Older Patients Have Specific Risks for GLP-1 Use

 As GLP-1s continue to surge in demand, older patients in your practice may inquire about these medications for their weight-loss efforts. Although they are known to improve conditions such as high cholesterol and obesity and help with the management of type 2 diabetes, certain precautions should be considered for patients older than 65 years.

Older adults often do their own research on wellness trends. If they ask about GLP-1 medications, knowing clinical and science-based facts can keep them informed and safe. Some experts say these medications and this patient population should be carefully considered.

Yuval Pinto, MD, DABOM

Yuval Pinto, MD, DABOM, assistant professor of medicine and part of the Healthful Eating, Activity & Weight Program at Johns Hopkins School of Medicine in Baltimore, laid out some of the risks.

High Risk

Sarcopenia. Sarcopenia is an age-related progressive loss of skeletal muscle mass and strength that accelerates after age 65, increasing a patient’s risk for frailty, falls, disability, and functional decline. “GLP-1 RAs [receptor agonists] exacerbate sarcopenia by promoting lean mass loss along with fat mass loss during weight reduction,” said Pinto. “This is particularly concerning in rapid weight-loss scenarios as it may push an already vulnerable population into frailty and increased fall risk.”

Bone loss. This can lead to an increased risk for fractures. “Rapid weight loss reduces mechanical loading on bone, decreases the forces that stimulate bone formation, disrupts bone mineral homeostasis, and leads to decreased bone mineral density,” Pinto said. Older patients with diabetes treated with GLP-1 RAs showed a 12% increased fracture risk compared to those treated with other diabetes medications. Moreover, the FDA labeling for Wegovy (semaglutide) documents hip fracture rates of 1% vs 0.2% with placebo. This is particularly important for postmenopausal women who face elevated baseline osteoporosis risk, research supports.

Dehydration/acute kidney injury. Nausea, vomiting, and diarrhea, which are all common side effects of GLP-1 RAs, reduce fluid intake and increase fluid loss. “Elderly patients, particularly those with baseline reduced kidney function or poor hydration habits, are at high risk for severe dehydration even from mild gastrointestinal [GI] symptoms,” said Pinto.

Moderate Risk

GI side effects. These are common with these medications and can include nausea, diarrhea, abdominal pain, and vomiting. “Symptoms are often tolerable in younger patients; they can precipitate serious medical complications in elderly patients, particularly dehydration and acute kidney injury,” he said.

Hypoglycemia. When used as monotherapy, GLP-1 RAs pose a low hypoglycemia risk; however, when combined with insulin or sulfonylureas, hypoglycemia risk increases significantly, Pinto outlined.

Neurologic changes. Among older adults receiving GLP1-RA treatment, dizziness is the most frequently observed neurologic side effect.

Greater Supervision?

If your assessment leads you to believe that an older patient is a suitable candidate for a GLP-1, more monitoring is warranted.

Shauna Levy, MD, MS

“Older individuals benefit from closer monitoring on GLP-1 medications, and these patients need to closely monitor their muscle mass hydration status and nutritional status,” said Shauna Levy, MD, MS, chief of bariatric surgery at Tulane University School of Medicine and medical director of Tulane University’s Bariatric and Weight Loss Center, both in New Orleans. “These individuals also may overly restrict their calories, which could lead to malnutrition and other complications.”

Also, she said, physicians should regularly check labs on these patients to make sure there are no obvious abnormalities, especially when it comes to hydration status and kidney function.

In addition, advising patients to use only branded GLP-1s is key.

“It is also important that the patient uses branded medications rather than compounded medications to ensure consistent medications and that the dosing schedule can be followed closely,” said Levy.

Levy also provided additional directives to ensure the patient remains healthy:

• The patient should strive for 60-90 g/d of protein and ideally meet with a dietitian to monitor their oral intake.
• The patient should strive for 64 ounces of decaffeinated fluid per day.
• The provider should emphasize resistance training several times per week.
• The medication dose should not be increased until the patient is tolerating the lower dose.

