Rural Minnesota economies under threat as feds cut safety net programs Small, outstate communities tend to rely more on funding from programs like Medicaid that face deep cuts under the 2025 federal budget.

www.startribune.com/federal-bene...

Longitudinal modeling of cognitive outcome (CDR-SB) over time as a function of postoperative delirium (Blue- no delirium, Red- delirium) in the cognitively unimpaired cohort (top plots, solid lines) and in the cognitively impaired subgroup (bottom plots, dotted lines). Note that higher CDR-SB indicates worsening of dementia severity rating scale, as such Y axis is inverted to show decline. Model output denoted by fit line in the graph, while observed data points are computed by averaging the outcome (CDR-SB) over subjects that experienced postoperative delirium (red) and those that did not experience delirium (blue).

Delirium after hip fracture surgery is associated with increased cognitive decline - especially in people without cognitive impairment at baseline.

Could better prevention of delirium lead to better cognitive outcomes?

www.ajgponline.org/article/S106... #medsky #dementia #delirium

Network of interventions for (A) behavioral disturbance (B) mood disturbance (C) agitation (D) global cognitive function. Each node represents a different intervention. The size of each node is proportional to the total sample size for that intervention. The thickness of the connecting lines (edges) reflects the number of direct comparisons between interventions.

What therapies work best to ⬇️behavioral & psychological symptoms of #dementia?

- agitation (pacing, wandering, aggression, sexual disinhibition): simulated presence therapy (SPT)
- mood disturbance (depression, apathy): multisensory stimulation (MST), SPT

www.ajgponline.org/article/S106... #medsky

Two graphs titled 'Any emergency department use' and 'Any inpatient discharge.' Both show coefficient versus months to HCBS initiation, ranging from -6 to 5. Trends show changes in healthcare utilization before and after HCBS initiation.

In a cohort of older adults, Medicaid home and community-based services initiation was associated with decreased emergency department use and inpatient discharges, indicating reduced reliance on acute care.

ja.ma/4uWPLzd

Federal Judge Blocks Immunization Schedule Changes, Stays ACIP Member Appointments Preliminary Injunction stays Secretary Kennedy's pediatric vaccine schedule. Secretary Kennedy's 13 appointments to the Advisory Committee for Immunization Practices (ACIP) are stayed for likely havin...

The preliminary injunction in the lawsuit against RFK Jr. “stays the heavily revised vaccine schedule issued…on January 5, overturns the…Secretarial Directive on COVID-19 vaccine recommendations, and reverses the…Hepatitis B vaccine recommendations”.

What’s this unfamiliar feeling?

HAPPINESS.

"You can't properly assess for delirium when someone already has dementia."


Wrong.


New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations.


5 studies. 1,304 patients. International data.


#delirium #dementia

Proud to join ~500 other MN docs in signing on to this @nejm.org piece.

Proud of my colleagues. Proud of Ben Trappey for signing his name to it and taking the inevitable heat from some quarters.

Stand up and be counted 💪🏼💪🏼

What To Do If You Get Pepper Sprayed YouTube video by Dr. Glaucomflecken

Solid advice from @glaucomflecken.bsky.social

youtube.com/shorts/z4dy0...

I usually see 8-10 pts per clinic shift. In the last 2 wks I've seen fewer...total. They're cancelling, not scheduling, &not coming in.

They're scared to leave home; risk being harassed, taken, or worse; leaving medical needs uncared for.

That's not making us safe.
That's making us inhumane.

Opinion | Tim Walz: The Un-American Assault on Minnesota Federal officials are lying. My state’s Corrections Department honors all immigration detainers.

I am gifting the link. www.wsj.com/opinion/tim-...

Statement from the family of Alex Pretti: "We are heartbroken but also very angry. Alex was a kindhearted soul who cared deeply for his family and friends and also the American veterans whom he cared for as an ICU nurse at the Minneapolis VA hospital. Alex wanted to make a difference in this world. Unfortunately he will not be with us to see his impact. I do not throw around the hero term lightly. However his last thought and act was to protect a woman. The sickening lies told about our son by the administration are reprehensible and disgusting. Alex is clearly not holding a gun when attacked by Trump’s murdering and cowardly ICE thugs. He has his phone in his right hand and his empty left hand is raised above his head while trying to protect the woman ICE just pushed down all while being pepper sprayed. Please get the truth out about our son. He was a good man.”

NEW

Statement from the family of Alex Pretti:

Not until the last few weeks.

There was not a dangerous situation here. There was not a problem to be solved. The problem was manufactured and a dangerous situation has been created by those who wanted to make it.

