right away, so that care is both safer and responsive to what matters most to older adults and their caregivers. We want clinicians to have real tools, not just warnings."
Reference: American Geriatrics Society Beers Criteria® Alternatives Panel, Steinman, M. A., Semla, T. P., Akgün, K. M., Alessi, C. A., Beizer, J. L., ... & Steinman, M. A. (2025). Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria®. Journal of the American Geriatrics Society.
A new Cochrane review has found no clear scientific evidence to support the off-label use of ketamine in treating chronic pain, raising questions about the drug's growing use in clinical practice. The findings appear in the Cochrane Database of Systematic Reviews and call for greater caution and more rigorous research.
Ketamine, an anaesthetic widely used for short-term pain relief and procedural sedation, is often prescribed off-label for chronic pain conditions such as fibromyalgia, nerve pain, and complex regional pain syndrome. It belongs to a class of drugs called NMDA receptor antagonists, believed to reduce pain by blocking specific receptors involved in pain signaling.
The Cochrane review analyzed data from 67 clinical trials involving more than 2,300 adults. It examined five NMDA receptor antagonists — ketamine, memantine, dextromethorphan, amantadine, and magnesium — but found no convincing evidence that ketamine provides significant benefit in treating chronic pain.
“The most common adverse events we saw were psychotomimetic effects such as delusions, delirium and paranoia, as well as nausea and vomiting.” said Michael Ferraro, a doctoral candidate at UNSW and NeuRA and first author of the review. “These effects are distressing for many patients. Clinicians often try to balance the dose for pain relief without triggering those symptoms, but this isn’t always achieved.”
The review also highlighted a lack of studies reporting on whether ketamine reduced depressive symptoms or opioid use — two commonly cited reasons for its prescription.
The authors hope their findings will guide clinicians, inform patients, and drive better-designed trials to determine ketamine’s real role, if any, in chronic pain treatment.
Reference: Ferraro MC, Cashin AG, Visser EJ, Abdel Shaheed C, Wewege MA, Wand BM, Gustin SM, O'Connell NE, McAuley JH. Ketamine and other NMDA receptor antagonists for chronic pain. Cochrane Database of Systematic Reviews 2025, Issue 8. Art. No.: CD015373. DOI: 10.1002/14651858.CD015373.pub2. Accessed 19 August 2025.
COVID-19 Infection May Accelerate Vascular Aging and Raise Heart Disease Risk
A recent international study published in the European Heart Journal has found that COVID-19 infection may accelerate the ageing of blood vessels by up to five years — particularly in women — potentially increasing the risk of cardiovascular diseases such as stroke and heart attack.
The study, led by Professor Rosa Maria Bruno from Université Paris Cité in France, sought to investigate the long-term impact of COVID-19 on vascular health.
To explore these effects, the researchers studied 2,390 individuals from 16 countries between September 2020 and February 2022. Participants were divided into four groups: those never infected with COVID, those who had mild COVID without hospitalisation, those hospitalised in general wards, and those treated in intensive care units. Vascular age — assessed through pulse wave velocity (PWV), a measure of artery stiffness — was measured at six and twelve months post-infection.
The findings revealed that people who had COVID-19, even with mild symptoms, had stiffer arteries than those who were never infected. Women in particular showed more pronounced effects. Mild cases in women led to a pulse wave velocity increase of 0.55 m/s, rising to 1.09 m/s in those admitted to ICU — changes considered clinically significant and equivalent to five years of vascular ageing.
The study also found that vaccinated individuals had less arterial stiffness compared to those who were unvaccinated.
“There are several possible explanations for the vascular effects of Covid. The Covid-19 virus acts on specific receptors in the body, called the angiotensin-converting enzyme 2 receptors, that are present on the lining of the blood vessels. The virus uses these receptors to enter and infect cells. This may result in vascular dysfunction and accelerated vascular ageing. Our body’s inflammation and immune responses, which defend against infections, may be also involved,” Professor Bruno said.
She explained that a stronger immune response in women may explain their increased vascular damage.
Importantly, Bruno emphasized that vascular ageing is reversible with interventions like lifestyle changes, blood pressure and cholesterol control. As experts continue to unravel long COVID's effects, the study underscores the importance of monitoring heart health post-infection.
Reference: Rosa Maria Bruno, Smriti Badhwar, Leila Abid, Mohsen Agharazii, Fabio Anastasio, Jeremy Bellien, Otto Burghuber, Luca Faconti, Jan Filipovsky, Lorenzo Ghiadoni, Cristina Giannattasio, Bernhard Hametner, Alun D Hughes, Ana Jeroncic, Ignatios Ikonomidis, Mai Tone Lonnebakken, Alessandro Maloberti, Christopher C Mayer, Maria Lorenza Muiesan, Anna Paini, Andrie Panayiotou, Chloe Park, Chakravarthi Rajkumar, Carlos Ramos Becerra, Bart Spronck, Dimitrios Terentes-Printzios, Yesim Tuncok, Thomas Weber, Pierre Boutouyrie, the CARTESIAN Investigators , Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study, European Heart Journal, 2025;, ehaf430, https://doi.org/10.1093/eurheartj/ehaf430
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