When Not a Good Candidate for a GLP-1

GLP-1 medications aren’t appropriate for all patients. Pinto notes patients in these situations aren’t candidates for the medications.

The absolute contraindications for the initiation of GLP-1 in the older patients are:

• Personal and/or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 syndrome
• History of bowel obstruction or severe gastroparesis
• End-stage renal disease or dialysis

Consider these strong relative contraindications:

• Moderate-severe dementia or cognitive impairment (“These elderly patients can’t provide feedback on hunger, thirst, or GI symptoms,” he said.)
• CKD stage 4 due to elevated risk for kidney injury
• Baseline sarcopenia or frailty and history of falls
• Severe osteoporosis
• Uncontrolled severe psychiatric illness such as anorexia nervosa, bulimia, or severe depression (“This condition might be worsened when appetite is suppressed,” Pinto said.)

Pinto and Levy reported having no disclosures.

https://www.medscape.com/viewarticle/older-patients-have-specific-risks-glp-1-use-2026a10003bb

Secretary Kennedy Appoints New Chair, 10 New Members to Federal Alzheimer’s Advisory Council

The U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. today announced the appointment of a new Chair and 10 new public members to the Advisory Council on Alzheimer’s Research, Care, and Services. Established in 2011 under the National Alzheimer’s Project Act (NAPA), the Advisory Council meets quarterly to advise the Secretary on reducing the burden of Alzheimer’s disease and related dementias.

The newly appointed members bring a broad range of expertise and lived experience, including individuals with senior leadership experience in aging services, public health, and dementia advocacy, as well as a patient advocate living with dementia. Their perspectives will support HHS and its federal partners as the Department continues work to update the National Plan to Address Alzheimer’s Disease.

The new Chair is Michelle Branham, Secretary of the Florida Department of Elder Affairs. Appointed by Florida Governor Ron DeSantis in 2021, Secretary Branham leads the state agency serving nearly 6.5 million Floridians. She brings more than 25 years of experience in Alzheimer’s disease public policy, public health, and public relations.

“I welcome this accomplished group of new members to the Advisory Council,” Secretary Kennedy said. “Alzheimer’s disease devastates families, robbing people of their memory, independence, and dignity while placing heavy burdens on caregivers. We will not accept a future without answers. HHS is committed to pursuing real solutions with the help of these experts.”

In addition to public members, the Advisory Council includes representatives from federal agencies across HHS, as well as the Departments of Veterans Affairs and Defense and the National Science Foundation. The 2024 NAPA Reauthorization Act expanded membership to include the Social Security Administration, Federal Emergency Management Agency, and Department of Justice.

Alzheimer’s disease currently affects nearly seven million Americans and is projected to affect more than 20 million by 2050. Through NAPA, HHS coordinates efforts to accelerate research, improve care, and strengthen long-term services and supports for individuals living with dementia and their families.

Chair — Michelle Branham
Michelle Branham was appointed by Governor DeSantis four years ago and serves as Secretary of the Florida Department of Elder Affairs, leading statewide initiatives that support more than 6.5 million Floridians age 60 and older. With more than 25 years of experience in public policy, public health, and advocacy, she is a recognized leader in aging and dementia policy. Her leadership is deeply focused on strengthening support for families, caregivers, and individuals living with Alzheimer’s disease and related dementias. Her background includes nine years as Florida Vice President of Public Policy for the Alzheimer’s Association and service as past Chair and current advisor to the State of Florida Alzheimer’s Disease Advisory Committee. Under Secretary Branham’s leadership, Florida has emerged as a national leader in dementia innovation, expanding caregiver supports, advancing evidence-based policy, and launching the Florida Alzheimer’s Center of Excellence.

Vice-Chair — Katheryn Newkirk
Kate Webb Newkirk is a Licensed Graduate Social Worker and Geriatric Care Manager with Aging and Amazing, LLC, holding a Master of Social Work with a clinical concentration from The Catholic University of America. Her experience spans case management, public policy, nonprofit work, and direct care, from supporting residents in long-term care communities to lobbying for Alzheimer's legislation. As a TimeSlips Creative Storytelling Certified Practitioner, she is committed to advancing non-pharmacological interventions and enhancing quality of life for the elderly through advocacy, storytelling, and person-centered care.