Leading to fear, chaos, and fatal consequences.

I've lived in MN since I was born. I've lived in the suburbs, I have lived in the cities. I've taken the train, driven, cycled all over.

I've always felt safe, always felt my friends and family were living in safe places. I have never had concerns going to downtown Minneapolis or St. Paul.

...something, something...taxation without representation...

The Gerontologist, 2025, 65(S1), S60–S67 https://doi.org/10.1093/geront/gnaf222 Advance access publication: 1 October 2025 Supplement: Healthy Brain Initiative (HBI) and Building Our Largest Dementia Infrastructure (BOLD): Dementia as a Public Health Imperative: Forum Advancing inclusive brain health and dementia care for people with intellectual and developmental disabilities: a public health framework Beth Marks, PhD, RN, Jasmina Sisirak, PhD, MPH, Matthew P. Janicki, PhD, Kathryn P. Service, RN, MS, FNP-BC, Karen Watchman, PhD

People with intellectual & developmental disabilities are at higher risk of #dementia but face significant barriers to care.

The authors propose a public health framework to address this intersection of #disability & brain health.

academic.oup.com/gerontologis... #medsky

The West Wing - We Saw A Lynching YouTube video by Dex

After this week, it's hard to explain why this feels so different. We've heard and read about so many abuses from this govt.

But we saw this.

I'm reminded of these words from West Wing (and I know it's not a perfect comparison)

youtu.be/0qoj7ICwU6w?...

Grammar aside - the intent and depravity of the statement shouldn't be lost

Coverage by
- ACA. Constantly attacked. Just became wildly more expensive
- Medicaid and CHIP. Literally gutted by 'BBB'
- VforC. Especially important in rural/underserved areas where we've seen closures d/t Medicaid cuts

Not just children!
This change is also ableist and ageist.

High # of admissions I had to the hospital and post-acute care because of Flu A and RSV just this week.

➡️Mostly older adults. Who often have more severe cases

➡️Many with dementia who cannot easily treat or manage on their own

Children will die with RFK Jr.'s new vaccine recommendations. We're NOT doing the "experts disagree" game. The US vaccine schedule was painstakingly constructed through a deep & thorough process by experts with unquestionable expertise. This is policy by fiat. It is pre-meditated murder. 1/

And, for an administration that was supposed to be about cutting everyday costs 🙄, beyond the direct health impacts of these perverse "recommendations,"

This is just ridiculously expensive.

www.cdc.gov/mmwr/volumes...

This OpEd, by the inspirational @drdemetre.bsky.social in today’s @washingtonpost.com, is one of the best pieces of science writing of 2025

I’ll be assigning it to my students next semester in my class on ‘policy writing—turning evidence into public health action’

Thx Ed, for the free access link👇

Quite the long-game strategy to solve the geriatrician shortage 🫤🙄

Let me introduce you to prices in medicine:

Financial toxicity: a common problem affecting patient care and health - PMC
pmc.ncbi.nlm.nih.gov/articles/PMC...

I'm told that Roger Marshall is a medical doctor, like with a degree and everything, and yet every single time he opens his mouth to discuss health care it's like they pulled a random guy out of the beer line at a Royals game.

My patients are very aware of prices. Often more so than me.

Especially older adults on fixed incomes.

Because of that awareness, true, in the short term, they may not spend as much f.e. Medicare dollars.

🚨By forgoing necessary care🚨

LMFTFY:

👉 CDC panel Defies Experts with Hep B vaccine vote.

Grateful for the clear messages coming from @ameracadpeds.bsky.social @idsainfo.bsky.social @apha.org

Flowchart of study subjects: 193,510 age 65+ who started quetiapine, trazodone or mirtazapine -> 17,703 eligible included, including 375 on quetiapine -> after 1:4 propensity matching: 1500 on trazodone and 1500 on mirtazapine.

1- Insomnia in older adults can be difficult to address. CBT-insomnia is the gold standard - and the safest intervention.

Yet low-dose quetiapine is being used more to treat insomnia. How safe is it?

The authors of this study sought to find out.

#medsky

link.springer.com/article/10.1...

Probability of delirium associated with the proportion of each physician's admissions that include a first-generation antihistamine prescription, using mixed effects logistic regression. The red line represents the effect estimate and the gray shading represents the 95% confidence interval.

Prescribing 1st-generation antihistamines (e.g., diphenhydramine, hydroxyzine, meclizine) to hospitalized older adults is associated w/ ⬆️risk of delirium, according to this study of 328k inpatient admissions in Canada.

Just don't do it!

#medsky

agsjournals.onlinelibrary.wiley.com/doi/full/10....