February 2026

Any comments/suggestions please email the editor at editor@redrockrx.com

Edited by Malcolm Fraser MD, CMD

Vaccines have more benefits—off-target—
than we realize.

One question that I am frequently asked, especially since the new CDC vaccine guidelines announced earlier this year, is: “Should my mother/father/sibling have the vaccine for X?”—where X can be shingles, COVID, Flu, RSV, Tetanus, etc.


Let me start by saying that the recent changes in the CDC vaccination guidelines are mostly for the pediatric population. Here at Red Rock, we focus on a completely different population—the frail adult/geriatric population.

The answer to the “vaccine question” is that it varies and it depends, but in general YES—the frail elderly/geriatric population should receive most vaccines.


Let’s look at individual vaccines:


Shingles: In my experience, the biggest advocates for the shingles vaccine are people who have had shingles or know someone who has. Remember, some people are unfortunate enough to get shingles up to three times. In general, the vaccine has about 90% efficacy.


Respiratory Syncytial Virus (RSV): The main benefit is in older adults, where the risk of hospitalization decreases by about 70% in the year they receive the shot and by almost 60% over two years. After two years, the data is not yet known, as the vaccine only became available in 2023.


Pneumococcus: “One and you are done” is recommended for those over 50 years old. Excellent efficacy.


Tdap: The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among community-living older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for several months.


What is new over the last few years is the identification of what are known as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert. A recent study published in the British Journal Age and Ageing found a reduced risk of heart failure in people who have had the flu shot. Other studies have shown reduced cardiovascular risk for additional vaccines. For example, the Tdap vaccine is associated with a one-third decline in dementia.


This is a rapidly developing topic, and your Red Rock pharmacist will keep you updated.

Shixian Wang

Director of Operations

Hand Grip Strength Asymmetry: A Practical Metric for Health Risk in the Elderly


Introduction

Hand grip strength (HGS) is a well-established indicator of overall health and longevity in older adults. Recent research suggests that not only the absolute value of grip strength but also the asymmetry between the dominant and non-dominant hands—referred to as hand grip strength asymmetry—may be a significant marker of adverse health outcomes and increased mortality risk.

Definitions

• Hand Grip Strength (HGS) Asymmetry: A measurable difference in grip strength between the dominant and non-dominant hands.
• Dominant Asymmetry: The dominant hand is stronger than the non-dominant hand, which is typical in most individuals.

Why Asymmetry Matters

While overall grip strength is important, tracking asymmetry can provide additional insights. An increasing discrepancy, especially when the dominant hand remains stronger—may indicate a general decline in strength, with the dominant hand declining more slowly due to greater use. This metric can help identify individuals at higher risk and monitor improvements following interventions, even when baseline strength varies widely among individuals.

What’s Considered Normal?

• Typical Range: The dominant hand is usually about 5–10% stronger than the non-dominant hand. Right-handed individuals often show slightly greater asymmetry than left-handed individuals.
• Mild Asymmetry: Reflects normal use-dependent muscle development and brain motor dominance.
  

Interpreting Asymmetry: Practical Cut-Offs

Cut-off values may vary by protocol, but these ranges are commonly used in studies.

Measurement Protocol

To ensure accurate and reliable results, follow these steps:

1. Equipment: Use a calibrated dynamometer (affordable options are available online).
2. Position: Test with the elbow at 90° and the wrist in a neutral position.
3. Trials: Perform three trials per hand, alternating hands. Record either the best or the mean value, depending on your protocol.
4. Precautions: Screen for pain, recent exertion, or other factors that could affect grip strength.

Clinical Implications

• Expected Asymmetry: Dominant hand being 5–10% stronger is benign.
• Excessive or Changing Asymmetry: If the difference exceeds 15–20%, especially if it is new or worsening, further evaluation is warranted. This is particularly important in older adults or when accompanied by declining total grip strength, pain, or neurological symptoms.
• Next Steps: Consider further assessment for underlying conditions, referral to physical therapy, or ongoing monitoring.

Research and Future Directions

More data is needed to determine whether improvements in health after treatment are reflected in reduced grip strength asymmetry. Ongoing research will help clarify the role of this metric in clinical practice.

Tomas Roba, PT, MS

Director of Rehabilitation

Skylake Post Acute


Reference: Handgrip Strength Asymmetry Predicts Mortality Risk: A Prospective Cohort Study From the UK Biobank (Yuling Li, MS; Decheng Li, MPH; Ziyang Ren, PhD; Chen Chen, PhD; Shuai Guo, PhD; Zuliyaer Talifu, PhD; Xiaoying Zheng, PhD).