John D. Couris
John D. Couris serves as President and CEO of the Florida Health Sciences Center, leading Tampa General Hospital, the primary teaching hospital for the University of South Florida Health Morsani College of Medicine. Under his leadership, Tampa General has grown into one of the nation’s top integrated academic health systems, expanding access to academic medicine statewide while ranking among the top 20% of academic medical centers nationally for quality and safety. Couris has championed innovation in care delivery, including the development of TGH at Home and the use of advanced data analytics and artificial intelligence to improve patient outcomes and operational efficiency. He was named one of Modern Healthcare’s 2025 “100 Most Influential People in Healthcare” and serves as a trusted advisor to policymakers and industry leaders on health system transformation and access to care. Couris holds a doctorate in business administration from the University of South Florida and resides in Tampa with his wife and two children.

Samuel S. Giles
Dr. Samuel S. Giles MD is a practicing neurologist, chief medical officer, and medical director at Memory Treatment Centers, a group of community-based practices specializing in the timely diagnosis and safe implementation of disease modifying therapy for Alzheimer’s disease patients. Dr. Giles has led the real-world diagnostic and treatment efforts for Alzheimer's disease and has been instrumental in the navigation of industry obstacles within this growing national infrastructure. He serves as founder and director of CerebraLinked, an Alzheimer's treatment-based platform providing streamlined interconnectivity, safeguards, and best practices across administrative, clinical and patient-centric domains. Dr. Giles is a thought leader in the area of real-world clinical approaches to safe treatment practices, having overseen the treatment of nearly 1200 Alzheimer's disease individuals with anti-amyloid therapy. He additionally has served as an advisor for the development of practical solutions to reach the underserved Alzheimer's disease community (among other neurological diseases) through the founding of Cerebrus Health Ventures. He earned his medical degree from Tufts University School of Medicine and residency training at the University of Florida in Jacksonville, where he was awarded the Golden Apple Teaching Award in addition to the Key Patient Advocate Award—awards that reflect his dedication to patient care and empathy. Dr. Giles resides in the Jacksonville area where he lives with his wife and 5 children.

Ricardo A. Hanel
Ricardo A. Hanel, MD, PhD, serves as Director of the Baptist Neurological Institute, Co-Director of Stroke and Cerebrovascular Surgery, and Endowed Chair of Stroke and Cerebrovascular Surgery at Baptist Medical Center Jacksonville, where he also directs the Cerebrovascular Fellowship. A nationally recognized neurosurgeon, Dr. Hanel specializes in innovative, minimally invasive endovascular treatments for stroke and cerebrovascular disease, including advanced aneurysm therapies. He earned his medical degree and PhD from Universidade Federal do Paraná in Brazil and completed advanced neurosurgical fellowships at SUNY Buffalo and the Barrow Neurological Institute. Dr. Hanel has authored more than 500 peer-reviewed publications, served as principal investigator in over 100 clinical trials, is a pioneer in lymphatic surgical flow augmentation for Alzheimer’s disease, and is an active leader within national and international neurosurgical organizations.

James Hartsell
James S. Hartsell is a retired U.S. Marine Corps Major General, currently serving as Executive Director of the Florida Department of Veterans’ Affairs. He served in the Marine Corps with honor for 37 years of active and reserve duty, retiring in 2018. Concurrent with his reserve military career, General Hartsell completed a successful 22-year civilian career in the Healthcare Industry where he provided leadership in Marketing, Product Management, U.S. and Global Business Development, and Hospital Administration.  He is a former elected president of the National Association of State Directors of Veterans Affairs (NASDVA), where he championed the care of residents in State Veterans’ Homes.

