30-Second Takeaway
- High anticholinergic burden remains common and is strongly linked to all-cause, cardiovascular, and cancer mortality.
- Cumulative anticholinergic exposure shows a clear dose–response association with incident cardiovascular events, especially heart failure and arrhythmias.
- Among hypertensive adults, ARBs are associated with lower long-term dementia risk than ACE inhibitors, with notable agent-level differences.
- Frailty assessment tools and emerging biomarkers like GDF-15 offer complementary ways to stratify risk of disability and death.
- Light, routine physical activity and attention to loneliness meaningfully influence dementia and mortality risk in older adults.
Week ending March 7, 2026
Prescribing, frailty, and brain–heart–social health in older adults: what’s actionable now
High anticholinergic burden still powerfully predicts mortality in US older adults
In 16,188 NHANES participants, strong anticholinergic use and high anticholinergic burden declined over 32 years but remain frequent in older adults. Across multiple scales, high anticholinergic burden (score ≥3) independently predicted higher all-cause mortality, with adjusted HRs around 1.5–1.7. High burden also predicted cardiovascular and cancer mortality, with cardiovascular HRs approaching 2 on some scales. These long-term data support systematic anticholinergic review and deprescribing as a mortality-reduction strategy in geriatric practice.
ARBs vs ACEIs and 15-year dementia risk in hypertensive adults
Among 51,574 hypertensive adults (mean age 66), long-term ARB use was associated with lower dementia risk than ACEI use. After propensity matching and lifestyle adjustment, ARBs showed a 28% relative risk reduction for incident dementia versus ACEIs (HR 0.72; 95% CI 0.65–0.80). Agent-level analyses suggested particularly lower dementia risk with olmesartan, candesartan, telmisartan, and irbesartan compared with lisinopril. Captopril was associated with markedly higher dementia risk, although estimates were imprecise. Findings were robust across subgroups and sensitivity analyses but remain observational, so they should guide preference, not override other indications.
Heart failure in the elderly: aging biology meets geriatric management realities
This review highlights that most heart failure patients are older, with lifetime risk near 25% and incidence rising sharply after age 70. Aging-related changes—impaired autophagy, mitochondrial dysfunction, inflammaging, and clonal hematopoiesis—promote both preserved and reduced ejection fraction heart failure. Guideline-directed medical therapy remains foundational in older adults who tolerate it, but frailty, hypotension, and multimorbidity frequently limit dosing. Device therapy decisions must weigh competing non-cardiac mortality and functional status, not just ejection fraction and arrhythmia risk. The authors emphasize proactive advance care planning and early goals-of-care discussions in elderly patients with heart failure.
References
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Additional Reads
Optional additional studies from this edition.