Optimizing Medications During Skilled Nursing Admissions 

Transitions from hospital to skilled nursing facilities are among the most vulnerable points in a patient’s care journey. One increasingly common challenge we see occurs when the medication list provided by the hospital does not align with the medications ordered upon arrival at the SNF. What typically happens is that the Hospital will send a list of medications that are essential to the patients recovery to a SNF who then in turn sends the list to a Pharmacy and a decision is made by individual SNF whether or not to admit the resident.

However when the patient arrives at the Nursing Home there may be an additional list of meds that the patient is used to taking prior to the hospital admission. The hospital did not mention these meds because they were not felt to be essential to the successful recovery of the patient.

So what should the Nursing Home do? The first thing is to have the Red Rock Pharmacist review the additional medications and discuss the need for these meds with the Director of Nursing and the Attending Physician. Nine times out of ten the Attending Physician will decide that the Hospital doctors know best and hold off once-starting the additional medicines.

A skilled nursing stay is typically short-term, medically complex, and goal oriented. Residents are often recovering from acute illness, surgery, or functional decline and may be experiencing pain, weakness, fatigue, nutritional challenges and reduced tolerance of side effects. 

Adding non-essential medications can complicate recovery as it is introducing multiple additional variables. For example, medications such as GLP-1 receptor agonists, specialty injectables, and certain brand-name therapies can contribute to nausea, dehydration, dizziness, or weakness which may impact rehabilitation tolerance, so these residents’ regimen should be evaluated on a case-by-case basis.

While medication optimization is essential, it is equally important to evaluate whether every medication added at admission meaningfully supports and does not hinder the primary goals of a skilled rehabilitation stay.

The primary focus during this time is stabilization and rehabilitation to improve mobility and safely transitioning the resident to the next level of care.

So what can Nursing Homes do to optimize the medications a skilled resident is taking:

1. In addition to the essential medication  list sent by the hospital, ask for a list of medicines that the resident was taking prior to hospitalization.

2. Send BOTH lists to Red Rock Pharmacy for review.

3. Your Red Rock Pharmacy will review both lists and promptly get back to you.

4. In complex situations, you may want to have your Medical Director review the Pharmacy Recommendations.


 Dave Rimlinger, Director of Marketing

With Dr. Malcolm Fraser, MD, CMD Editor 


Survey Update 

Nothing new BUT…


As we’ve mentioned before, there is increased survey focus this year on:

• Non-pharmacological interventions
• As-needed medication use and documentation
  

Gaps in these areas can result in citations, including an F605 tag, and the consequent dreaded Red Hand on NHCompare.gov.


Compounding these concerns are recent updates to the Minimum Data Set (MDS)—including changes related to antipsychotic medication tracking—which are expected to create new compliance risks for nursing homes.


Surveyors are facing a more subjective and evolving regulatory landscape, making consistent documentation and proactive review more important than ever.

Read Related Article: Nursing Homes Face Murky Compliance Landscape in 2026 Amid Surveyor Subjectivity & Vague Regulation

Brain Decline – The 3 “Magic” Numbers for All of Us: 57, 70, and 78

A new study published in Nature Aging found that there are three distinct ages at which cognitive decline becomes more evident in all of us. These clear spikes—seen at 57, 70, and 78 years—are significantly more pronounced in some people, and the reason is simple: lifestyle.


These key ages represent points at which we begin to see substantial changes in the brain.

• At 57: It’s about how well we have managed the physical changes that come with middle age.
• At 70: It’s about how well we have kept our brains stimulated in the years leading up to—and following—retirement.
• At 78: It’s related to the level of “cognitive reserve” we have built by consistently challenging ourselves to do hard things.
  

So what can we do to minimize these changes?

Exercise—both physical and mental—maintain a healthy diet, stay socially engaged, and avoid excessive alcohol use. Brain exercise means doing new and challenging things—not just completing a crossword or Sudoku puzzle every day.

Reference: Click Here

High Hospital Nursing Turnover Associated With Increased Patient Falls


What many of us in long-term care (LTC) have known for years has now been validated by our hospital colleagues. Higher nurse turnover in hospitals has been found to be associated with an increase in patient falls, according to a recent study published in JAMA Network Open.


The study reviewed more than 40,000 patient falls across 8,000 hospital units in the National Database of Nursing Quality Indicators (NDNQI) between January 1, 2022, and December 31, 2023.


Results showed that medical units had a mean of 2.97 falls per 1,000 patient-days, while surgical units and medical-surgical units had mean rates of 2.39 and 2.79 falls per 1,000 patient-days, respectively.



The authors noted that a 10 percentage point increase in nursing turnover was associated with approximately 36 additional patient falls per year in a hospital with an average daily census of 1,000 inpatients.

Reference: Click Here