Michael Mayo
Michael A. Mayo, DHA, FACHE, serves as Executive-in-Residence for Baptist Health in North Florida, from which he recently retired as President and CEO. Baptist Health is a large integrated health system with a focus on quality patient care and community well-being. Dr. Mayo was responsible for over 15,000 team members and 2,900 medical staff, guiding Baptist Health to multiple recognitions for workplace excellence, diversity, and healthcare quality. With more than 32 years in healthcare leadership, Mayo chairs regional and state healthcare boards and committees, contributing to policy, quality, and patient safety initiatives. Mayo holds a Doctor of Healthcare Leadership & Management from Medical University of South Carolina, Charleston, SC, a Master of Science in Healthcare Administration from Texas Woman’s University, Denton, TX, and a Bachelor of Science in Human Resource Management from the University of Alabama, Tuscaloosa, AL.

Kristi Putnam
Kristi Putnam has more than 25 years of policy and hands-on experience in human services, early childhood services, aging and adult protective services, education, workforce development, and health policy in both the Executive and Legislative branches, and has helped lead numerous transformative statewide policy initiatives in Florida, Kentucky, Arkansas, and others across the country. Most recently, Kristi served as Secretary of the Arkansas Department of Human Services under Governor Sarah Sanders from January 2023 – July 2025. She returned to Kentucky in late 2025 to be closer to family and currently is serving as Senior Policy Advisor to the Kentucky House of Representatives and as a Senior Fellow with the Cicero Institute, as well as serving in an advisor or board capacity for several social safety net leadership organizations. She believes in the power of connection to others as a transformational force, and in benevolent disruption of the status quo in government systems.

Steve Waterhouse
Steve Waterhouse is chair of the Alzheimer’s Association of Central and North Florida and a recognized advocate at the state and national levels. His involvement with the organization began after his wife, Gina, was diagnosed with Alzheimer’s disease in 2016. Professionally, Mr. Waterhouse built a career as an electrical engineer, author, consultant, and international speaker.

Gina Waterhouse
Gina Waterhouse was diagnosed with Alzheimer’s disease in 2016 and subsequently participated for two years in the successful Aducanumab clinical trial. She remains an active advocate with the Alzheimer’s Association at both the state and national levels. Mrs. Waterhouse previously worked as a television director and was a business partner with her husband, Steve Waterhouse, in a diverse range of entrepreneurial ventures.

Jonathan Weiss
Jonathan Weiss is an entrepreneur and business strategist focused on turning innovative technologies into real-world, system-level solutions. In his role as a senior executive at Insightec, Jonathan leads key industry partnerships supporting the advancement of non-invasive focused ultrasound therapy for neurological and neurodegenerative conditions, including Alzheimer’s disease. In all aspects of his work across varying industries, Jonathan brings hands-on experience building and scaling initiatives in complex, high-stakes environments.

Continuing Member:

Randall Bateman
Randall Bateman is the Director of the Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU), a practicing neurologist at Washington University School of Medicine in St. Louis, and the Charles F. and Joanne Knight Distinguished Professor of Neurology. Dr. Bateman’s research focuses on the pathophysiology and development of improved diagnostics and treatments of AD. He was selected for the American Brain Foundation Potamkin Prize in 2019 and elected to the National Academy of Medicine in 2020 for his many contributions to the understanding of this brain disease, such as developing a blood test which detects the earliest stages of AD. He is a key leader in the field and is particularly gifted at making research findings understandable for people with dementia and their families.

https://www.hhs.gov/press-room/hhs-kennedy-appoints-new-chair-ten-members-federal-alzheimers-advisory-council.html

NIH Chief Details Plans for FDA Modernization at Senate Hearing

 The NIH must be structurally overhauled to deliver more cures, spend taxpayer dollars more wisely, and regain public trust, NIH Director Jay Bhattacharya, MD, PhD, said Tuesday during a Senate hearing on modernizing the agency.

In the wide-ranging Senate Committee on Health, Education, Labor, and Pensions hearing, Bhattacharya outlined his plan to make NIH more accountable, better coordinated, and more focused on measurable impact for patients.

"Meaningful reforms that increase transparency, strength, and scientific rigor, and ensure accountability are necessary to bolster the NIH's ability to meet America's current and future public health needs," Bhattacharya said. "As science itself evolves, so too must the structures that support it."

Sen. Bill Cassidy, MD (R-La.), the committee's chair, broadly agreed about the need for reform but warned that modernization should not also destabilize the nation's premier biomedical research agency.

Noting that Congress typically revisits NIH policy roughly every decade -- citing the 2006 NIH Reform Act and the 2016 21st Century Cures Act -- Cassidy said the moment has arrived again. At the same time, he cautioned that recent funding cancellations by President Donald Trump's administration had rattled the research community and could weaken U.S. readiness for future pandemics.

"We must acknowledge recent actions at NIH have created uncertainty within the American research enterprise and potentially undermined the agency's ability to serve," he said.

Cassidy pointed to his 2024 white paper as a road map for reform, calling for changes to the grant review process to reward "more big ideas and fewer incremental experiments," better coordination between NIH's intramural scientists and university researchers, wider use of artificial intelligence to make both positive and negative study results accessible, and stronger oversight of foreign-funded research.

Bhattacharya emphasized reforms already underway at NIH, including centralized peer review to reduce duplication, a new analytic office in the Office of the Director to address the replication crisis, and a unified funding strategy to better align investments with national health priorities. He also called for stronger federal oversight to "ensure that NIH-funded research does not lead to significant adverse social consequences" and said portfolios under his leadership would be evaluated by their impact on disease and population health, not publication count.

"We also need to move the needle and incentivize high-risk, high-reward research," he said. Research "will be judged by their success at curing disease, improving population health, and creating fundamental scientific breakthroughs, rather than simply how many scientific papers each project yields," he added.

During questioning, senators pressed Bhattacharya on vaccines, funding cuts, and politicization of NIH.

Asked directly by Sen. Bernie Sanders (I-Vt.) whether vaccines cause autism, Bhattacharya replied, "I have not seen a study that suggests any single vaccine causes autism."

That led to an exchange between Cassidy and Bhattacharya about public trust in vaccines amid HHS Secretary Robert F. Kennedy Jr.'s skepticism. Cassidy warned of potential increases in meningococcal disease, for example, among the unvaccinated following changes to the CDC's childhood vaccination schedule. Clear, consistent education, he said, is essential to restore confidence.

"If you keep on telling people permutations of what is false, they don't know who to believe," Cassidy said.

Sen. Patty Murray (D-Wash.) said Trump administration funding cuts affected roughly one in 30 clinical trials and more than 74,000 participants. Bhattacharya said NIH renegotiated terms with investigators and ensured continuity of care for affected patients.

"Ultimately, we worked with researchers across the country to make sure the clinical trials were really focused on advancing health and not on other political agendas," Bhattacharya said.

Sen. Tammy Baldwin (D-Wisc.) challenged Bhattacharya on the increase in political appointees at NIH from two to 10.

Asked why so many were needed, Bhattacharya responded: "I think the key thing to me is to make sure the grant reviews that we do are not political."

Countered Baldwin: "And so having five times as many political appointees as before helps make that less political?"

https://www.medpagetoday.com/washington-watch/washington-watch/119722

Amgen logs higher fourth-quarter revenue on double-digit volume boost

 Amgen posted higher revenue in the fourth quarter on double-digit product volume growth.

The biotechnology company on Tuesday reported a fourth-quarter profit of $1.33 billion, or $2.45 per share, compared with a profit of $627 million, or $1.16 per share, a year earlier. The company attributed its 111% boost in earnings to higher revenue and lower net unrealized losses on equity investments.

Adjusted earnings were $5.29 per share. Analysts polled by FactSet expected $4.51 per share.

Revenue rose 9% to $9.87 billion, ahead of the $9.47 billion projected by Wall Street, according to FactSet.

Product sales grew 7%, led by 10% growth in product volume. The gains were partially offset by a 4% decrease in selling price.

For 2026, Amgen forecasts revenue of $37.0 billion to $38.4 billion and adjusted earnings of $21.60 to $23.00 per share. Analysts are projecting revenue of $37.19 billion and adjusted earnings of $20.63 per share, according to FactSet.

The results follow Amgen’s October kickoff of its direct-to-patient program designed to lower the cost of drugs. The program, called AmgenNow, is in response to the White House’s call to reduce prescription drug prices for U.S. consumers.

https://www.msn.com/en-us/money/companies/amgen-logs-higher-fourth-quarter-revenue-on-double-digit-volume-boost/ar-AA1VAZ8c

Trump signs bill to end partial gov't shutdown

 United States President Donald Trump signed the bill on Tuesday to end the partial government shutdown after the proposal passed the House of Representatives in a tight 217–214 vote.

"I'm thrilled to sign the Consolidated Appropriations Act to immediately reopen the federal government and fund the vast majority of operations through the rest of the fiscal year," Trump said during the signing at the Oval Office.

"This bill is a great victory for the American people. Instead of a bloated and wasteful omnibus monstrosity full of special interest handouts, we've succeeded in passing a fiscally responsible package that actually cuts wasteful federal spending, while supporting critical programs for the safety, security and prosperity of the American people," he insisted. Then, House Speaker Mike Johnson praised Trump's economic policy and "innovations," claiming that "we're spending less money year over year."

President Trump Participates in a Bill Signing, Feb. 3, 2026

https://breakingthenews.net/Article/Trump-signs-bill-to-end-partial-gov't-shutdown/65599389

Pentagon confirms US downed Iranian drone

 The Pentagon stated Tuesday that a US Navy fighter jet shot down an Iranian drone approaching the aircraft carrier USS Abraham Lincoln in the Arabian Sea.

US Central Command said the Shahed-139 drone "aggressively approached" the carrier and failed to respond to de-escalation attempts. It was downed by an F-35C jet while the ship was operating in international waters about 500 miles off Iran's southern coast.

No injuries or damage were reported. The military's statement called the response necessary for the safety of US forces.

https://breakingthenews.net/Article/Pentagon-confirms-US-downed-Iranian-drone/65598040

English Only: Florida Eliminates Foreign Language Options For Driver's License Testing

 Florida announced on Friday that all driver's license exams will be conducted in English only starting Feb. 6, and will end testing in other languages such as Arabic, Chinese, Haitian Creole, Spanish, and Russian, the state's Department of Highway Safety and Motor Vehicles said.

Vehicles travel along I-95 in Miami, Fla., on May 24, 2024. Joe Raedle/Getty Images

The change applies to both commercial and non-commercial driver's licenses and permits. 

The move comes after federal authorities mandated last year that all commercial drivers be proficient in English to ensure safety - leading to 9,500 commercial truckers getting booted from service by December 2025 for failing proficiency checks. 

"This is a much needed step forward to protect Floridians," said Florida Chief Financial Officer Blaise Ingoglia in a post to social media. 

Miami-Dade County Tax Collector Dariel Fernandez agreed, writing on social media "This decision was made to strengthen roadway safety, ensure clear communication, and support consistent understanding of traffic laws across our state." 

That said, Fernandez acknowledged that this may be difficult for Floridians who don't speak English natively, writing "[As] an immigrant, I understand the challenges many in our community may face."

As the Epoch Times notes further, Florida, in recent years, has increased restrictions on the issuing of driver’s licenses, citing an effort to combat illegal immigration. In 2024, Florida Gov. Ron DeSantis signed into law legislation that stripped recognition of out-of-state licenses and identity cards issued to illegal immigrants and increased criminal penalties for driving without a Florida-recognized license.

“We don’t give driver’s licenses to illegal aliens, which you shouldn’t,” DeSantis remarked at an event in March 2024. “This is going to be a deterrent for illegal immigration into the state of Florida.”

Last August, an Indian national was accused of causing a deadly crash that killed three people when he made an illegal U-turn driving a semi-truck in Florida. The Department of Transportation found that Harjinder Singh, an illegal immigrant, did not pass an English proficiency exam. He was issued a commercial driver’s license by both Washington state and California.

Singh pleaded not guilty to charges of vehicular homicide in September 2025.

https://www.zerohedge.com/political/english-only-florida-eliminates-foreign-language-options-drivers-license-testing